Pacifier 101 – A labor and delivery nurse answers important questions

Ahhh, the beloved binky. Should you give one to your baby? Are they safe? How often should you replace them? We caught up with Sarah, BSN RN, EFM-C, a labor and delivery nurse, and mother of three, who’s also known as the “Labor Junkie RN” on social media, to ask her questions on everything from choosing a pacifier to whether we should even bother with those pacifier clips and attachments. We even got her to tell us which pacifier she trusted for her babies (Psst! It’s MAMOpens a new window!).

BabyCenter: What features should parents look for when choosing a pacifier? 

Sarah: Pacifiers need to be safe and practical. The American Academy of Pediatrics (AAP) recommends a single-piece model that has a soft nipple with a shield that is at least 1 ½ inches across (so a new baby cannot put the entire pacifier into their mouth) and is less likely to break or fragment and pose a choking hazard. I like the MAM Comfort PacifierOpens a new window, a one-piece silicone pacifier that also has holes in the shield to help the skin breathe. My babies had eczema and sensitive skin, so the vent holes helped reduce irritation around their mouths.

BC: When is the ideal time to introduce a pacifier? Should parents plan to bring one with them to the hospital? 

Sarah: Ultimately, if a family plans to introduce a pacifier, it’s never a bad idea to bring their own to the hospital, just in case. When I work in the NICU, nearly every baby is given a pacifier. Our NICU strongly encourages pacifier use because studies show benefits of non-caloric sucking in those babies. There’s also evidence that pacifiers’ calming and soothing effects may reduce stress and offer pain relief during minor procedures.

For formula-fed babies, pacifiers can usually be offered from the start (unless otherwise advised by their pediatrician). For breastfed babies, it’s recommended to introduce binkies after breastfeeding has been well established (AAP says 3 to 4 weeks). Regardless of feeding preferences, we always want to ensure pacifiers are not being used to replace feeds. If a family plans to use pacifiers, it’s a good idea to ask their provider whether the hospital or birthing center has a policy about introducing pacifiers and providing them to patients. 

However, a pacifier should never be forced on a baby who is disinterested and it should never replace feeding or nourishment.

BC: What do you see are the benefits of using a pacifier? 

Sarah: There is evidence showing several benefits of pacifier use in newborns and young babies. One in particular is their “protective effect” against Sudden Infant Death Syndrome (SIDS). Studies show that giving babies a pacifier when placing them down for sleep (in addition to practicing other safe sleep recommendations) resulted in a significantly reduced risk of SIDS. In fact, current evidence is so strong that AAP recommends offering pacifiers to infants when putting them down for sleep. 

BC: Speaking of SIDS, how do pacifiers reduce the risk?

Sarah: We don’t yet fully understand how it reduces the risk. Some hypothesize that pacifier use during sleep may help keep a baby’s tongue thrusted forward and keep the baby’s airway open. Others suggest pacifiers (during sleep) might improve autonomic controlled breathing — meaning the nervous system that requires no voluntary “thinking” is more activated and better regulates baby’s breathing. Some studies have even suggested the pacifier itself could act as a “barrier” between baby’s nose and mouth and a sleep surface if the baby were to roll onto his tummy during sleep. 

(For more information on SIDS, check out this BabyCenter article.)

BC: Did all three of your children use pacifiers? How did you decide which brand to use?  

Sarah: Yes. All my babies used them, and all three loved their binkies! When choosing a brand or specific model of pacifier, it was simply trial and error. When I was pregnant with my first child, we were given a hodgepodge of pacifiers from friends and family: Rubber, silicone, varying shapes and sizes — you name it. I wanted to be sure my daughter’s pacifier was safe and easy to clean. In the end, we gave her a MAM ComfortOpens a new window silicone pacifier. I saw MAM pacifiers used in my hospital’s NICU and Pediatric units; the babies seemed to love them and I loved that they fit the safety qualities I was looking for — they were safe, practical, easy to clean and sanitize, and affordable. Another bonus is that MAM has never had any product recalls, which is reassuring as a mom and nurse. Whether during the newborn phase, infancy or as older babies, all my children have used MAM pacifiers at one time or another. We love them.

BC: How many pacifiers should a baby have? Should parents rotate them?  

Sarah: It comes down to personal preference. My babies have been huge binky lovers — particularly for naps and bed. But guess what? Pacifiers get lost, dropped, left in the car, or lost at the doctor’s office. They also get used a lot and need to be cleaned and replaced. After nursing my baby in the middle of the night, the last thing I want is my husband scrambling to find a soother at 3 a.m. So, we always have plenty of backup pacifiers available — about five around the house. We also rotate them for several reasons. When the same pacifier is used again and again, the shape and integrity can wear down. We find it easier to keep up with cleaning and sanitizing when we have several to rotate. 

BC: How often should pacifiers be replaced? 

Sarah: That can depend on a few factors, such as the material it’s made of, the condition of the pacifier, or the recommendations of the manufacturer. Because binkies deteriorate with time and use, it’s important to inspect them for cracks, discoloration, tears, or damage before giving them to your baby. If there is any damage at all, discard it. In most cases, it’s recommended to replace pacifiers about every 4 to 8 weeks, but ultimately, you should follow the manufacturer’s suggestions. 

BC: How do you feel about pacifier clips? Should parents attach them to their babies? 

Sarah: Pacifier clips have the potential to be both useful and dangerous. The obvious convenience of not dropping and losing pacifiers all day is wonderful. But we also know some clips can break apart and become choking hazards. The lanyards can have unsafe parts, creating strangulation or choking hazards. So, it’s essential to be well-informed if you plan to utilize these clips. It is not recommended to use pacifier straps and clips when putting your baby down for sleep and they should only be used under adult supervision. It’s also wise to choose a one-piece clip of fabric or silicone lanyard, as opposed to ones composed of beads, balls, gems, etc.

BC: How do you clean or sterilize your pacifier? 

Sarah: It’s important to know that washing or cleaning an item is not the same as sterilizing or sanitizing it. When we wash pacifiers, we use soap and warm water to scrub them clean. Washing is a great way to kill many bacteria and microorganisms and prevent the spread of germs. Meanwhile, sanitizing or sterilizing your pacifier is the step you take after you’ve washed it because it provides a more thorough germ removal. Some people believe sanitizing is unnecessary, but as much as I love simplifying things and keeping my day-to-day routine “minimalistic,” sanitizing isn’t something I’d recommend skipping. Pacifiers, bottles, pump parts, and other high-contact oral baby items can harbor stubborn microbes that cause oral yeast infections (thrush) or illnesses. Sanitizing reduces that risk of infection drastically.  

If your pacifier came with a sterilizer container like the 2-pack MAM pacifiersOpens a new window do, you can simply follow the simple instructions to sterilize using the case itself. Otherwise, you can place the binky in a pot of boiling water for five minutes or use a microsteam bag, which can be found in-store or online for just a few dollars. Finally, another common method is placing the pacifier in a plug-in sterilizing device.

Also, it’s recommended that pacifiers be sanitized daily and as-needed for young or immunocompromised babies.

Bottom line: Deciding whether your baby should use a binky or what kind to choose should be based on your baby’s needs and what you’re comfortable with. Pacifiers offer many benefits and can be a great way to comfort your baby. And anything that makes your parenting journey a little easier is a win in my book!