Quick Answer
Yes, and current safe sleep guidelines from the American Academy of Pediatrics (AAP) actually recommend offering a pacifier at sleep time for babies from birth to 12 months, as research consistently shows it reduces the risk of sudden infant death syndrome (SIDS). You do not need to replace the pacifier if it falls out during sleep. There are some caveats around timing, breastfeeding, and dental development that are worth understanding before you start.
Why Pacifiers at Sleep Time Are Recommended
Multiple large studies have found that pacifier use at sleep time is associated with a significant reduction in SIDS risk, with some research suggesting a reduction of up to 50 percent. The mechanism is not fully understood, but leading theories include:
- Pacifiers may help maintain a more open airway during sleep
- Sucking on a pacifier may prevent babies from falling into excessively deep sleep states from which arousal is more difficult
- The pacifier may help babies maintain a safer sleep position
Based on this evidence, the AAP recommends offering a pacifier at the start of every sleep period, including naps, for the first 12 months of life.
When to Introduce a Pacifier
- Formula-fed babies: A pacifier can be introduced from birth
- Breastfed babies: The AAP recommends waiting until breastfeeding is well established, typically around 3 to 4 weeks, before introducing a pacifier. This reduces the risk of nipple confusion and breastfeeding difficulties in the early weeks when feeding patterns are being established
How to Use a Pacifier Safely at Sleep Time
- Offer it at the start of sleep: Offer the pacifier when you put your baby down to sleep. You do not need to keep it in your baby's mouth or replace it if it falls out during the night
- Never force it: If your baby does not want the pacifier, do not force it. Some babies simply do not take to pacifiers, and that is fine
- Never coat it in anything sweet: Do not dip the pacifier in honey, sugar, juice, or any other substance. This is a choking and dental health risk
- Use a one-piece pacifier: Choose a pacifier that is made in one piece (shield and teat together) to eliminate the risk of the teat detaching and becoming a choking hazard
- Check the size: Pacifiers come in age-appropriate sizes. Use the correct size for your baby's age
- Keep it clean: Sterilise pacifiers regularly, particularly in the early months. Do not clean a dropped pacifier by putting it in your own mouth, as this can transfer bacteria
- Do not attach it to a cord or string around the neck: This is a strangulation hazard. Pacifier clips attached to clothing are safe; cords around the neck are not
Does Pacifier Use Affect Breastfeeding?
The evidence on this is mixed. Some studies suggest that pacifier use in the early weeks can interfere with breastfeeding establishment, while others find no significant effect. The current consensus is that waiting until breastfeeding is well established (around 3 to 4 weeks) before introducing a pacifier minimises any risk to the breastfeeding relationship. Once breastfeeding is established, pacifier use at sleep time is unlikely to cause problems for most babies.
Does Pacifier Use Affect Dental Development?
Pacifier use in the first 2 years has minimal impact on dental development. Prolonged pacifier use beyond 2 to 4 years can affect the alignment of teeth and the development of the palate, but this is not a concern in infancy. Most paediatric dental guidelines recommend weaning from the pacifier by 2 to 4 years of age.
When to Wean From the Pacifier
The AAP recommends stopping pacifier use after 12 months, when the SIDS risk reduction benefit is no longer relevant and the risk of ear infections (which is slightly increased with prolonged pacifier use) begins to outweigh the benefits. Many families choose to wean between 12 and 24 months gradually. There is no single right approach, and the timing should be guided by your child's readiness and your family's circumstances.
When It's Worth Checking In With Your Pediatrician
Speak to your pediatrician if:
- Your baby is having significant difficulty settling to sleep with or without a pacifier
- You are concerned about the impact of pacifier use on breastfeeding
- Your baby is frequently waking to have the pacifier replaced, and this is significantly disrupting sleep for the whole family
Key Takeaway
Offering a pacifier at sleep time is recommended by the AAP for the first 12 months, as it is associated with a significant reduction in SIDS risk. For breastfed babies, wait until breastfeeding is established at around 3 to 4 weeks before introducing one. You do not need to replace it if it falls out during sleep. Use a one-piece, age-appropriate pacifier, keep it clean, and never attach it to a cord around the neck.
Parents Also Ask
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How Do I Get My Baby to Sleep Without Being Held?
What Is Safe Sleep and Why Does It Matter?
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your pediatrician or a qualified healthcare provider with questions about your baby's health.