Baby Pacifiers: Benefits, Risks, and When to Wean

Gina Maria Jansheski, MD, FAAP
Reviewed by Gina Maria Jansheski, MD, FAAPWritten by Neve Spicer Updated on September 9th, 2021

Parents of babies know that pacifiers can prevent breakdowns—yours, not the infant’s. A screaming baby loses a lot of charm after a few hours of incessant crying.

Pacifiers are chewed and sucked on by babies. Very often, they can help an infant to suck for comfort and fall asleep. And a really bad teething day is a time for some serious chewing on the pacifier. Eventually, it becomes the primary means used by babies to soothe themselves in stressful situations.

The other option is thumb or finger sucking. Many babies will move to this method if not offered a pacifier.1Finger Sucking in Children
hopkinsallchildrens.org/ACH-News/General-News/Finger-Sucking-in-Children

  • Babies use a strong sucking or chewing motion with the pacifier when in pain from colic or teething. Studies have shown that this action, called non-nutritive sucking, seems to calm them and help them cope with the discomfort.2Riddell, R. R. P., Racine, N. M., Gennis, H. G., Turcotte, K., Uman, L. S., Horton, R. E., … & Lisi, D. M. (2015). Non‐pharmacological management of infant and young child procedural pain. Cochrane Database of Systematic Reviews, (12).
    ncbi.nlm.nih.gov
  • Pacifiers are known to help prevent sudden infant death syndrome (SIDS).3Hauck, F. R., Omojokun, O. O., & Siadaty, M. S. (2005). Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics, 116(5), e716-e723.
    pediatrics.aappublications.org
  • Extra sucking may be good for some babies who naturally demand more than they get at feedings. Using a pacifier can help by keeping them from overeating and its resultant tummy discomfort.

However, there’s a flip side to pacifiers that leaves a lot of parents concerned. Not all models are great for babies’ dental health, and long-term use can be problematic. 

At one year, babies become toddlers. They can find other things to chew on and certainly will. This is a good time to get rid of the pacifiers, all of them from every room and each automobile. Studies appear to differ on their findings to some degree on exactly when pacifier use should be stopped. The earliest mention was by 18 months duration of use.4Melink, S., Vagner, M. V., Hocevar-Boltezar, I., & Ovsenik, M. (2010). Posterior crossbite in the deciduous dentition period, its relation with sucking habits, irregular orofacial functions, and otolaryngological findings. American Journal of Orthodontics and Dentofacial Orthopedics, 138(1), 32-40.
pubmed.ncbi.nlm.nih.gov
This means the significance lies in how long the baby has used it, not how old the child is—although, for many, those two things may be synonymous.5Melink, S., Vagner, M. V., Hocevar-Boltezar, I., & Ovsenik, M. (2010). Posterior crossbite in the deciduous dentition period, its relation with sucking habits, irregular orofacial functions, and otolaryngological findings. American Journal of Orthodontics and Dentofacial Orthopedics, 138(1), 32-40.
pubmed.ncbi.nlm.nih.gov
Others stated that dental health is not adversely affected until after age 2, so this leaves a very gray area when it comes to recommendations.6Sexton, S. M., & Natale, R. (2009). Risks and benefits of pacifiers. American family physician, 79(8), 681-685.
aafp.org

Pacifier use is not a black-and-white issue. There are shades of meaning, depending on your baby’s needs. If you know the facts, you can save both your baby’s dental health and your peace of mind.

Pacifier upsides

Giving babies opportunities to comfort themselves is tremendously helpful to parents. As much as we love our babies, holding them every moment of the day isn’t good for them or for us. 

Babies who use pacifiers to comfort themselves when they’re feeling fussy give parents a break to do the other million things awaiting their attention.

Pacifiers aren’t just a convenient source of soothing stimulus for babies. There’s also evidence that they can reduce the risk of sudden infant death syndrome (SIDS).7Hauck, F. R., Omojokun, O. O., & Siadaty, M. S. (2005). Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics, 116(5), e716-e723.
pediatrics.aappublications.org

In fact, the American Academy of Pediatrics recommends offering a pacifier along with other prevention measures.8Reduce the Risk of SIDS & Suffocation
healthychildren.org
With benefits like that, it’s not surprising that pacifiers are used by so many babies with their parents’ full endorsement.

What if you decide not to use a pacifier for an infant who is colicky or has significant teething pain? Thumb and finger sucking will often happen instead. Remember, you can take away the pacifier, and it’s helpful that it is something you can control.9Thumb sucking and pacifier use
ada.org
Whereas the thumb-sucker may not even stop until they meet peer pressure at school. 

Dental downsides: The facts

While they do make life easier, there’s dental health information parents need to know. The longer they are used past the age of one, the more chance that a significant dental problem will result.10Lima, A. A. D. S. J., Alves, C. M. C., Ribeiro, C. C. C., Pereira, A. L. P., da Silva, A. A. M., Silva, L. F. G. E., & Thomaz, E. B. A. F. (2017). Effects of conventional and orthodontic pacifiers on the dental occlusion of children aged 24–36 months old. International journal of paediatric dentistry, 27(2), 108-119.pubmed.ncbi.nlm.nih.gov

Parents need to know how the pacifier is used and when to have the toddler quit the habit.

Wondering what can make this classic childhood soother problematic? The answer is simple: allowing children to use their pacifiers too frequently or grow too old without taking it away. 

Because they are often one of their first security objects, many babies who use pacifiers often aren’t ready to give them up without some major fussing. However, the frequent use of pacifiers beyond the infant period can set a baby up for orthodontic issues like crooked teeth, misaligned jaw, front tooth separation, and other problems.11Nelson, A. M. (2012). A comprehensive review of evidence and current recommendations related to pacifier usage. Journal of pediatric Nursing, 27(6), 690-699.
pubmed.ncbi.nlm.nih.gov

While those are serious issues, they are preventable. Wondering how to make sure your baby’s pacifier use doesn’t become problematic?

  • Don’t let the pacifier be a substitute for feeding. Sucking on a pacifier can confuse a very young infant. They may use it instead of sucking on the breast or bottle. Make sure breastfeeding is well established before starting the pacifier to avoid nipple confusion. And whether you are giving breast or bottle, pay attention to how long your baby usually takes between feedings and ensure that he isn’t hungry instead.
  • It’s a good idea to have your child stop pacifier use by the age of one year.12Martinez Sanchez, L., Diaz Gonzalez, E., Garcia-Tornel Florensa, S., & Gaspa Marti, J. (2000). Pacifier use: risks and benefits. An Esp Pediatr, 53(6), 580-5.
    pubmed.ncbi.nlm.nih.gov
    If your baby uses a pacifier, she is in control over its use. Free use within the first 12 months allows your baby to chew or suck on the pacifier when needed for teething, colic pain, or settling down. But when it’s time to stop, it should not be given again. It doesn’t work well towards discontinuing it if you attempt to control the pacifier by giving it on and off while you’re trying to decide if she needs it or not or for how long. 
  • If your child is a toddler or preschooler, discontinuing pacifier use is crucial. By this age, sucking a pacifier, thumb13Sucking, S. T. ” That most children depend heavily on the sucking activity to relax and fall asleep at naptime and bedtime. The sleeping habit is the strongest part of the behavior and it takes the longest to eliminate. It will be important to address the sleep time sucking at the same time you are working on the daytime habit to minimize frustration and enhance success.”(2015).
    purewow.com
    , or finger may have already begun to cause significant dental issues. And some studies have shown that the oral effects of the behavior may go on even after the habit has ceased.14Management of the Developing Dentition and Occlusion in Pediatric Dentistry
    aapd.org
    As the child grows older, it becomes more and more likely that teeth and gums will be pushed out of alignment, causing problems with permanent teeth and the eventual need for an orthodontist to come to the rescue.15Doğramacı, E. J., & Rossi-Fedele, G. (2016). Establishing the association between nonnutritive sucking behavior and malocclusions: A systematic review and meta-analysis. The Journal of the American Dental Association, 147(12), 926-934.
    pubmed.ncbi.nlm.nih.gov

What makes a healthy pacifier

If you’re like most parents, knowing the hard facts about pacifiers will go a long way in easing any concerns you have about their use. However, you may still be wondering what to look for in a soother to make sure it’s a good fit for your baby.

  • Look for natural latex rubber or silicone. They’re the two materials used most often for pacifiers, and both are safe for your baby!16Pacifier Safety
    earth911.com
    Most of these do not contain harmful chemicals; however, it is important to make sure they are BPA-free.
  • More expensive isn’t better. Price does not ensure safety when choosing a pacifier. The American Academy of Pediatrics gives a couple of helpful guidelines:17Joyner, B. L., Oden, R. P., & Moon, R. Y. (2016). Reasons for pacifier use and non-use in African-Americans: does knowledge of reduced SIDS risk change parents’ minds?. Journal of immigrant and minority health, 18(2), 402-410.
    healthychildren.org
    • Take a look at the number of pieces that make up the pacifier. It’s recommended only to purchase those that come as one molded unit, so there is no possibility of it coming apart and causing a choking hazard.
    • Keep these specifications in mind: “The shield between the nipple and the ring should be at least 1-½ inches across…and be made of firm plastic with ventilation holes.”
  • Seek out orthodontic nipples for older kids. They’re better for toddlers and preschoolers because the end of the nipple is flat on the bottom and round on top, matching the natural shape of your child’s mouth. Orthodontist-approved types of pacifiers are important to use, especially for older kids that are still using one. One study also found that infants that began using orthodontic pacifiers between ages 0 and 3 months were less likely to develop a finger-sucking habit, which is more difficult to deal with in the end because it’s harder to break.18Caruso, S., Nota, A., Darvizeh, A., Severino, M., Gatto, R., & Tecco, S. (2019). Poor oral habits and malocclusions after usage of orthodontic pacifiers: an observational study on 3–5 years old children. BMC pediatrics, 19(1), 1-9.
    ncbi.nlm.nih.gov

Maintaining baby’s pacifier

One part of ensuring that your baby stays safe while using their pacifier is making sure that the binky they pick up is clean and free of damage. Sanitizing pacifiers is a straightforward process. The materials to use are found in just about every household.19Al-Assadi, A. H., Al-Dahan, Z. A., & Al-Rammahy, A. K. (2016). Pacifier Sucking Habit and its Relation to Oral Health of Children Aged 1-5 Years (comparative study). Iraqi Dental Journal, 38(2), 90-94.
health.clevelandclinic.org
Here’s how to keep your baby’s pacifier collection in tip-top shape:

  1. Wash all pacifiers with gentle dish soap and warm water using a soft cloth, and dry them. Follow the manufacturer’s recommendations for washing before the baby’s first use.20Pacifiers: Satisfying Your Baby’s Needs
    healthychildren.org
  2. After the pacifiers are dry, examine them for any damages or defects, looking at the holder and mouth shield as well as the nipple and weeding out any with broken or chewed parts. Those with defects can lead to choking hazards for your kiddo.

Families who have a dishwasher can also use it for sanitizing pacifiers. Check the packaging to make sure binkies are dishwasher-safe. Use only the top rack of the dishwasher to prevent heat damage in the drying cycle.

Putting down the pacifier

Some kids put down their pacifier on their own and never turn back, but for others, kicking the pacifier habit is a very real fight. For parents who are facing the possibility of enormous future orthodontic bills, giving in to their cries simply isn’t an option. 

Looking for ways to help your older munchkin move on? If your child is two or older, it’s an urgent task to wean them off using pacifiers. These hints might make the chore easier.

  • Teach new ways of coping. The new ways might mean talking to mom or dad, cuddling a favorite stuffed animal, or retreating to a quiet space. These teach young kids new ways to cope that can help them feel less reliant on their binky. Once they get comfortable using a different way of self-soothing, they’re less likely to regress to that previous coping strategy.
  • Track their progress and reward successes verbally and tangibly. When kids decide not to use their pacifier, take note of it, and give them encouragement. Be prepared to notice every instance of the desired new behavior. Catch them doing good, and reward them with your attention. 
  • Don’t get angry if they demand the pacifier. Remember, they’re still toddlers, and their pacifier is an object of significant comfort. You probably already know that upset babies aren’t up for negotiations. Save reinforcement for when they’re ready to learn instead of feeling picked on or angry. Just remember that, even though it can be a harrowing experience in the short run, it doesn’t take long for little ones to get over habits if you don’t give in.
  • Be creative when asking your child to give up their pacifier. Create a story with your child as the hero. At the end of the story, have him give up his pacifier to the Tooth Fairy or other imaginary character. The first birthday party is a great time for a symbolic leaving of infancy and entering into toddler status. The Tooth Fairy can leave a gift as a trade, perhaps an awesome sippy cup.

Pacifier use can be very helpful for parents by getting their babies through some difficult times like teething and other discomforts. Thanks to the benefit of science and historical hindsight, we are better able to use these tools safely. Knowledge about the process of infant soothing is both beneficial to our babies and helps avoid future problems.

When we use orthodontic-friendly models, keep them clean, and transition away from them at an appropriate age, pacifiers can be healthy soothers for our babies.

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Gina Maria Jansheski, MD, FAAP
Reviewed by Gina Maria Jansheski, MD, FAAPWritten by Neve Spicer Updated on September 9th, 2021

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