Pacifiers. Yes or No?

 Anyone who works with new families can be assured that this question is coming:

“Is it okay to give my baby a pacifier?” And the honest answer? It depends. Not because we don’t know, but because we actually know just enough to understand that this is not a “one-size-fits-all” decision.

First, let’s define the population

This discussion applies to healthy, full-term newborns. Preterm infants, infants with neonatal abstinence syndrome, or those requiring procedural pain management are a different clinical category—and require different guidance.

What the evidence actually tells us:

Pacifiers & safe sleep

The American Academy of Pediatrics recommends:

• Offering a pacifier at nap time and bedtime to reduce the risk of sudden infant death syndrome (SIDS)

• If breastfeeding, delay introduction until feeding is well established (~3–4 weeks)

Pacifiers & breastfeeding outcomes

• Studies have shown an association between pacifier use and earlier weaning. But here’s the key nuance: that relationship is not clearly causal. In other words, pacifiers may not cause breastfeeding problems—they may be a marker of them.

Pacifiers & SIDS

• Pacifier use is associated with a reduced risk of SIDS

• The mechanism isn’t fully understood, but the protective association is consistent across studies.

Pacifiers & other risks

• Increased risk of otitis media (ear infections)

• Prolonged use (>1 year) associated with dental malocclusion and palate changes

Pacifiers are almost universal across cultures

• Current reports indicate up to 85% usage depending on region

• Pacifiers made of clay, silver, pearl or coral, and sugar teats have been described, dating back over thousands of years

Where this gets clinically interesting-  Let’s look at two very real scenarios:

Scenario 1

• First-time mother

• Baby struggling with latch

• Flat/retracting nipples

• Feeding requires assistance

• Baby is fussy

• Pacifier introduced early

In this situation, after the introduction of the pacifier, feeding will likely become more difficult.

Scenario 2

• Second-time mother

• Prior breastfeeding success

• Used a pacifier with first baby

• Adequate milk supply

• This newborn infant is feeding effectively

• Pacifier introduced

Here, breastfeeding will likely continue without issue.

What’s the difference?

It’s not the pacifier. It’s the feeding foundation. In the first scenario, the pacifier is entering a feeding situation that is already unstable. In the second, it’s entering a feeding situation that is working well. This is exactly what the literature suggests - pacifier use reflects underlying feeding dynamics—it doesn’t define them.

Clinical considerations before recommending pacifier use. Before answering the “pacifier – yes or no” question, consider:

• How old is the infant?

• Is latch effective and consistent?

• Is milk transfer adequate?

• What is the mother’s breastfeeding experience?

• What are her goals?

• What is nipple anatomy and comfort level?

• Is the infant’s weight appropriate?

• Why is the pacifier being used?

• Is it replacing or delaying feeds?

• Is the infant being fed on cue? Is cluster feeding being allowed?

Motor learning matters: Feeding is a learned neuromotor skill. Newborns are born with reflexes—but not mastery. They must learn to coordinate:

• Suck

• Swallow

• Breathe

This is a complex motor task and it is happening in the first days and weeks of life. Early, repeated practice at the breast supports what is known as motor memory consolidation—the process by which a skill becomes efficient, stable, and automatic. When artificial nipples are introduced early, some infants demonstrate:

• Decreased latch efficiency

• Changes in suck pattern

• Reduced feeding effectiveness

Clinically, this shows up as something you may have heard frequently in the hospital:

 “She was latching great yesterday (intro pacifier) … today she’s not.”

So what should we recommend?

Evidence-aligned guidance

• Delay pacifier introduction until breastfeeding is established (3–4 weeks)

• Prioritize frequent, effective feeding at the breast in early days

• Use pacifiers thoughtfully—not as a substitute for feeding cues

Use caution when:

• Latch is inconsistent

• Milk supply is not established

• Weight loss or gain is not appropriate

• Pain or nipple trauma is present

Avoid:

• Blanket messaging such as “never use a pacifier” or “pacifiers are fine”

• Blaming pacifiers for complex feeding issues

• Ignoring the underlying feeding assessment or reason for pacifier use

Pacifiers used appropriately have not been shown to be inherently harmful. But timing, context, and feeding effectiveness matter—a lot. The early weeks of a baby’s life are about skill-building, and babies need some time to become efficient feeders. Later on, there can be more flexibility and room for individual and family preferences.

Remember, the pacifier may not be the problem, but in the wrong moment, it can get in the way of solving the real one. Let’s teach new mothers to avoid them at least for a few weeks in order to allow babies to become “expert,” at breastfeeding.

References

1. American Academy of Pediatrics. Safe Sleep and Your Baby: How Parents Can Reduce the Risk of SIDS and Suffocation. 2022. doi:10.1542/peo_document088

2. Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: updated 2016 recommendations for a safe infant sleeping environment. Pediatrics. 2016;138(5):e20162938. doi:10.1542/peds.2016-2938

3. Kramer MS, Barr RG, Dagenais S, et al. Pacifier use, early weaning, and cry/fuss behavior: a randomized controlled trial. JAMA. 2001;286(3):322-326. doi:10.1001/jama.286.3.322

4. 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. doi:10.1542/peds.2004-2631

5. Hanafin S, Griffiths P. Does pacifier use cause ear infections in young children? Br J Community Nurs.2002;7(4):206-211. doi:10.12968/bjcn.2002.7.4.10227

6. Hung M, Marx J, Ward C, Schwartz C. Pacifier use and its influence on pediatric malocclusion: a scoping review of emerging evidence and developmental impacts. Dent J (Basel). 2025;13(7):319. doi:10.3390/dj13070319

7. Mitev K, Frewin KL, Augustinova M, et al. The who, when, and why of pacifier use. Pediatr Res.2025;97:2282-2287. doi:10.1038/s41390-024-03540-6

8. Recommendations for the use of pacifiers. Paediatr Child Health. 2003;8(8):515-528. doi:10.1093/pch/8.8.515

9. Swank D. On motor learning. In: More Than Reflexes. Published 2015-2024.

10. Kalhoff H, Kersting M, Sinningen K, Lücke T. Development of eating skills in infants and toddlers from a neuropediatric perspective. Ital J Pediatr. 2024;50(1):110. doi:10.1186/s13052-024-01683-0

11. World Health Organization. Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding. ELENA: e-Library of Evidence for Nutrition Actions.

12. Baby-Friendly USA. Pacifiers and safe sleep.

13. Lubbe W, Ten Ham-Baloyi W. When is the use of pacifiers justifiable in the baby-friendly hospital initiative context? A clinician’s guide. BMC Pregnancy Childbirth.2017;17(1):130. doi:10.1186/s12884-017-1306-8

14. Tolppola O, Renko M, Sankilampi U, Kiviranta P, Hintikka L, Kuitunen I. Pacifier use and breastfeeding in term and preterm newborns: a systematic review and meta-analysis. Eur J Pediatr. 2022;181(9):3421-3428. doi:10.1007/s00431-022-04559-9

15. O’Connor NR, Tanabe KO, Siadaty MS, Hauck FR. Pacifiers and breastfeeding: a systematic review. Arch Pediatr Adolesc Med. 2009;163(4):378-382. doi:10.1001/archpediatrics.2008.578