When are pacifiers appropriate?

Many parents worry whether or not they should allow their child to use a pacifier. Furthermore, pediatricians rarely provide concrete recommendations regarding pacifier use, thus making the decision even more difficult for parents. So to simplify things, here is the current evidence for and against pacifier use at different ages.

0-6 months:

The American Academy of Pediatrics (AAP) suggests offering the pacifier at bedtime for infants from birth to 6 months, as evidence supports that its use helps to prevent Sudden Infant Death Syndrome (SIDS). For premature infants, pacifiers help to teach them how to suck (which leads to shorter stays in the hospital), and improves their bottle feeding technique. A possible downside to pacifiers in this age group is the association with not breastfeeding well. Please see Breastfeeding section below.

The AAP also recommends pacifiers for pain control, if your baby is undergoing a small procedure.

6-12 months

The AAP recommends weaning a child from the pacifier during the second six months of life. This is because pacifier use after 6 months is associated with an increased risk of recurrent ear infections. Recurrent ear infections may lead to scarring of the ear drum which in turn may lead to hearing loss. Weaning of the pacifier at this age is probably best done "cold turkey". The child will have learned to fall asleep with the aid of the pacifier and will therefore need to relearn how to self-soothe without it. Removing the pacifier all at once and throwing them away will prevent parents from giving in when their child is fussy. This will make for 3-4 nights of increased fussiness to outright crying; but ultimately the child will be able to fall asleep without the pacifier.

1-2 years

The AAP recommends no pacifier use in this age group as there is no medical benefit, paired with the risk of recurrent ear infections. Weaning at this age may still be done "cold turkey"; however, it may be beneficial to include the child in the decision. To help the child view pacifier weaning as good thing, parents can make an event or celebration about giving the pacifiers away, place the pacifier in a special box or remind the child that he/she is getting older – “big boy/girl”. Children may still cry for the pacifier at night, but gentle reminders that the pacifier is gone may help to ease the separation. A gradual wean is another option. Some parents wean the pacifier by using it only at bedtime, and some cut off the end of the pacifier a little bit at a time over days to weeks until there is nothing left to suck.

2-4 years

If a child is still using the pacifier at this time, the concern is for his or her teeth. Pacifier use (as well as finger sucking) has been correlated with increased risk of over or under bite and other jaw misalignment problems. The official recommendation of the American Academy of Pediatric Dentistry is to actively discourage pacifier use over the age of four years. Methods of pacifier weaning in this age group are similar to those effective in the 1-2 year age group. Positive reinforcement of nights/naptimes without pacifier use with small rewards (such as a sticker) or verbal praise may be an effective method of a gradual wean in this age group.

Breastfeeding and Pacifiers
Many parents worry that pacifier use will make it difficult for the baby to breastfeed properly. However, there is not enough evidence to demonstrate whether or not pacifiers can negatively impact breastfeeding. However the official AAP recommendation is that a pacifier should not be introduced until breastfeeding is well established or around 1 month of age. However this does not apply to premature infants because the benefits of pacifiers are bigger than this issue. To help make a decision parents should talk to with their pediatrician, keeping in mind feeding goals for the baby and the baby’s well-being.

Contributed by Allison Langs-Barlow, M.D.
Edited by Margee Louisias, M.D.