Pacifiers

In the newborn days

Rooting, hand-to-mouth movements, lip smacking, and sucking can be early hunger cues. Offer a feed rather than using a pacifier to delay one. After a feed, a baby who still wants to suck may find a pacifier calming; another baby may spit it out or never want it. Both are common.

Use it safely

Once feeding is going well, offer a pacifier when placing baby down for naps and nighttime sleep. This is one part of safer sleep, not a guarantee against SIDS. Continue every other safe-sleep step: place baby on their back in their own firm, flat, bare sleep space.

• If it falls out after baby falls asleep, leave it out. Do not force it back in or wake baby to replace it.
• Do not attach it to clothing, blankets, stuffed toys, or other items. The NIH Safe to Sleep guidance says attachments can create strangulation, choking, and suffocation hazards.
• Do not dip or fill it with honey, sugar, syrup, juice, or medicine. Give medicine only with the method and dose a clinician recommends.
• Use a size made for baby’s current age and follow its instructions. Prefer a one-piece model with a firm, ventilated shield; never substitute a bottle nipple.
• Before each use, inspect the whole pacifier. Replace it if it is torn, cracked, sticky, discolored, swollen, loose, past its expiration date, or otherwise worn.

Pacifiers sold in the United States must meet CPSC requirements for shield size and ventilation, structural strength, and other hazards. Check the model against current CPSC pacifier recalls, especially if it is secondhand.

What changes next

1. When feeding becomes well established: a directly breastfed baby can begin trying a pacifier at sleep times. Comfort with feeds and steady growth—not the calendar alone—are the useful signals.
2. Through about 6 months: follow the manufacturer’s directions to boil or dishwasher-clean a dishwasher-safe pacifier frequently. Let it cool and squeeze trapped water from the nipple with clean hands. After 6 months, the AAP says soap and clear water are enough.
3. During later infancy: keep checking the age range, wear, and fit. Establish a dental home by 12 months and ask about continued pacifier use then.
4. After 12–18 months: prolonged use matters more. The American Academy of Pediatric Dentistry pacifier policy says use after 12 months can raise the risk of ear infections, and use beyond 18 months can affect the developing mouth and bite; it encourages ending nonnutritive sucking habits by 36 months.

Reassuring signs

Pacifier use is fitting safely into the day when:

• baby’s feeding cues lead to a feed, not a delayed meal;
• feeds remain comfortable and effective, with growth reviewed at routine visits;
• baby can accept or refuse the pacifier without it being held in place;
• the skin around the mouth looks comfortable and the pacifier remains clean and intact; and
• every caregiver follows the same no-attachments, no-coatings rule.

When to ask or act

Usually not a worry

• Refusing it: some babies never like a pacifier. Do not force it; use another soothing approach.
• Dropping it after falling asleep: it does not need to stay in all night to be worth offering at the start of sleep.
• Preferring one shape: babies may accept one age-appropriate shape and reject another. “Orthodontic” labeling does not remove the need to limit prolonged use.
• Wanting to suck after a good feed: non-feeding sucking can be soothing. Recheck hunger cues if baby will not settle, feeds poorly, or the pattern changes suddenly.

Useful today

1. Decide whether feeding is established enough; if unsure, make that the next question for the pediatrician or lactation professional.
2. Read the pacifier’s age range, cleaning directions, expiration information, and recall status.
3. Clean it as directed, let it cool, and inspect the nipple, shield, and handle.
4. Remove every attachment and keep honey, sweeteners, and medicine off it.
5. Once ready, offer it after feeding when placing baby down for sleep; accept “no” and leave it out if it drops.