Giving a baby a pacifier/dummy: pros and cons
Should you give your baby a pacifier/dummy?
Parents often assume that all babies automatically need a pacifier/dummy. But do they really? This article will explore the use of a dummy for babies, when they can be helpful and beneficial, and what some of the drawbacks of using a pacifier might be.
Pacifiers are very popular!
Pacifiers in their modern form (the rubber teat with a plastic back) have been in use for just over one hundred years. Of course, it is likely that parents have been giving babies something to suck/chew on for thousands of years. However, the advent of the rubber dummy, which can be cleaned and isn’t likely to break apart or cause a choking hazard, has been accepted in most countries as an essential piece of baby kit.
The pacifier symbol is synonymous with babies, used on greeting cards, in books and on decorations. Most parents buy a pacifier and try their baby with one at some point. There is clearly something that makes pacifiers such a useful parenting tool. However, a cautious approach may be warranted.
Spoiler alert – I’m biased
My own personal opinion is that pacifiers are not essential for babies. They certainly have their place, but for the most part, I usually discourage parents from using them unless they have to. Let’s take a look at the pros and cons of giving a baby a pacifier/dummy.
The reason why it’s called a pacifier
I’m going to start off by looking at the soothing aspect of sucking on a pacifier/dummy. The clue is in the name, isn’t it? There is a reason why we call it a soother or pacifier. Babies (especially newborn babies) have a strong need to suck. If you are breastfeeding, it’s probably been a big shock to realize just how much your baby needs to stay latched on – more about this below in the section on breastfeeding!
Sucking and swallowing is soothing
The facial nerves involved in sucking and swallowing are linked to the Vagus nerve. If you’re not familiar with the Vagus, it’s a long nerve that runs throughout the body. It’s involved in regulating our emotional response. In very simplistic terms, when it’s activated, it helps to calm us down. Therefore, sucking and swallowing for babies helps to activate this Vagus nerve and calm them down. (Porges, 2023)
Pacifier use and independence
In Western society, we value independence, and we often work hard at keeping our babies separate from us and settled without our presence. I suspect that one of the reasons pacifiers are so popular in the West, is because it allows parents to keep babies soothed without cuddling them.
However, this is not the biological reality of our species. Babies (and newborn babies especially) expect to be held in close contact as much as possible. Offering a pacifier instead of cuddles may soothe them, for sure. However, there are many benefits to holding our babies and soothing them through touch. Instead of using a dummy to soothe a baby, an alternative would be to carry them in a sling throughout the day, or co-sleep safely at night.
Regulation of a baby’s nervous system
Babies are born with a very immature nervous system, and require a lot of co-regulation. This just means that they need us to regulate their nervous system and keep them calm. Holding, rocking, cuddling helps regulate their nervous system. And of course, sucking helps too!
Newborn babies dysregulate very easily, which is why they are prone to fussiness and crying. As they get older and their nervous system matures, this fussiness and crying settles a bit. However, even older babies and toddlers still need a lot of co-regulation.
It is, of course, very important to work on keeping your baby regulated. Using a pacifier or dummy may be one of those tools at your disposal to help with this. There will always be situations (eg in the car) when it is impossible to cuddle or soothe your baby. In that situation, using a pacifier may be a good option. It was one of the few times I used a pacifier with my youngest. He hated the car seat and would scream on the school run every morning. It was so stressful and I roped my eldest into being on dummy duty in the back seat!
Newborn babies feed a lot!
Newborn babies feed a lot in the first few weeks! It wouldn’t be unusual for babies to be latched on pretty much constantly. The first few weeks are crucial for establishing a generous milk supply. Newborn babies also feed a lot because they need to build your milk supply. It is unlikely that they will only feed every 3 hours. It’s much more likely that they will want to feed hourly, and that sometimes they will cluster feed for several hours! If you are worried about your newborn baby’s feeding pattern, and wonder if they are getting enough milk, this article may be helpful: Cluster feeding: Here’s what you need to know : Rebecca Scott-pillai (rebeccascottpillai.co.uk)
Breastfeeding offers more than just food
Mums often worry that their babies are “using them as a dummy”, or that they are “feeding JUST for comfort.” Breastfeeding, however, isn’t just about nutrition, it is a package deal: it provides nutrition, contact with an adult and that soothing aspect that I discussed in the previous section. Breastfed babies often learn quite quickly how to do “non-nutritive” sucking. This is where they latch on and only suck for comfort, not to get milk. This is as valid a reason for breastfeeding as the times that they get milk!
Your baby isn’t using you as a dummy
A lot of newborn babies love to “hang out” at the breast. They spend ages latched on, doing the occasional little suck. If you are able to, the best thing you can do is get comfortable, get a basket with snacks, your phone and charger, the tv remote, and chill out on the sofa, with your baby at the breast. For thousands of years, babies have established breastfeeding by frequent feeds, and long periods of time at the breast. The pacifier is a relative newcomer to this relationship, and your baby isn’t using you as a dummy, they are feeding the way they are supposed to feed. The dummy, or pacifier, is a substitute for the breast.
Pacifiers can interfere with your milk supply
There is the potential that dummy use may decrease your milk supply because it reduces the number of times that your baby goes to the breast. This is especially true for newborn babies, when your milk supply is becoming established, but can also happen with older babies too.
I have seen babies that were gaining weight well until a dummy was introduced. At that point, their weight starts to plateau, and they no longer maintain their growth along a centile line on a growth chart. Often these babies are going long periods of time between feeds, and sucking on a dummy in between feeds. In this situation, sucking on a dummy acts a little bit like us chewing chewing gum – it suppresses the appetite. When a baby isn’t cueing for a feed, or missing feeds because they are sucking on a dummy instead, they don’t get enough milk and mum’s supply drops.
Is it ever ok to give a breastfed baby a pacifier?
I don’t work in absolutes, so of course, there will be times when giving a pacifier/dummy will be fine for breastfeeding families. A dummy may be helpful in situations where:
- Mum has an abundant milk supply and babies want to just comfort suck and not get milk. Often these babies will latch, start swallowing and then cry and unlatch. They settle with a dummy because they don’t want milk at that particular moment in time. If this is you, just keep a close eye on your baby’s weight gain and your milk supply.
- Someone else needs to settle the baby to sleep if mum isn’t available.
- For babies that get “disorganized” and can’t work out how to latch on, it may be helpful to use a dummy for 10-15 seconds before latching the baby on. This sucking on a dummy sometimes helps to calm them enough that they can focus on latching on properly.
- To settle a baby in the car!
Babies that are bottlefed will usually find the sucking/swallowing action on a bottle to be very soothing and comforting. However, unlike the breastfed baby, they get milk every time they suck. They aren’t really able to do any “non-nutritive” sucking on a bottle. It is quite easy to overfeed a bottlefed baby, partly because they do need to suck for comfort, but also because the flow of milk can be quite fast for them.
If a baby is lying on their back, and the bottle is tipped up so that the milk flows into their mouth, they often have no choice but to continue sucking, in order to protect their airway. Often, parents will give babies quite big volumes of milk via a bottle, and whether consciously or not, encourage the baby to finish the bottle, which leads to overfeeding.
Making bottlefeeding soothing for babies
We encourage parents to used a paced feeding technique with bottle fed babies, as this allows them to control the flow a bit better and reduces the volume of milk that a baby gets at each feed. It should take around 20 minutes for a feed. This allows babies to get plenty of sucking, plus allows their brain to recognize that their tummies are full and that they don’t need to keep feeding. This will result in a much calmer and more soothing feed.
Additionally, using a baby friendly approach means not scheduling feeds but feeding on cue. However, a baby may not be hungry every time they fuss. Therefore it’s important to learn to read their cues and not always offer a bottle in the first instance.
Pacifiers satisfy the need to suck
Pacifiers can be very helpful for bottlefed babies. If your baby has had a good volume of milk, but is still rooting or looking for something to suck on, then offering a pacifier at the end of a bottlefeed may be a good way of meeting that need for non-nutritive sucking. Additionally, if your baby is fussy in between feeds, and you don’t feel that they are hungry, you can offer a dummy in that instance too.
Sleep and SIDS
You may have read that giving a baby a pacifier/dummy reduces the risk of SIDS. In fact, the guidelines in the USA do recommend using a pacifier as a way to reduce the risk of SIDS. The guidelines in the UK are slightly different, and the Lullaby Trust neither recommends nor discourages dummy use as a way of reducing the risk of SIDS: Dummies and SIDS – The Lullaby Trust.
Breastfeeding, pacifiers and SIDS
The big issue is that if you are breastfeeding, we know that dummy use may have an impact on breastfeeding. Breastfeeding is protective against SIDS, and therefore you could argue that it doesn’t make sense to introduce a dummy if you are breastfeeding just to reduce the risk of SIDS. You need to weigh up the potential effect of a dummy on your milk supply, with all that entails.
Don’t STOP using a pacifier
However, if you have started to give a dummy for night sleep, it is a good idea not to remove it before 6 months, as there does seem to be a link between removing a dummy and an increased risk of SIDS. So, if you are breastfeeding and you have started to give a dummy at night time, keep a close eye on your baby’s weight and ensure that they are feeding a few times a night. If you are bottlefeeding and you want to give a dummy overnight, then it may reduce the risk of SIDS, but the evidence isn’t clear cut. (BASIS, accessed 22/01/24)
Will giving a baby a pacifier help them sleep better?
Some babies sleep better with a dummy
Many parents give their babies a pacifier because they find that they sleep better. Babies can access the soothing aspect of sucking on a dummy and may sleep for longer periods overnight. Of course, one could probably argue that the “natural” way for babies to act at night time is to breastfeed frequently overnight. Therefore, dummy use replicates this to some extent, and is probably why it is so effective.
Dummy use at night can be disruptive to sleep
However, as a sleep consultant I also work with a a lot of parents where their sleep is disrupted because they have to keep giving a baby a pacifier overnight! Babies suck, they fall asleep, then the dummy falls out of their mouth and they wake up. If they are unable to put the dummy back in themselves, then they rely on a parent to put it back in. It is probably worth exploring what is going on in this situation, as it may have something to do with the baby’s tongue and mouth position while sleeping. The next section will look at that in more detail.
Pacifiers and sleep disordered breathing
This is where it gets really interesting! Over the last few years I’ve done a couple of online courses that have looked at the intersection between tongue function (usually within the context of tongue tie), breathing and sleep.
There is a link between how we breathe and how well we sleep. Now, most of this new information is coming from the world of dentistry. I am not a dentist. However, I am a lactation consultant and a sleep consultant, so this information is relevant to my work. I should also point out that since it is a fairly new and emerging area of study, there really isn’t much scientific evidence to back this up. That doesn’t necessarily mean that it isn’t true. However, bear in mind that just because a lot of people keep saying the same thing on the internet, does not necessarily mean it’s true.
Let’s start off with tongue position. At rest (ie when your mouth is closed and you aren’t eating or talking), your tongue should rest in the roof of your mouth. This helps to shape the palate. Your hard palate (the roof of the mouth) should be fairly flat or have a slight curve to it. If the palate is high or arched, then the space in your nose may be restricted as the palate pushes up into the nasal cavity. A high palate is more common with a tongue tie, and it is hypothisised that this happens because a tongue that is tied doesn’t sit in the roof of the mouth. Instead the tongue sits flat on the bottom jaw.
It’s worth bearing in mind, however, that some babies also have reduced muscle tone around their mouth and jaw, and their mouth naturally sits open. So, a tongue tie isn’t always to blame. However, if your tongue doesn’t sit in the roof of the mouth at rest, it can impact on breathing in two ways:
- Because there is reduced space in the nasal cavity due to a high, arched palate, it makes it harder to breathe through your nose, meaning mouth breathing may become the default.
- A tongue sitting flat in the mouth allows mouth breathing to happen. Essentially, if the tongue rests against the roof of the mouth, it is impossible to mouth breathe and nose breathing is the ideal.
Signs to watch out for
- They sleep with their mouth open.
- They snore (either because their nasal passages are narrowed, or because the tongue falls back in their mouth).
- If they sleep with their mouth closed, and you gently pull down on their chin, the tongue is flat in the mouth and not suctioned to the roof of their mouth.
Nasal breathing versus mouth breathing
By default, all babies must breathe through their nose. When they are feeding, they breathe through their nose without breaking the suction on the breast or the bottle. They develop a co-ordinated suck, swallow, breathe pattern. If they don’t sleep with their mouth closed and/or the tongue isn’t in that optimal roof of the mouth position, then they may develop the habit of mouth breathing.
Red flags for sleep
Mouth breathing in babies is a red flag for sleep. While initially it may not cause any issues, over time it can cause problems. Air that enters through the nose gets warmed and moistened. If a baby is mouth breathing, then the air that moves through the throat is colder and dryer. Over time, this can irritate the tonsils and adenoids and cause them to become enlarged. This then further narrows their airway and often results in snoring and if severe enough, in sleep apnoea.
Sleep apnoea is where there is a pause in breathing because the airway has become temporarily blocked. How would you know if your child has sleep apnoea? You would hear your child breathing rhythmically, then there is a pause in breathing, followed by a gasp. They may even wake up at that point. If you hear this pattern of breathing, then it is important that you get them checked out as soon as possible by a doctor (preferably an ENT specialist).
What does this have to do with pacifiers?
When a pacifier sits in the mouth, it prevents the tongue from adopting that position of being fixed to the roof of the mouth. Additionally, even the softest of pacifiers is more rigid than the tongue or a nipple. There is the potential that the pacifier will influence the shape of the palate, making it more narrow and arched. As a result, the jaw will be more crowded and it may be necessary to have orthodontic treatment later in life.
Babies that do get used to having a pacifier in their mouth for sleep may lose that natural position of having the tongue rest against the hard palate. However, since they have also got used to having something in their mouth when they sleep, they may find it hard to adjust to sleeping without a dummy.
Does this mean that a pacifier will cause a child to have poor sleep?
I assumed that pacifier use affected speech, as I’ve often read that it isn’t recommended to let toddlers keep a dummy in their mouth during the day. In fact, when I did a search on Google Scholar, the evidence seems to be mixed. Some studies seem to find no correlation between prolonged dummy use and speech and others do. Therefore, I think it makes sense to follow the current guidelines from speech and language therapists, after all, they are the experts in that area! The general advice is to consider reducing dummy use after the age of six months, and to only use it for sleep.
What if your baby won't take a pacifier?
Does your baby actually need a pacifier? Now that you’ve read the information above, maybe you want to explore other ways to help your child settle or sleep better. However, if you do want your baby to take a pacifier, then the best thing to do is just offer it frequently, but don’t try to shove it into their mouth or force them to hold it in their mouth.
It can take some babies a bit of practice to work our how to hold a dummy in their mouth. This can be especially true if they have a high palate or reduced muscle tone in their face or tongue. Babies need to be able to create enough of a vacuum in their mouth so that the dummy stays in! That takes practice.
How, and when, to stop giving a baby a pacifier
The ideal time to get rid of a dummy (if you have been using one regularly), is between six and 12 months. The SIDS risk is reduced, and they haven’t developed an emotional attachment to the dummy yet. If you are using it to help them fall asleep, or to stay asleep, then you may want to:
- Add in some new soothing, comforting sleep associations to help them fall asleep. eg patting, shushing, rocking, white noise etc.
- Try removing it sooner in the process eg remove it once they are asleep, and then once they can sleep without a dummy in their mouth, remove it before they are fully asleep, then just give them a few quick sucks before trying to get them to sleep without it.
- Close the gap! If you notice that their mouth falls open without the dummy and you feel this causes them to wake, help them keep their mouth closed without the dummy in place. Put your finger on the soft spot under their chin and press up – this pushes the tongue up into the roof of their mouth. You may have to do this frequently to get them used to keeping their mouth closed.
If you have a toddler, they probably will have developed a strong attachment to their pacifier. Getting rid of it between the age age of a year and 18 months will probably result in a lot of tears and upset. Depending on their understanding, you may want to wait until they are closer to 3, and you can involve them more in the process. For example:
- You can prepare them for the dummy going away, by saying next week you won’t be getting a dummy any more, in three days… tomorrow… etc.
- Help them choose a new toy to cuddle or reward to get when the dummy goes away.
- Use an existing milestone eg. Easter, or a birthday as a time for it to go away.
- Talk about the dummy fairy taking it away and leaving something in it’s place. We have a fairy grotto near us and any time I’ve taken my kids, there are dozens of dummies left outside the fairy doors!
Do you need help?
I offer breastfeeding and sleep consultations for babies and toddlers. I also offer a specialized consultation for parents of newborn babies where we take a holistic approach to feeding, sleep and fussy behaviour. You can find out more here: Book a consultation : Rebecca Scott-pillai (rebeccascottpillai.co.uk)