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The Pros and Cons of Pacifier Use

Updated: 4 days ago




As a parent, you want to give your baby whatever they need to be comfortable and happy. But you might be unsure about whether to offer them a pacifier. Don't worry—we're here to walk you through all the potential benefits and risks so that you can make an informed decision about how best to meet your baby's needs. We’ll also provide guidance on when to introduce a pacifier and how long you might want to use it.


In this article:


What is a pacifier?

Whether you call it a paci, binky, nook, or just a pacifier, it's a soothing device designed to imitate the shape of a mother's nipple and provide comfort to babies.


Why babies love pacifiers

Even before they are born, babies have a strong urge to suck—ultrasounds have even shown fetuses sucking their fingers while still in the womb! This sucking reflex makes sense—it's what keeps babies alive. However, using a pacifier is "non-nutritive sucking"—the baby isn't getting any nutrition from it.


So why do many babies love pacifiers if they aren't filling their tummies? Because they have a soothing effect in an otherwise frustrating and overstimulating world.


When a baby sucks on a pacifier, it stimulates their brain to release the hormone oxytocin, the "feel-good hormone." Oxytocin can have a calming effect on babies and can help to reduce stress.


Pacifier pros

There are multiple benefits to offering your baby a pacifier.


Pros and cons of pacifier use

1. Comfort

The primary reason why parents have been offering their babies pacifiers for decades is right there in the name. Pacifiers are designed to soothe and comfort a tired or fussy baby.


As mentioned above, babies naturally have a strong sucking reflex—that's why they love to suck on their fists, toys, and anything within reach. However, they don't have the muscle control or coordination to put their own hands in their mouths for many months. A pacifier provides an easy alternative for your baby.


Fussy newborn with a pacifier

Just keep in mind that you shouldn't rely on a pacifier every time your baby fusses. It's important for them to learn and respond to other soothing techniques.


Additionally, if your baby is extremely fussy, you should determine the underlying cause of their discomfort instead of automatically giving them a pacifier.


2. Improved infant sleep

Sleeping baby with pacifier

Because they provide a sense of comfort, pacifiers can help many babies fall asleep more easily and stay asleep longer.


Additionally, the sucking motion helps to regulate a baby's breathing, leading to a more rhythmic breathing pattern and deeper sleep.


3. Pain relief

Sucking on a pacifier can relieve pain in babies, such as pain from shots or other medical procedures, teething, ear infections, and air pressure changes while flying.


Baby about to get a shot

4. Reduced risk of sudden infant death syndrome

Studies have shown that sucking on a pacifier during sleep—both naps and at night—can lower the risk of sudden infant death syndrome (SIDS).


Pacifiers reduce the risk of sleep-related infant deaths by regulating the baby's breathing, making it more rhythmic and preventing instances where breathing becomes more shallow or stops altogether—both factors that can contribute to SIDS. Pacifiers may also increase babies' blood pressure and improve their heart rate control, which may further protect against SIDS.


Pacifiers may be even more beneficial for preterm babies, who are at a much higher risk of SIDS. In fact, 29% of SIDS victims are premature babies. These babies are less able to regulate their heart rate and blood pressure, which may raise their SIDS risk.


For these reasons, the AAP recommends that babies sleep with pacifiers at nighttime and naptime to reduce the risk of SIDS. Just remember that sleeping with a pacifier is not sufficient to prevent sleep related deaths. It is also crucial to provide a safe infant sleeping environment by laying your baby on their back for sleep and removing any hazards from their crib.



This one-piece silicone pacifier is the brand provided by many hospitals. The shape of the Soothie promotes the grooving of the tongue that is used to latch at the breast.



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Potential pacifier cons

While pacifiers can be beneficial for some babies, they can also have potential risks. Not all babies will experience these risks and the severity of any potential issue varies greatly by child.


1. Dental problems

Prolonged pacifier use (past the first couple of years) can lead to problems with the growth and development of a child's jaw, baby teeth, and alignment (how the teeth fit and work together). Ultimately, this may make it more likely that a child will need orthodontic treatment at some point.


However, normal use of a pacifier in the early years generally does not cause these problems.


2. Ear infections

An ear infection occurs when fluids build up behind the eardrum, causing bacterial growth. Pacifiers can present a slightly increased risk of middle ear infections, possibly because the sucking motion changes the pressure in a child's ears and makes it harder for them to remain clear of fluids.


However, babies under 6 months generally have lower rates of ear infections. Because this is also the age when the risk of SIDS is the highest, the potential benefits may outweigh the risks for this age group.


3. Impaired speech development

You may have heard that baby pacifier use can interfere with the development of speech and language skills. The theory is that frequent daytime pacifier use gives a child less time to practice babbling and saying early words.


In actuality, there is little evidence to suggest that this is a significant problem. Using a pacifier for hours each day may contribute to speech errors such as dropping consonant sounds. However, many children outgrow these issues.


There is no evidence that using a pacifier when your baby falls asleep or during the night has any impact on speech and language development.


4. Nipple confusion

Some studies have suggested that using a pacifier can cause a newborn baby to have trouble breastfeeding—known as "nipple confusion." This theory claims that because sucking on a pacifier uses different mouth and jaw movements than breastfeeding, it may cause a baby to have trouble latching on and nursing successfully, and could potentially lead a mother to stop breastfeeding sooner.


However, most studies have not supported this theory. As long as the pacifier is introduced after the baby has learned to latch and breastfeeding is well established, it should not cause nipple confusion.


Pacifiers and sleep: Are they safe?

It is safe for babies—even newborns—to sleep with a pacifier. Remember, the AAP specifically recommends using a pacifier at night time and during naps to reduce the risk of SIDS.


You do not need to remove your baby's pacifier once they fall asleep. Just be sure to choose a safe type of pacifier and review the safety tips for pacifier use discussed below, which are particularly important during newborn baby sleep.


However, there is no safe way to keep a pacifier in your baby's mouth while they sleep. If your baby wakes up frequently and fusses because the pacifier falls out of their mouth, you can encourage them to fall back to sleep using other calming techniques.


Introducing a pacifier

Age to introduce

Although pacifiers are fine for breastfed babies, offering your baby a pacifier too early can make it harder for them to become comfortable with breastfeeding and may affect your milk supply.


If you are breastfeeding, the American Academy of Pediatrics (AAP) recommends waiting to introduce a pacifier until your nursing routine is well-established. This generally means that you should wait until:

  • Your baby is reliably latching onto your breast

  • You feel confident about your milk supply

  • Your baby has regained their birth weight and is consistently gaining weight

In most cases, this will be approximately 3 to 4 weeks after birth.

If you are exclusively bottle-feeding your baby, you can begin offering a pacifier right after they are born.


If your baby won't take a pacifier

Not all babies like pacifiers. Pacifiers are an individual preference and can be influenced by a baby's feeding style and comfort preferences.


However, you can try a little reverse psychology to see if it encourages your baby to keep a pacifier in their mouth. Once your baby's lips close around the nipple, give it a gentle tug. Your baby may respond by sucking harder. If you do this regularly, your baby may gradually become more attached.


However, you should never force your baby to take a pacifier. There are many other ways that you can soothe them, such as rocking, singing, and gentle pats.


Choosing the right pacifier for your baby

There are several factors to consider when choosing a pacifier for your baby.


Pacifier material

The most common materials for pacifiers are:

  1. latex (rubber)

  2. silicone

Although latex pacifiers are softer and may be more immediately appealing to a baby, they are not dishwasher safe and break down more quickly.


Silicone pacifiers last longer and can be washed in the dishwasher, which is recommended by the AAP for babies under 6 months (discussed in more detail below).


Pacifier shape

Pacifiers are available in numerous nipple shapes:

  1. Standard/symmetrical pacifiers have a straight, cylindrical, elongated nipple.

  2. Orthodontic pacifiers have a flat nipple and are designed to encourage natural jaw and tongue movement.

  3. Rounded pacifiers look much like a standard pacifier but have a ball-shaped tip.

  4. Bulb pacifiers are similar to rounded pacifiers but have a larger nipple.

But ultimately, unless your pediatrician or dentist recommends a specific type, the best pacifier for your baby is the type that they like and will use! You may need to try several different pacifiers to find one that your baby likes.


Teething pacifiers

Some manufacturers offer a type of pacifier that is specifically designed for teething babies. These pacifiers usually have a bumpy or textured nipple (some are shaped like raspberries) to soothe sore gums and may be larger than a regular pacifier. Manufacturers may also suggest putting teething pacifiers in the freezer.


Teething pacifiers are generally safe for babies, as long as they meet the same safety standards that we describe below for regular pacifiers.


In particular, it is essential to choose a teething pacifier that is only one piece and to check it frequently for any signs of wear or damage. Because these pacifiers withstand a lot more chewing, they may break apart more quickly and could pose a choking hazard.


It’s best not to freeze any teething toy—this can make them too hard and could hurt your baby’s gums. Instead, you can refrigerate a teething pacifier to provide a cold surface for sore gums.


Specifications for choosing a pacifier

Cleaning a pacifier

Clean your baby's pacifier frequently to get rid of germs and prevent bacteria from growing.


Sterilizing

When your baby is less than 6 months old, it's best to sterilize pacifiers before each use. You can sterilize in the following ways:

  • If the pacifiers are dishwasher safe, wash in the dishwasher with hot water and a heated dry setting

  • Place them in boiling water for 5 minutes.

  • Microwave on high for 2 to 3 minutes in a bowl of water. Always check the manufacturer's instructions before sterilizing this way—some pacifiers should not be microwaved.

Note: Let the pacifier cool off after sterilizing and squeeze out any remaining hot water using clean hands before giving it to your baby.


Cleaning

After 6 months, it's usually fine to just wash pacifiers with soap and water, unless your baby has a compromised immune system or other medical condition that requires sterilizing.


Never "clean" a pacifier by putting it in your mouth. This can introduce germs that could harm your baby's developing teeth.


How to clean a pacifier before and after 6 months

Weaning from a pacifier

Recommended age for weaning

As your child gets older, the risks of using a pacifier begin to outweigh the benefits.


The AAP recommends weaning a child from a pacifier between 2 and 4 years of age because of potential issues associated with long-term pacifier use. The American Academy of Pediatric Dentistry recommends reducing pacifier use around 18 months.


Side effects of weaning

1. Difficulties with weaning

Prolonged pacifier use can make it more difficult for children to break the habit, leading to difficulties with weaning.


2. Difficulty falling asleep

The most common side effect of weaning from a pacifier is difficulty falling asleep. The severity and duration of this issue will depend on how much your baby relies on a pacifier at bedtime or nap time.


3. Increased fussiness and clinginess

Other side effects include increased fussiness and clinginess as your child adjusts to other ways of self-soothing and feeling secure. Your baby might even want to eat more, since they are no longer engaging in non-nutritive sucking.


Because of the potential for these issues, some experts recommend stopping pacifier use earlier, around 6 or 7 months, because a baby won't have become as emotionally attached but will have passed the age of highest SIDS risk.


However, every child is different. Many children continue to use pacifiers well past this age and are able to give them up with few issues.


Tips for weaning

Many children independently stop using a pacifier between 2 to 4 years old—often from peer pressure once they begin school. However, some kids need help giving up their paci. The following tips can help you through the pacifier weaning process.


1. Take it slow—your child doesn't have to give up a pacifier cold-turkey! You can gradually reduce the frequency of pacifier use, such as limiting it to nap times and bedtime.


2. Choose the right time to wean from the pacifier. Don't expect your child to give up a significant source of comfort when they are sick or during a major life change like a move.


3. Be consistent—if you're giving up the pacifier for nap time, don't give in when your child cries.


4. Have a relaxing bedtime routine to help your child calm down for sleep without their pacifier.


5. Encourage your child to use other comfort items, such as a stuffed animal or special blanket, when they need to feel comforted and secure. Just wait until your baby turns 1 before offering a comfort object at bedtime.


6. Be patient and positive. Give your child praise when they don't seek out a pacifier for comfort. Depending on your child's personality, consider sticker charts or rewards. You can even have a special goodbye ceremony to bid farewell to the pacifier, such as "giving" it to a new baby. Never scold, tease, or punish your child for using a pacifier.


7. Use fun distractions—your child might be seeking out a pacifier if they feel bored.


8. Consult with your child's pediatrician or dentist if they are really struggling with giving up their pacifier.


If this process is making your child feel tense or unhappy, stop and wait a couple of months. They will eventually give up their pacifier. Just remember that no child brings a pacifier to college!


Pacifier safety

Keep the following safety tips in mind if you offer your baby a pacifier:


1. Choose one-piece pacifiers. Pacifiers with multiple parts could separate and pose a choking hazard or harbor bacteria. Those cute mustache pacifiers are not safe for your baby!


2. Regardless of your baby's age, choose a pacifier with a shield that is at least 1½ inches across and is made of firm material with air holes, to prevent choking.


3. Never tie or otherwise attach a pacifier to your baby's clothing or bed. This creates a strangulation hazard.


4. Check the pacifier regularly for any signs of tearing, holes, or discoloration and replace it immediately if you notice any damage. If the pacifier has an expiration date, replace it by that date.


5. Some parents choose pacifiers that have stuffed animals attached, which make the pacifier easier to hold and harder to lose. You should only offer this type of pacifier when you are watching your baby—never provide it for nighttime sleep or unsupervised naps.


Pacifier safety dos and don'ts

Frequently Asked Questions

1. Is there a pacifier that stays in a newborn's mouth?

If your baby often spits out their pacifier, they are probably hungry, congested, or simply not a fan of that particular type. Test out different brands—if your baby likes a certain pacifier, they will usually keep it in their mouth. Never try to tie or otherwise force a pacifier to stay in their mouth.


2. At what age does a pacifier affect teeth?

Prolonged pacifier use (use that continues past 4 years) can lead to problems with tooth growth and alignment. Normal use before age 4 usually doesn’t cause dental problems.


3. Which pacifier shape is best?

Unless your pediatrician or dentist recommends a specific type, the best pacifier shape is the one that your baby prefers! Every baby has their own preferences, so you may need to offer several different types before you find your baby’s favorite.


4. Is an orthodontic pacifier better?

Orthodontic pacifiers have a flat nipple and are designed to prevent issues with tooth and jaw alignment. However, normal pacifier use before age 3 does not usually cause dental problems, so an orthodontic pacifier may not be necessary.


5. What is the best orthodontic pacifier?

Look for an orthodontic pacifier that is all one piece. Good options include:

  • Chicco PhysioForma (one-piece version)

  • NUK Silicone Orthodontic Pacifier

  • Medela Silicone Orthodontic Pacifier

  • Boon Jewl


6. What is the most realistic pacifier?

Symmetrical or round pacifiers are designed to be similar to the shape of a mother’s nipple. These are often recommended for breastfeeding babies because they feel more familiar and can help prevent breastfeeding issues.


7. What is the best pacifier for breastfed babies?

Breastfed babies might prefer symmetrical or round pacifiers, such as:

  • Philips Avent Soothie

  • Dr. Brown's HappyPaci

  • Nanobébé Pacifier

  • Ryan & Rose Cutie-Pat

  • Evenflo Feeding Balance Pacifier


8. How long does pacifier withdrawal last?

The duration of any sleep disruptions from pacifier weaning will depend on how much your baby relies on a pacifier for naps or bedtime. Some babies may adjust in only a couple of days, but others will take a week or more to sleep well without their pacifier.


9. What is the difference between soother and pacifier?

“Soother” and “pacifier” are two words for the same thing! Both describe a comforting device designed to imitate the shape of a mother's nipple and help babies calm down and fall asleep.


10. What is the difference between a pacifier and Binky?

A binky is usually used as another name for a pacifier, a soothing device for babies. Although a binky can refer to any pacifier, there is also a specific model of Playtex pacifier called Binky.


11. When should you give a newborn a pacifier?

To prevent pacifier use from interfering with breastfeeding and affecting a mother’s milk supply, the American Academy of Pediatrics (AAP) recommends waiting until the nursing routine is well-established, usually 3-4 weeks after birth.


12. Is 18 months too old for a pacifier?

Because prolonged pacifier use can contribute to dental problems and ear infections, the American Academy of Pediatrics (AAP) recommends weaning between 2 and 4 years. The American Academy of Pediatric Dentists recommends reducing pacifier use by 18 months.


13. When should I stop using a MAM pacifier?

Due to the potential issues with prolonged use, the American Academy of Pediatrics (AAP) recommends weaning from any pacifier between 2 and 4 years of age. The American Academy of Pediatric Dentists recommends reducing pacifier use by 18 months.


14. Why is there a hole in the Soothie pacifier?

Soothie pacifiers have a hole in the center that leads into the hollow nipple. This hole allows parents to insert their finger to hold the pacifier in place and help the baby latch on. Once a baby gains the proper coordination, they can put their own thumb in the hole to hold it in place.


15. What is the point of pacifier clips?

Pacifier clips are designed to keep a baby’s pacifier close at hand so that it is always nearby when they are fussy. A clip prevents the pacifier from falling on the ground and getting lost or dirty.


16. Are pacifier clips safe to sleep with?

Pacifier clips are not safe for sleep. You should never attach anything to your baby's clothing or bed because this can create a strangulation hazard. Babies are usually not supervised as closely when they are asleep, making this even more dangerous.


17. Are beaded pacifier clips safe?

Beaded pacifier clips are not a safe choice for babies. The beads can come loose and present a serious choking hazard. The Consumer Product Safety Commission has recalled certain beaded clips due to this very risk.


18. Are silicone bead pacifier clips safe?

Pacifier clips with silicone beads are not safe for babies. Manufacturers claim that silicone beads are easier to clean and good for teething, but they still pose a serious choking risk and should never be used.


19. Are teething pacifier clips safe?

Teething pacifier clips with beads are not safe for babies because they pose a choking hazard. Pacifier clips with only larger teething objects are safer, but should still be used only with close supervision due to the strangulation risk from the cord.


20. Are pacifier clips safe?

Although pacifier clips come in many designs and materials, no particular clip is a 100% safe choice for babies. Any clip has some risk of strangulation from the cord and choking from small pieces and/or beads. Clips are particularly unsafe for sleep.


21. Are pacifier clips worth it?

Any pacifier clip has at least a small risk of harm due to strangulation by the cord or choking on small pieces and/or beads. If you are worried about always having a clean pacifier available, it is far safer to buy multiples of a one-piece pacifier so you always have an extra.


The Takeaway

For many reasons it is recommended to offer your newborn a pacifier, especially for sleep. Pacifier use can improve sleep, help your baby self soothe, and protect them from SIDS. As long as you are careful not to rely on this tool forever, Pathfinder Health believes that the benefits outweigh the risks. However, the decision of whether or not to use a pacifier is ultimately up to you—and your baby!


Sources:

  1. American Academy of Pediatric Dentistry, Policy on Pacifiers (2022), available at https://www.aapd.org/globalassets/media/policies_guidelines/p_pacifiers.pdf

  2. Hanafin S, Griffiths P. Does pacifier use cause ear infections in young children? Br J Community Nurs. 2002 Apr;7(4):206, 208-11. doi: 10.12968/bjcn.2002.7.4.10227.

  3. Hauck FR, Omojokun OO, Siadaty MS. Do Pacifiers Reduce the Risk of Sudden Infant Death Syndrome? A Meta-analysis. Pediatrics (2005) 116 (5): e716–e723. https://doi.org/10.1542/peds.2004-2631

  4. Horne, R., Fyfe, K., Odoi, A. et al. Dummy/pacifier use in preterm infants increases blood pressure and improves heart rate control. Pediatr Res 79, 325–332 (2016). https://doi.org/10.1038/pr.2015.212

  5. Howard CR, Howard FM, Lanphear B, et al. The Effects of Early Pacifier Use on Breastfeeding Duration, Pediatrics (1999) 103 (3): e33. https://doi.org/10.1542/peds.103.3.e33

  6. Strutt C, Khattab G, Willoughby J. Does the duration and frequency of dummy (pacifier) use affect the development of speech? Int J Lang Commun Disord. 2021 May;56(3):512-527. doi: 10.1111/1460-6984.12605. Epub 2021 May 3.

Bio of Dr. Paul Patterson


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