Maximize the Benefits of Pacifiers and Minimize Problems

by Cathryn Tobin, MD

Do begin offering a pacifier after breastfeeding is well established. Sometimes a baby will refuse the breast after sucking on a rubber nipple. This is commonly referred to as nipple confusion. I suspect, however, there is no confusion -- some babies simply prefer a rubber nipple. In order to avoid problems, a pacifier or bottle should not be introduced until the baby is well established at the breast. (I consider this to be when a baby is steadily gaining weight. In general, I advise parents to wait a minimum of 2 weeks before offering a pacifier.)

Do choose the right pacifier for your baby. Parents often ask which pacifier is best. There is no such thing as an ideal. Some babies prefer a short nipple, while others prefer a round one. The best pacifier, then, is the one your baby prefers.

  • Do choose a clear silicone pacifier. The yellow rubber ones tend to break down over time.

  • Do pay attention to your baby's signals. A pacifier is meant to soothe, not silence, a baby. If your baby spits out her "binkie," it means she doesn't want it. Please don't keep sticking it back in.

  • Do expect some dental problems. Prolonged or excessive pacifier use may have a detrimental effect on teeth, gums, and other dental areas. For instance, malocclusion, or "bad bite," in which the teeth are not lined up properly, is common among pacifier users.

  • Don't clean a pacifier by sticking it in your mouth. Your saliva can easily spread germs. If the pacifier falls on the floor, rinse it under running water.

  • Don't tie or clip a pacifier to clothing. A baby can choke or strangle, or ribbons can become twisted around tiny fingers and impair bloodflow.

  • Don't dip a pacifier into something sweet to tempt a baby to take it. In particular, honey and corn syrup pose significant risks for babies because they may contain spores from the bacteria Clostridium botulinum. In an infant under 12 months, the spores can release a toxin that causes botulism, a life-threatening illness. Sweeteners may also cause cavities in developing teeth.

  • Don't worry about ear infections. Although there's some evidence that pacifiers increase the risk of ear infections (the theory is that vigorous sucking by older babies causes a disturbance in pressure in the middle ear), the jury is still out on this one. A young baby who uses a pacifier at bedtime tends to grow into an older baby who relies on one for sleep. So, even though this study refers to older babies, it's something to keep in mind.

Excerpted from The Lull-a-Baby Sleep Plan: The Soothing, Superfast Way to Help Your New Baby Sleep Through the Night . . . And Prevent Sleep Problems Before They Develop.

Cathryn Tobin, MD, is a pediatrician, a trained midwife, and a member of the Canadian Pediatric Society and the Royal College of Physicians and Surgeons. She has been speaking on parenting issues for more than twenty years. Visit her on the Web at

Copyright © Cathryn Tobin, MD. Permission to reprint granted to, LLC by Rodale, Inc., Emmaus, PA 18098.