When I worked as a nurse in the NICU, many moms requested that we not offer pacifiers to their newborns. These parents had heard that pacifiers and breastfeeding don’t mix, and they wanted to optimize their chances of successful breastfeeding once their premature babies were big enough. At the same time, I witnessed many benefits of pacifiers, like providing soothing and pain relief and helping babies coordinate and strengthen their sucking to learn how to eat. My experience as a nurse taught me about the pros and cons of pacifiers, which helped me decide whether to offer a pacifier to my own daughters. If you’re unsure whether you should give or avoid pacifiers for newborns and babies, let’s explore the pros and cons of using a pacifier!
Why Do Babies Like Pacifiers?
Babies are born with innate reflexes, or physical responses to stimuli that happen without effort or intention. Many of these reflexes aid in infant survival and feeding, but they can also soothe an unsettled baby. One such reflex is the suckling reflex. When something such as a finger, breast, or bottle nipple touches the roof of a baby’s mouth, they reflexively suck. They may even suck their finger, thumb, or hand in the womb before they’re born!1,2
In addition to being essential for feeding and nutrition, suckling also brings babies comfort. Sucking that isn’t for eating is sometimes called “nonnutritive sucking.”2 Babies can perform nonnutritive sucking at the mother’s breast, but this often gives breastfeeding moms little breaks. To satisfy their need for suckling, babies may resort to sucking their hands, thumbs, or fingers. Some parents offer a pacifier (also called a dummy or soother) to comfort their baby and satisfy this innate desire. Pacifiers provide a feeling of relaxation and may help your child feel sleepy or fall asleep.2,3
The suckling reflex disappears around 12 months of age. At this point, a baby has learned how to feed and can do so without the reflex. Children often self-wean from nonnutritive sucking between the ages of 2 and 4 years old unless parents remove the pacifier sooner.3
Pros and Cons of a Pacifier
Even though babies like pacifiers, you might wonder if they’re even good for your little one. To help you decide, take a look at the major pacifier pros and cons below:
Pros
The fact that many babies like pacifiers is a benefit in itself! But pacifiers have other benefits as well, including:
Lower Risk of SIDS
Many studies have shown a reduced risk of sudden infant death syndrome (SIDS) in babies who use a pacifier during sleep, from newborns to infants who are 6 months old.2 There are many theories as to how pacifiers may help prevent SIDS, including:2,8
Mechanically preventing baby from being completely face down on their mattress
Tongue positioning and airway openness
Less movement during sleep
Reduced reflux and aspiration
Increased motivation to breathe around the pacifier
Pain Relief
Pacifiers can provide comfort during minor painful procedures in newborns and babies, such as circumcisions, blood draws, and vaccinations. Studies have shown that pacifier use reduces pain and stress during discomfort and that pacifiers are more effective than sugar water for infant pain relief.2,9
Self-Soothing
Babies have little control over their world and environment, which alone can be stressful. Sucking on a pacifier is a stimulus that the infant can control on their own, which soothes them. Suckling also brings pleasure, calmness, and emotional regulation.2,9
Nonnutritive Sucking
Sucking on a pacifier is a form of nonnutritive sucking. This can strengthen oral-motor muscles and suck-swallow-breathe coordination to aid in oral feeding. Nonnutritive sucking also provides a sensory experience for baby, teaches them self-regulation, and may facilitate their sleep.2
Cons
After analyzing all the pros of pacifiers, a parent must also consider the cons. Despite their benefits on pain, sleep, and SIDS, are pacifiers bad in any way? Here are some of the cons of pacifiers to consider:
Interrupting Breastfeeding
The World Health Organization (WHO) recommends avoiding pacifiers for breastfeeding infants while they’re still in the hospital.7 If you’re hoping to breastfeed, your baby needs to spend a lot of time at the breast suckling, and if you use a pacifier, it may interrupt this time at the chest. To avoid interfering with breastfeeding and establishing a good milk supply, it may be wise to wait until breastfeeding is well-established before introducing a pacifier. But it’s unlikely that pacifier use actually causes early weaning from breastfeeding.2
Ear Infections
Pacifiers have been associated with a higher risk of developing ear infections. This may be because of the germs found on pacifiers, the effect of pacifiers on ear tube openness and anatomy, or the theory that pacifiers impede successful breastfeeding and that breastfeeding protects against ear infections. The American Academy of Pediatrics (AAP) recommends weaning your child from pacifiers in the second six months of life.2
Dental Problems
A common question parents have is whether pacifiers are bad for baby’s teeth. Pacifiers and teeth aren’t the best match, as pacifiers have been associated with cavities, bite misalignment, receding gums, and impaired jaw and oral muscle development, particularly when pacifier use extends beyond age 3-4. However, these issues can even present at earlier ages, such as between ages 2 and 3. Ideally, a baby stops using a pacifier by 12 months of age.4
Despite these associations, the American Dental Association (ADA) promotes pacifier use over thumb sucking, as pacifiers are easier to wean. Pacifiers should be clean and never sweetened with honey, syrup, or sugar to get baby to suck on it. This is important for their dental health and nutrition.2
Impact on Speech and Cognitive Development
Studies have shown that hours of pacifier use during the day can impact speech development in children, particularly past the ages of 2-3. Even 1-year-olds who suck on a pacifier frequently throughout the day have a smaller vocabulary than their non-pacifier-sucking counterparts. It makes sense that a child with a pacifier in their mouth all day is less likely to babble and talk. Not only is it blocking their mouth for talking, but it can also affect their ability to make certain facial expressions, impacting their social, emotional, and cognitive development.5
So, Are Pacifiers Bad?
After weighing the pros and cons of pacifiers, each parent must make their own decision about when and whether to use one. Your child’s pediatrician will likely encourage pacifier use for the first six months of life to decrease the risk of SIDS (after breastfeeding and milk supply are established) and encourage you to wean them after they’re 6 months old to prevent future problems.2,10,11
Many of the cons of pacifier use may be correlation, as opposed to causation. For instance, fussier babies — whether caused by ear infection pain or difficulty feeding — may be offered a pacifier more frequently to calm them. This would mean that pacifiers aren’t causing issues but rather being used to treat them.8 Due to this and the benefits of pacifiers, they aren’t inherently bad for your baby.
When To Introduce a Pacifier
If your baby needs more soothing than you can provide and you do choose to use a pacifier, you might be wondering when exactly to introduce it. Here are some pacifier timing considerations to keep in mind:
After Nursing Is Well-Established
If you plan to breastfeed, it’s best to wait until nursing has been well-established before introducing a pacifier. This may take around one month.4
After a Feed
Bottle- and formula-fed babies can take a pacifier sooner. But you should always make sure your baby isn’t hungry for milk before presenting a pacifier.4 Newborns take eight to 12 feeds per day. They often cluster feed, which is essential for their nutrition and hydration and even helps with night sleep.6 You should never use a pacifier to delay a feeding.4
Before Sleep
Pacifiers offer comfort and can make your baby drowsy for sleep. As mentioned, they can also reduce the risk of SIDS. So, before sleep is an excellent time to introduce a pacifier. Try offering it after a feed and before naps and bedtime.4
Can Babies Sleep With a Pacifier?
For a baby, sucking can provide a feeling of relaxation that brings about drowsiness or sleepiness.3 Because of this, sucking on a pacifier can be a valuable tool to help a baby fall asleep. In addition, since pacifiers can reduce the risk of SIDS, babies can sleep with a pacifier.2
Should I Remove the Pacifier When My Baby Is Sleeping?
If your baby spits out their pacifier while sleeping, you don’t need to reintroduce it. You also shouldn’t force it into your baby’s mouth. The pacifier will likely fall out at some point in the night, but you don’t need to go out of your way to remove it once your baby is sleeping. Only reintroduce the pacifier if your baby needs it to fall back asleep.2
The Choice Is Yours
Again, pacifier use is up to the parent and baby. Personally, my first daughter took to the pacifier immediately. She depended on it for stressful situations, car rides, and sleep. We had to make sure we always had one with us, and they were useful when we needed her to be quiet and content. Her pacifier use didn’t affect her breastfeeding, and she breastfed for over a year. I was nervous about weaning her from it, but we slowly cut back to just using it for car rides and sleep, then just sleep. One night, around 15 months old, I didn’t offer it to her, and she was fine!
My second daughter refused to ever take a pacifier from her newborn days. I was nervous about having a baby who wouldn’t take a pacifier, as I had learned with my first that it can be a useful tool! Now that she’s 18 months old, I’m glad I never had to rely on one for her, keep track of it, or wean her off it. But if I had a third baby, I would consider offering one to them. It’s a personal decision that isn’t black-and-white, all bad or all good!
If you and your baby are interested in pacifier use, you can reap its benefits of self-soothing, pain relief, and SIDS reduction. There are ways to avoid many of the drawbacks by waiting to introduce a pacifier until feeding has been well-established, setting boundaries and limits on their use, keeping it clean and intact, and weaning your baby from it before dental and speech issues become too much of a concern. Whether you decide to have your baby use pacifiers ultimately depends on your values and goals for feeding, soothing, and sleeping.