Are you pregnant and wondering if your baby will be safe while using a pacifier? Do concerns of the older people in your life about pacifier safety have you sweating bullets?
We live in a day and age, where the traditional ways of raising children are being questioned. We now know that some medicines our grandparents used are toxic, and that crib comforters turned out to be a pretty bad idea.
So, as modern parents, we naturally cast a suspicious eye over everything we are recommended. Is it safe? Or is it somehow unknowingly dangerous?
Pacifiers, unfortunately, are one of those items that are not very clear-cut. They have some serious upsides and some worrisome downsides to them. The science shows that, even though we know they are associated with certain positive and negative outcomes, we don’t always know exactly why. Also, some of the known effects can happen at different ages, so that has to be taken into consideration too.
I can’t tell you what to do in your situation, but I can make sure you have all the facts, so as a parent you can make an informed decision.
Will Pacifiers Hurt My Baby’s Teeth?
Pacifiers are not great for teeth. This much the experts agree on, and it’s actually many parents’ biggest concern about pacifiers. Nevertheless, it appears that more than 40% of babies are using pacifiers by the age of one year (source).
Because of the shape of them, when used for a long period of time, they cause your baby’s teeth to be gently nudged into a new position, a bit like braces do. There is moderate evidence that they can make the upper teeth begin to splay out and the lower teeth to fold in (source). It also appears that they can affect the shape of the roof of the mouth.
There are some tooth-friendly bottles out there, but pacifiers are different. Because a pacifier is in the baby’s mouth for longer periods of time throughout the day, there is constant pressure making a bigger impact on the alignment of the teeth.
Even a naturally-shaped pacifier is going to have some effect. And buck teeth or a severe overbite are not just cosmetic problems — there can be delays in proper speech, effects in swallowing, eating solids, and even jaw development.
Most of these problems do not seem to be an issue when your baby has no teeth or only a few. But for these reasons, you should wean your baby off a pacifier well before they have their full set of baby teeth (1).
I’ve Heard Babies Have Choked On Pacifiers
With anything that goes into a baby’s mouth, there is a real risk of choking that should not be underestimated. Just because a pacifier is made for sucking and is sold in stores does not mean we should automatically trust that it is safe or even good for your baby.
Always buy pacifiers from established manufacturers. Some cheap novelty ones, or old designs, may have loose parts that are choking hazards (source). When you are going to buy a pacifier, check the U.S. government’s website for recalls, www.recalls.gov, to make sure there has been no problem with that particular brand.
Check your pacifier for size, moving parts, and air vents.
- Size: Your baby’s mouth size will determine the right pacifier size. Always choose the one that is age-appropriate, unless your baby is small because of a medical condition such as dwarfism, intrauterine growth restriction (IUGR), or prematurity. A safe pacifier must be at least 1.5 inches across (2) so it cannot be taken fully into the mouth.
- Moving parts: Makes sure to buy a pacifier that is made of one solid piece of silicone. If there are any moving parts other than the handle, you need to throw it out. Check the integrity of the pacifier parts before each use, as sometimes the flexible nipple can crack and parts can loosen with time (an example). Learn how to do the Pull Test and do it every time. Video:
- Air vents: A pacifier must, by federal regulation, have at least two large air vents in the shield. This will allow a baby to breathe even if the pacifier gets sucked into their mouth (source).
Finally, never use a pacifier tie or strap, as these can be a serious hazard for your baby. They can get caught on a stationary object and wrap around your baby’s neck, causing a risk of strangulation.
Can Pacifiers Cause Nipple Confusion?
Pacifiers, when used too early, can make your baby reject the breast and even the bottle. Because the size and shape are so different from a real nipple or bottle nipple, a newborn baby might become confused.
The way babies latch on for nursing can be affected by pacifiers in those early weeks. The latch onto a pacifier tends to be more shallow, and this can cause baby to have difficulty when trying to take enough of the breast in to get a good feeding.
There are some pacifiers, like Hevea and NUK soothers, which try to imitate the shape and squishiness of mom’s natural nipple. These can help your baby suck in a manner most closely resembling the natural way.
Pacifiers can also present other feeding challenges. They can help to satisfy the sucking need of smaller babies, meaning they don’t notice as quickly when they are hungry and might feed less often. This can also affect a mom’s milk supply.
The flip side, of course, is that some babies use the breast as a pacifier. If your baby is sucking but not swallowing long after the feed is finished leaving you sore, you might want to use a pacifier then in limited amounts to prevent cracked nipples.
Will My Baby Get An Infection From Using Pacifiers?
Studies have shown that pacifiers carry bacteria and yeast, placing babies at risk for infections. This is because having something touching other objects and then going into the mouth frequently means those organisms may hitch a ride.
Bacteria and other microbes can also breed in tiny pores on pacifiers, especially the longer they are around, so unless you keep a supply and sterilize regularly, some bacteria will be carried around on your pacifiers (3). Wash them frequently with hot, soapy water, and let them air dry. Make sure not to lick them clean or share them among siblings. And throw them away after two to four weeks of use.
Most recent studies have shown a clear risk between pacifier use and otitis media (ear infections) from ages six months to two years. The reason for this, however, is still unclear. It is thought that sucking on the pacifier changes the pressure gradient between the eustachian tube and the middle ear, which might create an environment more conducive to infection. Others have suggested that pacifiers, since they are used more often in babies that have weaned early, may be a marker for babies that are not breastfed and, therefore, are already known to have a greater risk for ear infections (4)(5).
Both the American Academy of Pediatrics and the American Academy of Family Physicians recommend weaning the pacifier by age 6 months in order to help prevent ear infections.
Is It Safe To Put My Baby To Bed With A Pacifier?
Pacifiers can really be a lifesaver for parents with a restless baby. The act of sucking has been found to help babies get to sleep, but if you keep nursing your baby to sleep, you can create a sleep association that will leave you exhausted.
Pacifiers have also been found to reduce the risk of SIDS. It is assumed this is because the motion of sucking keeps babies’ breathing regular.
The big downside to both of these is that pacifiers can create a sleep association, which is basically a habit. This means that you may end up with a baby who cannot fall asleep without the pacifier. Your baby may then have a problem waking to find the pacifier has fallen from their mouth, start crying, and you have to get up throughout the night to keep replacing it. To prevent this, you should wean them off the pacifier between four and twelve months of age.
Are There Times when a Pacifier Can Really Help?
There are situations where giving a pacifier has been shown to really help babies (source). It gives them periods of Non-Nutritive Sucking (NNS), which has benefits for babies in certain contexts.
- Studies have shown that giving a pacifier during or just after a painful procedure, like circumcision, heel prick, or vaccination, can comfort babies and help their heart rates return to normal more quickly. Putting expressed breast milk or formula on the nipple creates an even greater effect on pain control and stress relief. This should only be done when the pacifier is used for pain management, but never on a regular basis as it contributes to tooth decay.
- When babies have to be separated from mom for a period of time, there is a benefit to pacifier use. This might happen if an infant becomes ill, for example, and has to be admitted to the hospital. There may be periods of time with procedures or testing where they are not able to feed. Pacifiers can give them a way to cope by self-soothing NNS and also prevents loss of the sucking reflex.
- Premature babies who are developing the coordination for suck-swallow-breathe may need stimulation to move this process along. NNS gives them the chance to practice and learn to establish a healthy pattern while transitioning to oral feeding. This would take place in the NICU environment with the guidance of medical professionals.
When Should I Start, And Stop, Using A Pacifier?
If you intend to use a pacifier, the starting age depends on you and your baby.
A healthy breastfed baby should only begin when feedings are well established to decrease the risk of nipple confusion. For bottle-fed babies, it is a good idea to wait until they are back to birth weight (6).
Crucial to Know
Some babies will even wean themselves off their pacifier, or start chewing it instead when they begin teething. This could make the transition very easy, so seize the moment and give them a teething toy instead. Make sure to get rid of all your pacifiers if this happens, and you won’t have to go back.
The Bottom Line
As I said at the start of the article, pacifiers are not a black or white thing. They have some benefits and some downsides, and nobody but you can make the choice for your baby.
Looking at the available evidence, it appears that starting a pacifier too soon and ending its use too late can clearly cause problems. Also, how frequently it is used plays a role in ear infections, arrangement of the teeth, sleeping patterns, development of speech, learning to self-soothe, and the eventual ability to discontinue use.
The advantages for the prevention of SIDS might mean it would be helpful to use it for sleep only, and only during the first year of life. Beyond that time, the beneficial effects are less, and more of the negative factors begin to weigh in more heavily.
With this guide, you can now make an informed decision about whether pacifiers may be right for you and your child. It may not have to be an all-or-nothing thing. Noting the particular times that a pacifier will be helpful and indicated is key. And then not using it as a crutch and weaning it when recommended will ensure that all goes well for you and your baby.
What do you think about pacifier use? Did your babies love them or hate them? What difficulties did you face when using a pacifier?
We’d love to hear all about your experiences in the comments. If you know of any moms who are wrestling with this decision, send this article their way.