What’s the Best Pacifier for My Baby?

Dr. Greene's Answer

When Jacques Cousteau first took cameras under water, he opened up an enchanted new world for us to see. Prenatal ultrasounds uncovered an even more marvelous world. Sights that had been hidden for ages were now open to our view, and one of the first things we saw was that babies suck their tiny thumbs even before they are born.

Infants are hardwired to need and enjoy sucking as a separate experience from feeding. In some infants this need is more pronounced than in others. Infants turn to sucking most when they are tired, bored, or in need of comfort. Some form of non-nutritive sucking has been common in every society we know.

Pacifiers come in many shapes and sizes. Orthodontic pacifiers have been scientifically designed to support the shape of babies’ developing palates and jaws. The flattened shape not only simulates the shape of a mother’s nipple when flattened in the mouth, but also encourages the most natural sucking action to help proper oral development.¹

Studies indicate that children who use orthodontic pacifiers have a smaller chance of developing an open bite or an overbite than those who use conventional round pacifiers.² This difference is hard to demonstrate, though, because neither type tends to cause problems unless sucked intensely for years.

It’s more important to choose a shape your baby enjoys. Children can have quite strong preferences on these matters, and ultimately they will decide which one is for them. Because you can’t know beforehand which your child will prefer, you might want to get several different types to try out.

Pacifiers come in different sizes to accommodate babies’ different sizes. Most newborns do best with pacifiers designed for newborns, and preemies with those designed for preemies.

While babies decide which pacifiers they like, you decide which are safe and convenient. Choose sturdy pacifiers with a shield that is at least 1 1/2 inch across to prevent choking. I like dishwasher-safe pacifiers for extra convenience, but the choice is yours. Replace your child’s pacifiers as they become worn.

Another important feature to look for is vented shields to protect the skin around your baby’s mouth. Without them, saliva can collect behind the shields, irritating the skin and causing a rash.

The American Academy of Pediatric Dentistry solidly prefers pacifiers to thumbs for meeting children’s sucking needs (because pacifiers are easier for parents to control). I think pacifiers and thumbs are both fine – but bottles should never be used as pacifiers (this can cause terrible tooth decay). Nor should pacifiers be used to say, “quiet down!” without words, or as replacements for noticing babies or their needs.

Research within the past few years indicates that there is an association between pacifier use and a reduction in the risk of sudden infant death syndrome (SIDS). The American Academy of Pediatrics (AAP) recommends the use of pacifiers at nap time and bedtime throughout the first year of life. One caveat is that the AAP recommends waiting one month for breastfed infants before introducing pacifiers in order to firmly establish breastfeeding.

Used correctly, pacifiers can be wonderful.

When babies suck on pacifiers or thumbs, they are able to create their own mini-vacations that are reminiscent of some of their favorite moments – feeding in mother’s arms or the quiet stillness before they were even born. What a nice gift to allow them to make this magic for themselves!

Footnote References:

¹Turgeon-O’Brien H, Lachapelle D, Gagnon PF, Larocque, I., Maheu, R.L.F. (1996). Nutritive and nonnutritive sucking habits: a review. ASDC: Journal of Dentistry for Children, 63(5), 321-327.
²Adair SM, Milano M, Dushku JC, Evaluation of the effects of orthodontic pacifiers on the primary dentitions of 24- to 59-month-old children: preliminary study. Pediatr Dent 1992 Jan-Feb;14(1):13-8