Most new parents and caregivers will reach for a pacifier at some point when it comes to settling an upset baby. While pacifiers go by many names, the goal is usually the same—to satisfy a baby’s natural need to suck and offer comfort to a fussing baby. Pacifiers are safe to use from birth and have shown some benefits for children, especially in the first six months of life. Long-term pacifier use, however, can come with complications. Here’s a look at how to introduce a pacifier to your baby, when and how to use it effectively, and signs it may be time to let it go:

How to Use a Pacifier

While not all babies will happily take a pacifier from the moment they're born, doctors agree it is safe for them to do so. In fact, premature babies are often given pacifiers after birth to encourage their suck and swallow reflexes to develop. But just because it is safe for newborns to have a pacifier, doesn’t mean it’s the right choice for your family. Parents who are breastfeeding, for example, are sometimes encouraged to wait a few weeks to allow the baby to figure out feeding before introducing a pacifier. Once your child has mastered breastfeeding, or if you’re bottle feeding, your baby is ready for a pacifier. 

Most pacifiers sold consist of a silicone or rubber nipple connected to a piece called a shield. Pacifier nipples come in different shapes and sizes depending on the infant's age. Parents should ensure the entire pacifier (nipple and shield) cannot be placed in the mouth of a baby and that the pacifier is easy to clean and sterilize. Parents should also sterilize the pacifier after purchasing it before they place it in their baby’s mouth and continue to sterilize it often. Worn out pacifiers should always be replaced. 

Many babies love pacifiers from the moment they are given one. If a baby doesn’t seem to like their pacifier, however, parents can try different brands and different-shaped pacifiers. Or simply not worry with one. While there is some benefit in pacifier use in the first six months of a baby’s life, like reducing the risk of sudden infant death syndrome (SIDS), parents shouldn’t be overly concerned with forcing use if their baby isn’t interested. The safest and best way to reduce the chance of SIDS is by following the safe sleep practices provided by the hospital at birth. Lastly, pacifiers are safe to use at all times of day—whether asleep or awake—but should never be used to delay mealtimes or soothe a hungry baby. 

The Drawbacks of Pacifier Use

Though many parents use  the pacifier as a key tool in surviving the early months of a child’s life, its use doesn't come without complications. Parents and caregivers should consider a few downsides to pacifier use before choosing to introduce one to their baby. 

• For some babies who are breastfeeding, receiving a pacifier too early can interfere with their ability to properly latch and feed from their mom’s breast. Doctors and lactation specialists call this “nipple confusion”. Waiting a few weeks before introducing a pacifier is all it takes to avoid the problem. 
• Babies ages 6 months to a year who use pacifiers regularly may run the risk of greater fluid buildup in the ears, which can lead to ear infections or other ear problems. If your child is prone to ear infections and using a pacifier excessively at this age, it may be time to ditch it. 
• Some babies grow to rely on their pacifiers to stay asleep at night. While this may be fine once your baby is able to find their pacifier and place it back in their mouth on their own, it can be exhausting for parents who must wake up multiple times a night to replace a missing pacifier in their child’s mouth. 
• Children who use pacifiers long-term can be more prone to dental problems, as sucking on a pacifier can cause misalignment in your child’s teeth. Many pediatricians and pediatric dentists will encourage parents to halt use around a child’s first birthday, though most dental damage is done after a child’s second birthday. 
• While second-time parents may joke about the first-time parent’s quick cleaning of a dropped pacifier, it’s worth noting that pacifiers do carry a lot of germs. If pacifiers aren’t cleaned and sterilized regularly, they can make your baby sick, especially when there may be a big brother or sister around who likes to share. 

When to Pack Away the Pacifier

Even for children who haven’t experienced any of the downsides of pacifier use, there comes a time when parents should consider weaning children from their pacifiers. Pacifier use beyond the age of three can cause long-term dental problems in children, and the use of a pacifier in preschool or daycare settings can come with a higher risk of germ exposure. Pacifier use is not recommended for any children older than four. Many parents find it easiest to wean children off their pacifiers around age two. For some children, quitting ‘cold turkey’ may be easiest, while it may be more of a process for others. While there are many weaning strategies, parents should always praise their child for times they choose not to use a pacifier and offer lots of positive encouragement when it comes to breaking the pacifier habit. 

For more information on pacifier use in babies and young children, including when to ditch the pacifier, check out www.healthychildren.org or www.aapd.org.