Risks of pacifier use

What are the risks of using a pacifier?

Pacifiers may stop a baby from crying but they won’t solve the problem that made the baby cry. A baby may cry because of hunger, pain, fear, or having a wet diaper. Those problems need to be addressed, but a pacifier may simply mask them. Pacifiers may reduce the likelihood of exclusive breastfeeding and the duration of breastfeeding and increase the risk of poor weight gain. Frequent use of a pacifier may be a sign the baby is underfed and needs to be supplemented, or it may make a baby sleep longer than necessary, leading to problems with breast milk supply. There are other concerns over the use of pacifiers, including the transfer of harmful chemicals to the baby, teeth alignment problems, obesity, and ear and stomach infections.

A) Effect of pacifier use on the baby's breastfeeding

There are times when using a pacifier may be appropriate but pacifiers can also cause breastfeeding problems.

1. Decreasing the amount of milk a baby takes in

Pacifiers can decrease the amount of breast milk a breastfeeding baby takes in resulting in poor growth (Fonseca 2017). 

Babies who are sucking on a pacifier can easily be underfed because they can’t alert their parents that they are hungry. Babies may spit the pacifier out once they are really hungry, but the pacifier may have delayed the feed. If each feed is delayed a bit, the baby may have fewer feeds than needed over the course of the day.

Newborn babies may quickly become sleepy if they are underfed, resulting in them taking in even less milk. This makes pacifiers use extra risky for them.

Pacifiers can be used to make babies under the age of one sleep more than five hours, which can reduce milk supply over time and results in poor growth in the baby and other difficulties for the mother.

2. More difficulty latching the baby

If feeds are delayed, the baby may become very upset by hunger and the breast may be firmer as it has continued to make milk from the time of the last feeding. Both can result in latching problems and ineffective feeds. Again, newborn babies are at an increased risk of this.

3. Less breastfeeding

Pacifier use has been associated with breastfeeding problems including:

  • Less exclusive breastfeeding (Buccini 2018; Howard 2003; Maastrup 2014; Rigotti 2015; Soares 2003)
  • Increased infant formula use and earlier weaning (Fernándex-Cañadas 2017; Hermanson 2019; Muelbert 2018; Nickel 2013; Schliep 2019; Vieira 2021)

However, one review found that pacifier use did not affect the rate of exclusive breastfeeding at four months (Jaafar 2016).

4. Masking the baby’s hunger

Extensive pacifier use may be a sign that breastfeeding is not going well, as when a mother has nipple pain or does not have enough milk (Jaafar 2016; Kair 2017; Kramer 2001).  

We have seen many cases in which a pacifier was used to keep a hungry baby quiet. The mothers felt their baby really liked or needed the pacifier, but the baby was actually very hungry and needed to be immediately supplemented with milk. The problems should be addressed and not masked by the pacifier.

B) Pacifiers can mask a baby’s problems

Babies cry when something is bothering them. They may be feeling hunger, pain or fear, may have a wet diaper, may want to breastfeed to prepare for sleep, and so on. Crying alerts the parents of a need, and the baby stops crying when the need is met.

The most common reason for using a pacifier is to keep the baby quiet (Mauch 2012). Pacifiers can stop crying, but the problem remains. One study (Gunnar 1998) showed that while pacifiers stopped crying, they did not reduce the levels of stress hormones (cortisol) in the baby’s blood.

C) Exposing the baby to harmful chemicals

Pacifiers may contain chemicals that may be transferred into the baby. These include (Aliprandini 2011; Asimakopoulos 2016; Bouma 2003; Westin 1990):

  • Parabens
  • Bisphenols
  • Benzophenones
  • Triclosan and triclocarban
  • N-nitrosamines, n-nitrosatable substances
  • 2-Mercaptobenzthiazol

Babies may be allergic to the latex used to make some pacifiers (Freishtat 2002; Kimata 2004).

D) Changes in the baby’s mouth

Babies appear to suck differently on a pacifier than on a breast (Batista 2019). This may contribute to changes in the structure and function of the mouth and its muscles including:

  • Abnormal spacing and alignment of teeth (Chen 2016; Doğramacı 2016; Lima 2017; Nihi 2015; Schmid 2018; Traebert 2020)
  • Changes in the roof of the mouth (Agarwal 2014; Zen 2019)
  • Excessive action of jaw muscles (Agarwal 2014)

Pacifiers are frequently contaminated with bacteria that cause dental caries (cavities) (Nelson 2015). However, pacifiers do not seem to increase the risk of caries (Peressini 2003).

E) Possible effect on speech and language development

One study (Barbosa 2009) showed that pacifiers can affect speech development but a slightly larger study (Baker 2018) did not show any effect.

Another study (Barca 2017) showed that children who used the pacifier for more than three years had different ways of expressing themselves.

F) Increased risk of infections

Studies have reported an increased risk of certain infections with pacifier use:

  • Ear infections (Salah 2013)
  • Stomach infections (North 1999)
  • Higher levels of yeast in the baby’s mouth (Ollila 1997)
  • Thrush (Bessa 2004; Khalaf 2019)

Healthy babies who use pacifiers are more likely to have the fungus that causes thrush present in their mouth (Darwazeh 1995).

G) Other risks of pacifier use

Pacifier use has been shown to:

  • Thumb and finger sucking (Ling 2018)
  • Obesity at one and two years if used for four or more months (Hohmann 2017)

Babies may choke on poorly built pacifiers or from pacifiers on a cord (CRN 2008; USCPSC 2006).


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