• See Also
  1. Thumb Sucking
  • Indications
  1. SIDS Prevention
    1. SIDS reduced 50-90% when used for infants while sleeping
    2. Pacifier should NOT be attached to any clothing, crib or other item (Choke Hazard)
  2. Periprocedure anxiolysis
    1. Used with sugar solution before Circumcision, venipuncture, Heel Sticks IM Injections
  3. Air Travel
    1. May reduce Middle Ear Pressure during air travel during descent
  • Types
  1. General recommendations
    1. One piece, dishwasher safe Pacifier with shield (>=1.5 inches or 3 cm)
    2. Pacifiers are composed of silicone or latex
    3. Pacifier should NOT be attached to any clothing, crib or other item (Choke Hazard)
    4. Use of sweetener only around the time of procedure (otherwise unsweetened)
  2. Subtypes (no evidence for one Pacifier type over another)
    1. Physiologic Pacifier
      1. Ball shaped tip mimics human nipple
    2. Orthodontic Pacifier
      1. Nipple tip with one side flattened (slightly concave)
    3. Conventional Pacifier
      1. Longer tube Pacifier with rounded nipple tip at the end
  • Management
  1. See Thumb Sucking for extinguishing Non-Nutritive Sucking
  2. Under age 6 months
    1. No restriction on Pacifier use
    2. Appears to be preventive against Sudden Infant Death Syndrome (SIDS)
    3. Pacifier use does not interfere with Breast Feeding once it is well established
  3. Age 6 to 10 months
    1. Limit Pacifier use to while falling asleep
  4. After age 10 months (or 12 months)
    1. No Pacifier use
    2. Increased risk of malocclusion starts after 18 months (and highest risk >3-4 years old)
  • Complications
  • Prolonged Pacifier use
  1. Recurrent Acute Otitis Media
  2. Oral Candidiasis
  3. Dental Caries
    1. Associated with regular use of fruit juice or other sweetener added to Pacifier
    2. Unsweetened Pacifiers do not increase dental carie risk
  4. Dental Malocclusion (Pacifier use after age 18 months, and esp. age >3-4 years)
    1. Overjet malocclusion (Maxillary incisors overlap mandibular incisors)
    2. Cross Bite Malocclusion (buccal or lingual tooth displacement)
    3. Anterior open bite (opposing incisors fail to come in contact)
  • References
  1. Bryce (2025) Am Fam Physician 111(1): 31-6 [PubMed]
  2. Garcia (2025) Am Fam Physician 111(3): 230-5 [PubMed]
  3. Niemela (2000) Pediatrics 106:484 [PubMed]