Pacifier. What you need to know

With the collaboration of Francesca Veronesi, Pediatric Dentist.

The suction of the pacifier or thumb, or other fingers, is a way the child uses to calm down or to fall asleep, or to play and explore with the mouth.

The suction of the fingers can begin before birth, in utero.

However, it is necessary to know the benefits and the possible harmful effects of the pacifier, especially if this is used incorrectly and for too long.

Pacifier or Thumb?

My baby sucks his thumb, but he also takes the pacifier well. What can I do?

The pacifier is better because it is much easier to stop. 

Children who suck their thumbs are more likely to keep this habit for many years.

Pacifier and dental problems

If the pacifier or thumb habit persists for several years there may be dental problems.


This problem can appear even in primary teeth..

One of the most frequent malocclusion is the “open bite”. In this case the upper and lower incisors do not overlap well and there remains an open “window”.

Another condition is when the upper teeth, when you close the mouth, are inside the lower ones. In practice, the opposite of what normally happens.

And there may also be problems when the permanent teeth erupt.

The best way to identify early malocclusion, or better to prevent them, are the regular visits to the pediatric dentist specializing, already at 12 month.


The pacifier is not associated with caries problems, unless it is dipped in a sweet syrup, like honey. Or if the parents have the habit of putting it in his mouth before giving it to the child.

The best way to avoid caries or gums problems is to clean your child’s teeth properly, right from the appearance of the first tooth.

Pacifier in newborns. Any problems with breastfeeding?

Several old studies have shown that the introduction of the pacifier is associated with a more early interruption of exclusive breastfeeding. 

However, other more recent studies have shown that pacifier use does not interfere with breastfeeding when it is well established.

Pacifier yes or no?

My opinion is … Pacifier Yes.

In fact it is true that it has some disadvantage, for example dental problems if used badly and too long, but pacifier has a fundamental benefit.

If it is offered to the baby before sleep, this reduces the risk of SIDS (Sudden Infant Death Syndrome).

But it is always important to know the pros and cons of the pacifier, before offering it to the child.

Let’s see what they are.


When the baby is irritable, or is crying, inconsolable, sucking the pacifier can calm him.

If the child has difficulty falling asleep, the pacifier can help. It has no influence on the duration of sleep and on nighttime awakenings.

Research has shown that using pacifiers at the time of sleep reduces significantly the risk of SIDS.

On the plane, during take-off or landing, the baby may have ear pain due to pressure changes. Sucking a pacifier can reduce discomfort.

The pacifier can calm and distract the baby on some occasions. For example during a visit to the pediatrician, or during and after vaccinations.

The pacifier is not difficult to stop. When you have decided that it is the right time to do it, it can be thrown away.


While limited use in the first 2-3 years of life generally does not involve complications, an intense or prolonged use of pacifier can be harmful to the teeth, as mentioned above, with problems of malocclusion.

When the baby sucks the pacifier, he has a different sensation than the breast. For this reason it is advisable to wait until breastfeeding is well established before proposing the pacifier.

Several studies have shown that the use of the pacifier moderately increases the risk of otitis media.

Some children get used to always have a pacifier in their mouths. Even during the night, and then they wake up if it fall from their mouths.

When to give, or not, the pacifier to the newborn. Things to do and things to avoid.

But when do I start the pacifier? Since birth? What kind do I use?

Here are some tips on things to do and avoid about the pacifier.

Do not use the pacifier right away when the baby starts crying

Maybe he needs to be changed, or wants to be picked up, or he can calm with cuddles. Remember that the pacifier should never be used alone, in a crying baby, but always together with your caresses, or rocking.

Do not use the pacifier to delay meal time.

If the baby cries or shows signs of hunger, it should be fed as soon as possible.

Wait until breastfeeding is well established.

Better not to give the pacifier after a few days of birth. It is advisable to wait for breastfeeding to start well, usually after a few weeks.

Let your child want to use it.

If the baby is quiet and does not seem interested, do not give him a pacifier. If the baby is sleeping and the pacifier has fallen, do not put it back in his mouth.

Try to use it as little as possible.

Only at the time of falling asleep and if she cries inconsolably. So it will be much easier to remove it later.

Choose a one-piece, safe, dishwasher-proof silicone or rubber pacifier.

The pacifier in two pieces can break and lead to suffocation. 

Clean the pacifier often.

Make a thorough cleaning every time you give the pacifier to the baby. Up to 6 months of age his immune system is not mature, so you should boil it often, or use a sterilizer, or put it in the dishwasher. When your baby is 6 months old, you can wash the pacifier with soap and water.

Do not put drinks or other sugars on the pacifier

The child gets used to the sweet taste and increases the risk of tooth decay.

Check the pacifier often and keep it safe.

Change the pacifier often, every 1-2 months, and buy one suitable for your age. Whenever you give it to your child, check for cracks or cuts that can put you at risk of suffocation.

Do not use necklaces or chains around the neck to hold the pacifier.

In the event of a fall or rolling, for example while sleeping, the child is at risk of choking or serious injury. Instead you can use clips attached to the dress, with a very short cord.

Remove the pacifier. When should it be done? and how?

After a few years of using the pacifier, to avoid dental problems, it is advisable to accustom the child to abandon it.

But how to do it?

Here are some tips and methods you can try.

When to remove the pacifier?

It is worth starting to reduce the use of the pacifier after the first year of life, even if it will be difficult to abandon it definitively before the second birthday.

To avoid dental problems, it is best not to use the pacifier beyond the third year of life.

How to remove the pacifier?

Never force the child to abandon the pacifier, for example with punishments or humiliations (eg “you are already a big child, only infants use it, etc …”).

In this way you get exactly the opposite effect of what you want. In fact it increases the child’s stress and therefore the need to suck.

Instead, the child must be involved in the choice of removing the pacifier.

But how to do it?

First, look for a time that is as calm as possible.

If there is an important change, for example if you change house, or a little brother arrives, it is better, if possible, to postpone the removal of the pacifier for a few months.

Every family will find the right way to proceed, but positive reinforcements, which make the child happy, are more effective.

For example, using a calendar with star or other stickers to support progress. Or “sell” the pacifier to buy a beautiful gift.

Sometimes it is the child himself who wants to throw away the pacifier because “he has grown up”.

Express your admiration to the child for his effort to grow up, tell him that you are really happy.


American Academy of Pediatric Dentistry . Guideline on management of the developing dentition and occlusion in Pediatric Dentistry. Pediatr Dent. 2014;36(6):251. Canadian Pediatric Society. Pacifiers (soothers): A user’s guide for parents. Paediatr Child Health. 2003 Oct; 8(8): 520–521.

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