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Ahh, the age-old question. Ok, perhaps it’s not actually an age-old question, but it is one that is very frequently on the minds of new parents, and it is one that I get asked very frequently as a pediatric sleep consultant and mom of 4. Like many other aspects of parenting, there are many different ways to raise healthy, happy, children. Pacifier use tends to be one of the more polarizing topics, with some parents swearing by them, and others believing they should be avoided at all costs. So, what’s the deal? Let’s take a look at The Great Pacifier Debate.

One one hand, pacifiers can be a lifesaver. Because sucking is so comforting for infants, they can soothe a fussy babe from their very first days of life and can even help babies fall asleep faster. A pacifier can help your baby make it through that trip to the store or out to lunch without a major meltdown. As a pediatric sleep consultant, I can attest that the pacifier can be a wonderful tool for sleep. Plus, pacifiers have been shown to reduce the risk of sudden infant death syndrome (SIDS). According to the American Academy of Pediatrics, using a pacifier during sleep is associated with a reduced risk of SIDS by as much as 50%. 

On the other hand, pacifiers can have their downsides. Extended use of pacifiers can be linked to dental problems such as bite issues and crooked teeth. In the early days, pacifier use could potentially interfere with breastfeeding, as it could cause nipple confusion and affect milk supply. Parents may end up having to replace a pacifier for a baby who is too young to replace it themselves, which can get tiring quickly. Older babies or toddlers protesting bedtime can make a sinister game of tossing their pacifier out of their crib. And if your child becomes too reliant on their pacifier, it can make it difficult to wean them off of it when the time comes. Exhibit A: my almost-3.5-year-old, who still uses her pacifier for nighttime sleep and is not remotely interested in giving it up. 

So, what’s a parent to do? The decision ultimately comes down to what is best for your baby and to your preferences as a parent. If your baby is happy using the pacifier and it’s not interfering with breastfeeding, you should know that there is no harm in continuing to use it. Some babies don’t like or won’t take pacifiers, or will only take a specific type or brand, and so those preferences can also play into your decision about whether or not to use one. 

I started using the pacifier as soon as breastfeeding was firmly established with each of my 4 babies (about 4 days old with my oldest, and 1-2 days old with the other three), and we did not experience any nipple confusion or disruption to breastfeeding.  Each of my children had a different experience. 

• My oldest used one until she was about 3.5 months old and learned to roll from her back to her stomach. Once she figured out how to roll, she rolled onto her stomach for sleep each night and wanted nothing to do with her pacifier. 

• My second daughter absolutely loved her pacifier and used it for sleep (and the occasional public meltdown avoidance) until she was 3. Around her 3rd birthday, she got an ear infection, and using the pacifier seemed to hurt her ears more. She chose to stop using it cold turkey because she associated it with her ear pain. Perhaps not coincidentally, a study published in the journal Pediatrics found that prolonged pacifier use (past 6 months of age) was associated with an increased risk of ear infections in children. 

• My youngest daughter STILL uses her pacifier at nearly 3.5 years old, much to my chagrin. She uses it only at night (except for a recent setback while at Disney World when we decided making it through full days at the parks was more important than our pacifier principles). She wasn’t nothing to do with stopping it, and we are actively plotting how to get rid of it for good. 

• My 13-week son currently uses a pacifier for comfort and sleep. He is too young to be able to replace it on its own, which usually ends in me replacing his pacifier 2-3 times as he’s falling asleep for the night or for naps. Overall, he is thriving while using it, and so we are going to continue using the pacifier for the time being. 

Ironically, despite these varied experiences, all my 4 children preferred the exact same brand and type of pacifier despite being initially offered several different options. The right pacifier for you is whichever brand/type your baby prefers. Here is the pacifier preferred by my kids.

It's worth noting that pacifier use is not recommended for all babies. If your baby is premature, has a weak immune system, or has a history of ear infections, pacifier use may not be suitable for them. In these cases, it's best to consult with your pediatrician to determine the best course of action.

In the end, there's no one-size-fits-all answer when it comes to pacifiers, which is probably why it continues to be a topic of great debate. It's up to you to weigh the pros and cons and make the decision that's right for you and your baby. 

Sources: 

1. Source: American Academy of Pediatrics, "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment")

2. Source: O'Connell, E. et al., "Prolonged Pacifier Use and Ear Infections in Infants: A Meta-Analysis," Pediatrics, Vol. 141, No. 1, Jan. 2018