Pacifiers and Sleep: Benefits, Concerns, and Guidelines

Pacifiers are a topic with passionate opinions on all sides. The research, however, shows that pacifiers can actually be protective when used for sleep. Understanding the benefits and appropriate use helps you make informed decisions.

This guide covers what you need to know about pacifiers and infant sleep.

What You Need to Know AAP

Key finding:
Pacifier use during sleep is associated with reduced SIDS risk. The AAP recommends offering a pacifier at sleep time. AAP

Important points:

• Protective effect exists even if pacifier falls out
• Don't force if baby refuses
• Don't need to reinsert during sleep
• Don't attach clips or strings (choking hazard)

This recommendation:

• Applies to both naps and nighttime sleep
• Starts once breastfeeding is established
• Continues through the first year
• Is optional—not required

The SIDS Protection

What research shows:

• Multiple studies show pacifier use reduces SIDS risk
• Protection exists even if pacifier falls out during sleep
• Mechanism not fully understood

Possible reasons:

• Keeps airway more open
• Prevents rolling to stomach
• Creates arousal more easily
• May affect sleep depth
• Exact mechanism unknown but effect is consistent

The numbers:

• Some studies show up to 90% reduction in SIDS risk
• Effect persists across different study designs
• One of the modifiable risk factors AAP

When to Start

If breastfeeding:

• Wait until breastfeeding is well established
• Usually 3-4 weeks
• Ensures no nipple confusion issues
• Baby should be gaining weight well

If formula feeding:

• Can start from birth
• No concern about nipple confusion
• Offer at sleep times

What "offering" means:

• Present pacifier at sleep time
• Don't force if baby refuses
• Some babies never take one—that's okay
• Keep trying periodically if interested

How to Use Safely

Safe pacifier use:

• One-piece design (can't break apart)
• Age-appropriate size
• No strings, cords, or clips attached
• Replace if damaged
• Keep clean

At sleep time:

• Offer after feeding
• Don't reinsert if falls out during sleep
• Don't attach to clothing with clips
• No sweetening with honey or sugar

What NOT to do:

• Don't coat in sweet substances (decay, botulism risk)
• Don't attach to string around neck (strangulation)
• Don't let older children use smaller pacifiers
• Don't continue using damaged pacifiers

Common Concerns

"Will it affect breastfeeding?"

• Research shows no negative effect when introduced after breastfeeding established
• Wait until 3-4 weeks if breastfeeding
• If latching issues arise, stop and consult lactation specialist
• Pacifier use doesn't typically cause weaning AAP

"Will baby become dependent?"

• Some babies do form a strong attachment
• Most babies naturally lose interest by 2-4 years
• Weaning is possible when ready
• Benefits for sleep may outweigh this concern

"What about teeth?"

• Generally no issues in first 2 years
• Prolonged use past 2-4 years can affect teeth
• Orthodontic concerns typically with extended use
• Work on weaning by 2-4 years

"Baby wants it reinserted all night"

• This is common around 4-6 months
• Can become a sleep association issue
• Options: teach baby to find and replace, wean pacifier
• Some families ride it out; dependency often resolves

The Sleep Association Question

What may happen:

• Baby associates pacifier with falling asleep
• Wakes between sleep cycles and needs it replaced
• Can result in multiple night wakings

If this becomes a problem:

• Consider weaning pacifier
• Or teach baby to find and replace independently
• Place multiple pacifiers in crib (when older)
• This often resolves on its own around 6-8 months

Weighing the trade-off:

• SIDS protection is significant benefit
• Sleep disruption is real downside for some
• Each family can decide what works best

Choosing a Pacifier

Types:

• Orthodontic: shaped nipple
• Round: traditional shape
• One-piece construction: safest

Features to look for:

• Age-appropriate size
• BPA-free materials
• Ventilated shield
• One-piece design
• Easy to clean

What baby likes:

• Babies often prefer specific shapes
• May need to try different types
• Some babies never take one
• That's completely okay

Weaning from Pacifier

When to wean:

• AAP recommends offering through first year (SIDS prevention)
• Consider weaning between 6-12 months if desired
• Should be weaned by 2-4 years for dental health
• Earlier if causing sleep disruption issues

Weaning approaches:

• Cold turkey (often fastest, may have protest)
• Gradual reduction (only at bedtime, then eliminate)
• Pacifier fairy (for older children)
• Natural loss of interest (many babies outgrow)

What to expect:

• May have disrupted sleep temporarily
• Protest is normal
• Usually resolves within 1-2 weeks
• Find other comfort methods

What Other Parents Ask

Q: My baby won't take a pacifier. Should I keep trying?
A: You can offer periodically, but don't stress about it. Not all babies take pacifiers, and that's fine. The protective effect is a benefit but not the only way to reduce SIDS risk. Follow other safe sleep guidelines.

Q: Should I put the pacifier back in when baby wakes at night?
A: AAP says you don't need to reinsert if it falls out during sleep. If baby wakes and wants it, you can offer it. Around 6 months, many babies can learn to find and replace it themselves if you put several in the crib.

Q: Is there a "best" pacifier?
A: The best pacifier is one your baby will take. There's no evidence one brand or shape is safer or more effective than another. One-piece construction is safest (won't break apart). AAP

Q: My baby only sleeps with the pacifier. Is this a problem?
A: It can become inconvenient if baby wakes frequently needing it replaced. However, the SIDS-protective benefit is real. Weigh convenience against safety benefit and make the decision that works for your family.

Q: Should I use pacifier for all sleep or just nighttime?
A: AAP recommends offering at naps and nighttime. The protective effect applies to all sleep periods.

The Bottom Line

Pacifiers reduce SIDS risk when used during sleep. The AAP recommends offering a pacifier at nap and bedtime, without forcing if baby refuses. Wait until breastfeeding is established (3-4 weeks) if breastfeeding. Don't attach with strings, don't sweeten, and don't need to reinsert if it falls out. AAP

Key points:

• Reduces SIDS risk
• Offer at sleep times
• Don't force
• Wait 3-4 weeks if breastfeeding
• No strings or clips
• Protection exists even if it falls out

Clara is here to help you make informed pacifier decisions.