Pacifiers: Common Questions and Answers

Patients commonly seek guidance about the risks and benefits of pacifiers as well as when and how to wean children from them. Various types of pacifiers appear to have similar risks and benefits. The benefits of pacifier use include reduced risk of sudden infant death syndrome, decreased discomfort during air travel, and pain control during intramuscular injections, venipuncture, and heel sticks. Associated risks include potential negative effects on the initiation of breastfeeding, dental malocclusion, dental caries (when sugar is added), and otitis media. To mitigate the risk of dental caries, caregivers should avoid adding sugar to pacifiers. The American Academy of Pediatrics recommends using a single-piece pacifier with a soft nipple and a shield at least 1.5 inches in diameter with ventilation holes. The American Academy of Pediatrics also recommends delaying pacifier use until breastfeeding is well established, offering a pacifier when putting an infant to sleep, not reinserting pacifiers once an infant is asleep, and not forcing an infant to use a pacifier. The American Academy of Pediatrics recommends weaning pacifier use during the second 6 months of life to decrease the risk of otitis media. The optimal time to wean a child from a pacifier is unknown, but health risks appear to increase after 12 months of age.