Pacifiers & Soothies. To Use or Not to Use?


It seems like a simple question, but many parents are confused about whether their child should use one.  General recommendations are not to introduce one for the first 4 weeks of life until breastfeeding is well established so as not to cause nipple confusion.  This was one reason that I was concerned when the NICU nurse offered one to my newborn son, who needed to be put in an incubator because of jaundice.  She told me not to worry, if I was persistent with breastfeeding, there shouldn’t be a problem.  She was right!  Thank goodness for her and that pacifier!  The pacifier really helped my little guy soothe himself, since I couldn’t hold him when he needed to be in the incubator.  The pacifier also wasn’t something that my son had great difficulty parting with either, although I do understand that other children may develop a strong attachment to it.

Around the world there is a large variation in the amount of usage in infants to toddlers.[1],[2]  There certainly are benefits, and some risks too.  However, I while I do believe that some parents are aware of the health risks associated with pacifier use, I often hear most parents voicing their concern about long term dependency on pacifiers and this being the main issue affecting their decision on whether or not to introduce one.  An excellent recent literature review in the Journal of Pediatric Nursing, describes the benefits and risks of pacifier usage.[3] Many other sites like Baby Centre, and Public Health will also give reasons for the pros and cons of pacifier usage.

So what are the benefits?

Self Soothing

  • Sucking is widely acknowledged to be a healthy reflexive means for an infant to self soothe, calm, reorganize, and deal with stress.
  • Pacifiers may serve as a transitional object to decrease separation anxiety for toddlers.

Reduces the risk of SIDS

  • A number of studies have been conducted and consistently show that there is a reduction in the risk of SIDS associated with pacifier usage, especially if used when putting an infant to sleep.[4],[5]
  • Theories for why there is a “protective effect” are that there may be increased arousal responsiveness in frequent pacifier users, the position of the tongue when using a pacifier reduces the risk of oropharyngeal obstruction, and it may encourage mouth breathing if nasal obstruction should occur during sleep.
  • Although it is not clearly understood how pacifiers may provide a “protective” effect, the American Academy of Pediatrics does recommend pacifier usage in infants during sleep in the first year of life.[6]

Pain Relief?

  • Sucrose has been documented to relieve pain in neonates undergoing painful procedures, and the use of a pacifier along with sucrose appeared to have a synergistic effect[7] – although of course, Health Canada doesn’t really recommend you put anything sweet on a pacifier, especially NOT HONEY! (
  • Another meta-analysis suggested that either sucrose or breast milk, with or without non-nutritive sucking appears to be safe and effective in relieving procedural pain.[8] This stuck with me, as I remember that my little guy never seemed to mind his vaccination shots much while breast or bottle-feeding.  The times he wasn’t nursing are a completely different story…

What are the Risks?

Oral health – malformation of the teeth.

  • This is a major concern for a lot of parents, but as Nelson’s review indicates, a recent meta-analysis shows that pacifier usage doesn’t significantly impact the teeth if discontinued by age 2-3 years.[9]

Negative impact on breastfeeding

  • As you’re probably well aware, the World Health Organization recommends that babies be exclusively breastfed for the first 6 months of life.
  • When I was doing my pre-natal classes in 2011, I was advised that only about 20% of women in NS met the WHO recommendation…. I was surprised by a recent publication showing that now only 10.4% are following that recommendation… I’m sure there are other contributing factors, and not only the pacifier!
  • There are worries about nipple confusion as some studies indicate an association between the usage of pacifiers and poor breastfeeding outcomes (all cited in Nelson’s review).
  • In regions where breastfeeding rates are low, pacifier usage may be discouraged before breastfeeding is well established.

Otitis Media – Ear Infections

  • While no meta-analysis conducted to date, still accumulating data
  • There are some convincing studies that there is a causal relationship between pacifier usage and acute otitis media (AOM).[10]
  • One study followed infants for 5 year and found that pacifier usage was associated with a 1.8 times great risk of AOM.[11]
  • The AAP also has a subcommittee on the management of AOM and they recommend that parents reduce or eliminate pacifier usage in the second 6 months of life.  However, it hasn’t been reaffirmed due to the more recent recommendation to use pacifiers as a means to reduce the risk of SIDS.

Latex Allergy

  • Parents are much more cautious of materials in baby products these days.  There have been findings of latex allergy.  Thankfully there are options in terms of materials to choose from.

Introduction of Infection

  • The aseptic nature of pacifiers has recently been called into question – Silicone is slightly more resistant to fungal colonization than latex, but not significantly different & pacifiers may act as passive vectors of disease.[12]
  • Dentists would also discourage parents with active dental caries from “cleaning” soothers that have fallen on the ground and giving it to their children for risk of passing caries onto their children’s developing teeth.[13]

So as you can see, the debate on pacifier usage is still on going.  In the end, my personal opinion is that pacifiers are an excellent tool to help young babies self soothe before it is age appropriate to use a transitional object or lovey at night or nap time.  Parents will have to make their own personal decision based on the available information on benefits and risks associated with pacifier use.  Most of the risks can be avoided with ensuring that there is no nipple confusion early on, using materials that are hypo-allergenic, and using proper sanitation to avoid possible transmission of infection.  As far as sleep goes, I feel that pacifiers are not a problem, unless you have to go in all night and replace them when you child is perfectly capable of doing this for him/herself.

What influenced your decision to use or not to use a pacifier with your baby?

[1] Warren,  et al. (2000) Non-nutritive sucking  behaviors in preschool children: A longitudinal study. American Academy of Dentistry. 22: 187-191.

[2] Nelson, et al. (2005) International child care practices study: Breastfeeding and pacifier use.  Journal of Human Lactation. 21: 289-294.

[3] Nelson, AM (2012) A comprehensive review of evidence and current recommendations related to pacifier usage. Journal of Pediatric Nursing. 27:690-699.

[4] Hauck, et al. (2005) Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics. 116:e716-e723.

[5] Mitchel, et al. (2006) Should pacifiers be recommended to prevent sudden infant death syndrome?  Pediatrics. 117: 1755-1758.

[6] American Academy of Pediatrics Task Force on SIDS. (2005) Policy statement: The changing concept of sudden infant death syndrome: Diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk.  Pediatrics. 116: 1245-1255.

[7] Stevens, et al. (2010) Sucrose for analgesia in newborn infants undergoing painful procedures.  Cochrane Database of Systematic Reviews. 1:1-114.

[8] Shah, et al. (2009) Breastfeeding or breastmilk for procedural pain in neonates (review). Cochrane Database of Systematic Reviews. 3: 1-43.

[9] Poyak. (2006) Effects of pacifiers on early oral development. International Journal of Orthodontics. 17:13-16.

[10] Hannafin & Griffiths (2002) Evidence based practice”: Pacifier use and ear infections.  Comminuty Pactitioner. 75: 50-53.

[11] Rovers, et al. (2008) Is pacifier usage a risk factor for acute otitis media? A dynamic cohort study. Family Practice: An International Journal. 25: 233-236.

[12] DaSilveira, et al. (2009) Biofilm formation by Candida species on silicone surfaces and latex pacifier nipples:  An in vitro study.  The Journal of Clinical Pediatric Dentistry. 33:235-240.

[13] Klein et al. (2004) Longitudinal study of transmission, diversity, and stability of Streptococcus mutans and Streptococcus sobrinus genotypes in Brazilian nursery children. Journal of Clinical Microbiology. 42(10): 4620-6.