Should baby sleep with a pacifier?

by Anya Dunham, PhD

Research suggests that during baby’s first year, pacifier use is more a matter of preference than a health decision.

Babies are born with a powerful need to suck. Even in the womb, many babies suck on their fingers and toes.

And so pacifiers, in one form or another, have been around for thousands of years. The current form of the pacifier emerged in patents in the early 1900s, but soothing rings and teats made from linen rags stuffed with sugar have been documented in the medical literature from the 15th century.

Today, however, some parents feel uneasy about offering their baby a pacifier (also called 'soother', 'binky', and 'dummy' – see how even some of the names carry a negative connotation?). Let’s take a look at what science says about pacifier use during baby’s first year.

Pacifier use and breastfeeding

Several scientific studies looked at whether pacifier use affects whether and for how long babies are breastfed for – and found no association.^1,2

Another study reported that when mothers were highly motivated to breastfeed, prevalence or duration of breastfeeding was not affected regardless of whether pacifier use was encouraged or discouraged by medical professionals.³

Breastfeeding experts generally recommend waiting to introduce the pacifier until after breastfeeding is fully established (usually around 4 weeks).

Pacifiers and SIDS

Analyses of published case-control studies show that pacifier use during sleep is associated with a significant decrease in Sudden Infant Death Syndrome (SIDS).^4,5 These results come from many countries around the world and are remarkably consistent.

Exactly how pacifiers reduce the risk of SIDS is unknown. Scientists hypothesize that it may be because babies who use pacifiers tend to sleep on their backs and generally sleep lighter (so they wake easier if they have trouble breathing).^5,6

In 2016 the AAP Task Force recommended that pacifiers be used for up to one year from birth, for night sleep and naps; for breastfeeding babies, pacifiers should be introduced after breastfeeding is well established.⁷

Pacifiers and sleep

A pacifier is likely to become baby's sleep association. Sleep associations, or sleep cues, are people, things, and events that a baby associates with going to sleep and getting back to sleep. When a baby wakes in the middle of the night she tends to look for the sleep associations and cues she experienced at bedtime.

For example, a baby who bed-shares and falls asleep next to a parent will likely expect to find a parent next to her in the middle of the night. If she always goes to sleep nursing, she will likely want to nurse when she wakes. And a baby who falls asleep with a pacifier will likely look for it in the middle of the night.

Is this a problem? It may or may not be. One of the best things you can do to guide your baby towards sound sleep is developing soothing and consistent routines around sleep. 

In addition to being soothing and consistent for your baby, sleep routines must be sustainable for you: they must be something you are able to do, keep up with, and ideally enjoy every day (and night). A baby younger than 6-8 months is usually unable to find and re-insert a lost pacifier by himself, so he will need your help when he wakes in the middle of the night. If this is okay with you, then offering your baby a pacifier at bedtime could be part of his usual sleep routine. But if replacing the pacifier at night will be challenging for you, you might want to not offer your baby a pacifier and help her create other sleep associations.

Conclusions: Should baby sleep with a pacifier?

Overall, research suggests that pacifier use is a matter of preference rather than a health decision.

If you decide to offer your baby a pacifier:

• Consider choosing one-piece pacifiers (so they don't come apart)
• If your baby is breastfed, introduce pacifier after breastfeeding is established
• Clean and inspect pacifiers for tears regularly
• Offer pacifier mainly (or only) for sleep during the first year^7,8
• Don’t encourage pacifier use beyond baby's first year⁹

And last but not least, don’t use the pacifier as a go-to solution to calm your baby. Watch her carefully to see what she might be telling you so you can meet her needs and comfort her, building a strong bond between you.

  You might also be interested in:

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Warmly,

Anya

Hi! My name is Dr. Anya Dunham. I'm a scientist with a PhD in Biology, an award-winning author, and a mom to three young kids. Here and in my book, Baby Ecology, I analyze the research on baby's first year to find the optimal nurturing environment — the (usually wide) range of good options — to help you choose what works best for your baby and your family. Let's find the answers to  your new parent questions that are too complex to google. 

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