Pacifier Use: Everything You Need to Know

Should I introduce a pacifier to my baby? This is one of the most common questions we hear from new parents. And one issue where people tend to have very strong opinions. So today on the blog we’re going to break down pacifier use from an evidence based perspective, weigh the pros and cons, and leave you with enough information to allow you to make the choice that’s best for your baby.

The American Academy of Pediatrics (AAP) Recommendations

The AAP recommends waiting to introduce a pacifier until around 3-4 weeks for breastfed babies in order to make sure that feeding is well established. For a non-breastfeeding infant, a pacifier could be introduced earlier. If a breastfeeding family does decide to introduce a pacifier earlier than 3-4 weeks they should remember to follow their baby’s hunger cues and bring their baby to the breast frequently to make sure they are feeding well and their milk supply is being maintained. By feeding often and on-demand, they can still establish succesful breastfeeding. They should just be careful to not use a pacifier to delay feedings or mask hunger cues.

Pacifier Benefits

But why would you want to introduce a pacifier in the first place? There are several identified benefits to pacifier use. Notably, the AAP recommends offering a pacifier before nap and bedtime as pacifier use during sleep has been shown to reduce the risk of SIDS. Pacifiers are also routinely used with pre-term infants to help with suck-training.

Pacifier use has also been shown to reduce stress levels and calm infants. All babies have non-nutritive suck needs - the desire to suck that is not associated with hunger or feeding. And let’s be honest some babies have a very intense need to suck. For many parents, allowing their baby to satisfy that suck need with something other than the breast can bring some welcome relief. Between the ages of 0-6 months, infants have the highest reflexive suck needs and engaging that need can bring comfort to many babies. This is why many parents find pacifiers to be helpful tools for soothing fussy babies.

Pacifier Risks

But are there risks to using a pacifier? The biggest demonstrated risks happen with long-term pacifier use. Routine pacifier use after 18-24 months of age can lead to dental issues and affect the shape of the child’s mouth, especially if pacifier use extends beyond 2-4 years of age. Prolonged pacifier use has also been linked to an increase in ear infections in some studies.

Because the risks of pacifier use increase with age, the AAP recommends weaning from a pacifier between 6 and 12 months. This is also when babies’ non-nutritive suck needs tend to decrease, so it can be an ideal time to slowly begin weaning away from the pacifier. Remember that just because you introduce a pacifier when your baby is a newborn, this does not mean you have to let them use it forever.

Other Tips

A few other tips to help you with introducing a pacifier to your baby:

  • Never force your baby to take a pacifier or keep it in their mouth. This can lead to oral aversions for your baby. Instead, when your baby is calm, gently introduce the pacifier by tickling the babies cheeks, nose, and upper lips with the tip of the pacifier. This will stimulate the baby’s rooting reflex and they will seek to take the pacifier into their mouth on their own. You can help them keep the pacifier in their mouth as they learn to use it, but never force it to stay if your baby is actively trying to thrust it out of their mouth.

  • Always use the right size pacifier for your baby’s age. Pacifier’s generally are sized according to newborn, 3 months, 6 months, and 1 year of age. Use the right size for your baby’s age. And always check the label on the manufacturer’s packaging.

  • Sanitize pacifiers using a commerical bottle saniziter or by tossing into a pot of boiling water for 5 minutes before their first use. You should regularly clean and sanitize your baby’s pacifiers following that.

  • Check pacifiers frequently for any signs of wear and tear. A damaged pacifier can be a choking hazard, especially if the rubber nipple is designed as a separate piece to the plastic base. Throw out any pacifiers that look worn, cracked, or damaged.

Pacifiers can be great tools to calm and soothe babies and even have other safe sleep benefits when used at naptime and bedtime. If you are struggling with the decision to introduce one, assess the risks and the benefits and let that guide you to the choice that is right for your family. Happy sucking!

Kelly Rutan