When to introduce a pacifier: Can babies sleep with pacifiers?

Many parents have questions about pacifiers, lovingly known in some homes as binkies: when to introduce pacifiers, do pacifiers damage teeth, how long babies should use a pacifier in a day, and when to use a pacifier with a breastfed baby, are just a few of the most frequently asked questions. There are also some long-standing myths about pacifiers that you may have heard. So, are pacifiers “bad” and if not, when and how should you introduce one? Let’s break it down. 

IN THIS ARTICLE:

How to introduce a pacifier to baby

Many babies will take to pacifiers very easily and without any “coaxing.” If you have not tried introducing the pacifier, yet, you may be surprised at just how simple it is. If you have tried introducing a pacifier but your baby does not show any interest in it or has difficulty keeping it in their mouth, we have a few pro tips and tricks to try in the article below. 

Can newborns sleep with a pacifier

Yes! The recommends giving infants a pacifier during naps and bedtime to prevent the risk of SIDS. Make sure you're practicing pacifier safety, and never tie the pacifier to your baby's wrist or crib. Don't give your baby a broken pacifier, as that can be a dangerous choking hazard.

When to start using a pacifier 

Pacifiers can be introduced from birth (in healthy bottle-fed infants), though there are some conflicting opinions about when to introduce pacifiers to breastfed babies. The American Academy of Pediatrics (AAP) recommends waiting until breastfeeding is firmly established [], while the American Academy of Pediatric Dentistry’s (AAPD) 2022 Policy on Pacifiers [] points to evidence that pacifier use before breastfeeding is established doesn’t negatively impact the duration of breastfeeding.  

When breastfed babies can start using a pacifier 

For many years, new parents have been cautioned not to introduce a pacifier too soon when breastfeeding. The primary reason experts suggested waiting to introduce a pacifier was to reduce the risk of early weaning in breastfed babies.

In recent years, studies [] have shown there is no difference in duration of breastfeeding if offered from birth.

The AAP currently recommends waiting to introduce a pacifier until breastfeeding is well established which can vary from dyad (mother and baby) to dyad. Breastfeeding is thought to be well established if: 

• Mom has a sufficient milk supply

• Baby is able to consistently, comfortably, and effectively latch for milk transfer

• Baby is gaining weight appropriately

What does this mean for breastfeeding families? Pacifiers are not inherently “bad” and can be introduced from birth, even for breastfed babies.

It is important to use the pacifier appropriately - pacifiers should never be used to “hold off” a hungry baby in order to schedule feedings. Pacifiers can help soothe a fussy (yet full) baby, at the onset of sleep, while riding in the car, and during medical visits. It may also help soothe if you chose to start sleep training (like the or ).

When to stop using a pacifier

The AAP and the AAFP (American Academy of Family Physicians) recommend reducing or stopping pacifier use in the second 6 months of life. If you want to gradually wean your infant from the pacifier, you can consider a gentle . 

Some children will become more attached to their pacifiers and have a difficult time weaning from them before entering preschool. Long-term pacifier use can increase the risk for dental malocclusion (misalignment of the teeth, such as an open bite, crossbite, or overjet). The ADA (American Dental Association) and AAPD recommend actively discouraging pacifier use before age 3 [] with optimal weaning taking place when canines emerge (approximately 18 months). 

What to expect when giving your baby a pacifier

Babies are born with a strong desire to suck; suckling produces feel-good hormones such as oxytocin and cholecystokinin [] (CCK for short) which are responsible for the calming effect pacifiers have on babies as they suckle. Due to the intensity of these hormones babies will typically fall asleep or become very relaxed if all their other needs are being met. 

Sometimes, babies will struggle to take the pacifier at first. It is not uncommon for babies to spit out or drop the pacifier when initially introduced to the pacifier. Don’t be discouraged if this happens, especially if your baby is still a newborn and hasn’t had much time to develop stronger oral motor muscles. Patience and practice will pave the way for success with getting your baby to take a pacifier.

4 Tips and tricks for getting your baby to take a pacifier

Tip #1 Choose the right size and style of a pacifier for your baby’s age. 

Newborns do best with very lightweight pacifiers with smaller teats and mouth shields. Our favorite for newborns is the MAM (newborn size). Note: Many hospitals will supply Soothie-style pacifiers. This style of pacifier generally requires a caregiver to insert their finger into the opening and apply constant pressure in order for it to stay in. Switching to a lightweight pacifier can negate the need for caregivers to hold the pacifier in a baby’s mouth.

Softer pacifiers made of silicone are a good choice for all ages.

Older babies (12 month olds and up) may particularly enjoy Soothie-style pacifiers with a lovey attached. The lovey acts as a weight to help babies keep them in their mouths. Additionally, older babies can easily find their pacifier by grabbing onto the lovey. 

Tip #2 Be prepared to help!

Don’t be surprised if your baby needs a little help keeping the pacifier in their mouth at first. It is often necessary for a caregiver to apply pressure to the mouth shield for 10 - 20 seconds as babies build up enough negative pressure to keep the pacifier in.  

Tip #3 Demonstrate how to use a pacifier to your baby.

Babies learn a lot of skills by observation; how to suck on a pacifier is no exception! Consider demonstrating for your baby how it’s done by narrating the process for them as they watch you do it. Not comfortable with this activity? An alternative is to find videos online of babies using pacifiers to show your baby.

Tip #4 Do not give up too easily!

Your baby may need a lot of practice with the pacifier before they master the skill. Be patient and keep trying. We recommend practicing with the pacifier for at least 5 - 10 minutes every day and trialing different styles of pacifiers.

AAP guidelines for pacifier use in infants

The AAP has made the following recommendations:

• Offer pacifiers to infants at the onset of sleep to reduce the risk of SIDS (Sudden Infant Death Syndrome).

• Wean from pacifier use after 6 months of age to prevent ear infections [].

• Ensure the mouth shield is at least 1 ½ inches across so the baby cannot put the entire pacifier in their mouth. Also, the shield should be made of firm plastic with ventholes [].

• Avoid tying [] the pacifier to an infant’s arm, neck, or sleep space. 

• Do not attach pacifiers [] to blankets, plush, or stuffed toys for babies under 12 months old.

• Replace pacifiers if they become torn or reach their expiration date. Note that only some manufacturers issue expiration dates. 

The AAP guideline on breastfeeding infants does not contraindicate pacifier use for oral training [], specifically in preterm infants (also known as “suck training” -  for babies who need help coordinating sucking and swallowing or have low muscle tone). 

Will a pacifier help or hinder my baby’s sleep?

Introducing a pacifier for naps and bedtime can be a total game-changer for some otherwise difficult-to-soothe babies!

Using a pacifier to calm your baby before sleep can be very effective and help them fall asleep faster. But, there are cases where letting your baby fall asleep with a pacifier backfires.

During the first few months of life (3 months and under) pacifiers are generally helpful in putting babies to sleep. At this age, it is also common for babies to wake frequently to feed throughout the night, so we expect regular wakings. 

Once babies are capable of self-soothing and have begun to space out night feedings, pacifiers sometimes become a “negative” or parent-dependent sleep association. If your baby frequently wakes up because their pacifier fell out and they are too young to replace it themselves, weaning from the pacifier may be beneficial. 

Note: The fine motor skills needed for babies to be able to locate and insert the pacifier on their own usually develop around 7 months. A baby's usually include 3 naps and 11 - 12 hours of overnight sleep.  

Takeaway

• The American Academy of Pediatrics recommends giving infants a pacifier during naps and bedtime to prevent the risk of SIDS. Pacifiers can be offered from birth to bottle-fed and breastfed infants. In the past, early use of a pacifier was thought to contribute to weaning (i.e. cessation of breastfeeding prior to 3 months of age). In recent years, studies [] have shown there is no difference in duration of breastfeeding if offered from birth.

• Some tricks to help your baby take a pacifier include offering the right size and style pacifier. There are lots of styles and brands to choose from and you may need to try a few before your baby finds one they like. You may also need to help your little keep the pacifier in their mouth at first — this is normal! You can also try demonstrating how to suck on a pacifier for your baby or show them a video of a baby using one. Don't give up on getting your baby to take a pacifier too early. We recommend practicing for at least 5 - 10 minutes every day.

• Pacifiers can be very effective at helping babies fall asleep faster, but this can also backfire. They can sometimes become a “negative” or parent-dependent sleep association if your baby wakes up often because their pacifier fell out and they aren't able to replace it themselves. If this is the case, weaning from the pacifier may be beneficial.