Is It Good for Babies to Sleep With a Pacifier?

The sucking reflex is a normal physiological feature of a healthy newborn. Based on breastfeeding physiology, a newborn can naturally suckle at the mother's nipple, but some parents introduce a pacifier from the first days of their baby's life. But is a pacifier necessary for babies? And when is the best time to start using it at night? In this article, you will read about the pros and cons of using a pacifier and how to use it safely during your baby's sleep time.

Can babies sleep with a pacifier?

Yes. There is evidence that using a pacifier in the first year of life can protect babies from suffocation during infant sleep and reduce risks of sudden infant death syndrome (SIDS). Moreover, some researchers suggest that pacifiers may support healthy sleep, although there isn't much evidence to support this.

It's important to note that using a pacifier for too long can cause some health problems, and recommendations for using it depend on the baby's age.

How to use pacifiers safely during sleep

You can start using a pacifier for bedtime when breastfeeding is fully successful, usually after the first four weeks. If introduced incorrectly, pacifiers might disrupt breastfeeding. The main cause is that milk production depends on the frequency and duration of breastfeeding. If the baby uses a pacifier, the normal latching onto the breast process may be disrupted, which may hinder breastfeeding.

During the first weeks, mothers are advised to offer the breast as much as possible, ensuring proper feeding frequency and milk supply. Whenever breastfeeding is well established — the baby is above birth weight, the mother has a full milk supply, and the baby drains the breast effectively — a pacifier can be introduced for sleep if needed.

Sometimes babies need to suck just after feeding from the breast or bottle, and this is when a pacifier can be useful. If the pacifier falls out during sleep, it is not necessary to put it back in.

Benefits of sleeping with a pacifier

Here are the most acknowledged benefits of nighttime pacifier use.

Soothing effect

Pacifiers are a well-known soothing technique for infants. They can provide comfort during painful or unpleasant procedures, and they work for both preterm and term newborns.

Researchers found pacifier benefits for pain management in newborns during painful procedures in the hospital. Evaluation with neonatal infant pain scale shows that the pacifier, with and without dextrose, shortened crying duration and normalized heart rate during a tube insertion procedure in newborns. This suggests that using a pacifier while falling asleep and during sleep can help calm the baby.

SIDS reduction

There is some scientific literature on pacifiers and SIDS prevention. The meta-analysis of seven studies shows that pacifier use can lower the risk of SIDS. Researchers found that pacifier use decreased SIDS risk more for infants of mothers who were older, non-smokers, received adequate prenatal care, and breastfed.

The exact mechanism of how using a pacifier can lower the risk of SIDS remains unclear. Some believe that sucking pacifiers increases respiratory drive and may act as a mechanical barrier to the mattress and other bedding materials. The American Academy of Paediatrics suggests pacifier use can be offered at the onset of sleep.

Sleep aid

Even though there are some hypotheses that pacifier use may promote good sleeping habits and help babies fall asleep faster, there is no sufficient evidence to confirm this. You can try using a pacifier to help your baby sleep better, and it may work as nighttime soothing.

Potential risks of sleeping with a pacifier

Doctors and researchers warn about some adverse effects of prolonged pacifier use.

Acute otitis media risk

Researchers found a correlation between pacifier use and acute otitis media in children, which is an infection of the middle ear. Although the exact mechanism is not clear yet, pacifiers may cause Eustachian tube dysfunction, when a small canal in the ear doesn't function properly. To reduce the risks of otitis media, the American Academy of Paediatrics and the American Academy of Family Physicians recommend weaning children from pacifiers after six months.

Possible negative impact on breastfeeding

For adequate milk production, newborns have to breastfeed frequently. Artificial aids, like pacifiers or bottle feeding, disrupt the physiological basis of lactation. There are recommendations to avoid pacifiers in the first four weeks of life till breastfeeding is established and the baby sufficiently gains weight.

Dental malocclusion

The data shows that frequent, prolonged, and intensive sucking of a pacifier or even thumb can cause dental malocclusion. In fact, the longer the child uses a pacifier, the more orthodontic problems may arise.

Pacifier use beyond 18 months can influence the development of pathological conditions like anterior open bite and posterior crossbite. The risk increases significantly if the pacifier is not discontinued after three years. Moreover, pacifiers that are named orthodontics lead to the same risks as other pacifiers.

Infection risk

Pacifier hygiene is just as important as safety. Pacifiers can be colonized with microorganisms, such as Candida albicans, also known as oral thrush. Babies who use pacifiers have a significantly higher risk of oral thrush. Be sure to wash and disinfect pacifiers properly.

When to stop giving pacifiers to your baby for sleep

In the case of acute otitis media risk, the American Academy of Family Physicians recommends weaning children off pacifiers before they turn one. Moreover, the American Academy of Pediatric Dentistry (AAPD) recommends assessing pacifier use around three years of age to ensure normal positioning of teeth before permanent teeth emerge. Therefore, it is better to address oral habits such as pacifier or thumb sucking as soon as possible after a certain age and manage pacifier dependency wherever possible.

Using a pacifier can have benefits, such as a soothing effect, pain relief, and reduced risks of SIDS. Nevertheless, there are some risks of dental malocclusion, increased risk of acute otitis media, and possibly a negative impact on breastfeeding. It is recommended to consult your baby's doctor about the use of pacifiers if you have any questions or if pacifier weaning strategies are needed.