Parenting • Oct 03, 2013

Should I give my baby a pacifier?

Infants look awfully cute with “plugs” or “binks” in their mouths, but there is some question whether pacifiers are causing more harm than good. As parents, we have to ask ourselves, who are the pacifiers really pacifying, our babies…or us? Here are the pros and cons of pacifier use.


There have been several studies done which show a reduction in the risk of Sudden Infant Death Syndrome or SIDS for babies who use pacifiers. Some studies have shown a reduction by as much as 61%! Wow! This is such a significant reduction that the new American Academy of Pediatrics (AAP) guidelines actually encourage the use of pacifiers for children under one-year-old.

We have known for years that pacifiers make babies feel good. Studies have shown that sucking stimulates the release of “feel good” chemicals in the brain that actually decrease stress in infants. Who doesn’t want a soothed, less stressed baby?

When it comes time to wean off breast milk, pacifiers  have been shown to be a successful weaning tool. Additionally, pacifiers are a much easier habit to break when compared to thumb or finger sucking.


The biggest negative with pacifiers is they can potentially interfere with breastfeeding, a concept sometimes referred to as “nipple confusion.” There have been several studies done regarding the idea of nipple confusion. Pacifier use has been independently associated with a significant decline in the duration of full and overall breastfeeding. Breastfeeding duration in the first three months postpartum, however, was unaffected by pacifier use. Findings from this study suggest that the decreases in breastfeeding duration associated with pacifier use may be a consequence of less frequent breastfeeding among women who introduce pacifiers to their infants.

What this means is to be careful about pacifier use in the first three to four weeks after your baby is born while breastfeeding is being established. If your baby appears hungry, always offer the breast first. Nipple confusion becomes a very real issue when the pacifier is used in lieu of the breast for soothing.

As mentioned above, the use of pacifiers in the first year of life is recommended as a means to reduce risk of SIDS. However, frequent use beyond the first year of life is associated with an increased risk of ear infections. For this reason the AAP suggests stopping pacifier use by one year.

Additional issues that arise with prolonged pacifier use include:

  • Risk of dependence on the pacifier. Continued use of the pacifier beyond one year means you may have a rough time helping your child break the habit.
  • Risk for poor dentition (health and status of emerging teeth). Children who are still using the pacifier into the second year of life are at risk for cavities, crooked teeth, and gum disease.

Bottom Line

There are no definitive studies that mandate the use or disuse of pacifiers. For that reason it is up to you to make that final decision. And, as your health care provider, it is our job to inform you to the best of our ability so you can make an educated decision.

In our opinion, proper use of pacifiers has many added benefits. But note the emphasis on the word “proper.” Here are our tips:

  • If you are breastfeeding, limit or avoid the use of pacifiers until breastfeeding is well established (around 3-4 weeks of age).
  • If you need to use a pacifier before 3-4 weeks, make sure you keep a keen eye on its use by always offering the breast first.
  • If you are bottle feeding there is less risk of nipple confusion, but make sure you never dip the pacifier in things like honey or sugar. (Honey can be deadly to babies under one year.)
  • There’s no one brand or type of pacifier that’s right for every baby. This means you may have to shop around to find your baby’s favorite. Just make sure you get an age-appropriate size.
  • Make sure to clean the new pacifier as instructed before offering it to your baby.
  • Keep your baby’s pacifiers clean. That doesn’t mean popping it in your own mouth as a way of rinsing it off. You may think that your mouth is clean, but rinsing it under water is always best!
  • Throw away pacifiers that are showing signs of age and/or are cracking. Those cracks are very sneaky places for germs to hide!
  • Never tie the pacifier around the baby’s neck! And, if you have a pacifier connector attached to your baby’s clothing, make sure to remove it before naptime or bedtime. Babies should only sleep with a plain pacifier. In fact, a good rule of thumb is to only provide the pacifier at naptime and at bedtime. This inherent limitation will limit nipple confusion.

Finally, don’t worry if your child does not like the pacifier. Just give it a break and try it again in a few weeks. If it’s still a no-go, again, don’t worry about it. Just make sure to practice all the other SIDS-reducing practices you have been taught!