Should I remove pacifier when my baby is sleeping?

It’s the moment you have been waiting for you — your baby is finally down for the count and sleeping peacefully. But there’s just one problem: they still have their pacifier in their mouth. 

As a parent, you might start wondering if you should remove the pacifier when your baby is sleeping. Is having a pacifier in their mouth safe while they are sleeping? What if they spit it out? Will it wake them up? 

Sleeping babies are precious—especially if they sleep at the same time you’d like to catch some shut-eye—and you both need all of the restful sleep you can get. So before you reach for that paci and risk a restless night, here’s what you need to know about pacifier use when your baby is sleeping. 

Can a newborn sleep with a pacifier?  

Not only does the American Academy of Pediatrics (AAP) say that babies can sleep with a pacifier, they actually recommend it for babies up to 6 months, starting around 1 month of age.

Giving a pacifier to your baby at the onset of sleep can help to reduce the risk of SIDS, according to the AAP’s 2022 safe sleeping guidelines. Therefore, there is no need to remove it and potentially wake them up—yay! 

When to introduce a pacifier  

While the AAP says pacifier use is okay and can even help reduce SIDS risk, there is one important thing to know before you introduce a pacifier to your baby: the AAP recommends that you wait to introduce one until your baby has firmly established a feeding routine, usually after one month of age. 

Using a pacifier for breastfed babies

One of the reasons the AAP recommends waiting until your baby is at least a month old is to ensure anyone who is breastfeeding is able to establish an adequate supply first. 

Breastfeeding works on a supply-and-demand system, so again, if your baby isn’t getting enough sessions in at the breast, that may risk decreasing your milk supply. 

Using a pacifier for bottle-fed babies

Bottle-fed babies drinking formula may not need to worry about supply issues, but the AAP still recommends waiting to give a pacifier until your newborn is around one month old to make sure young newborns are getting all the nutrition they need and are not replacing feedings by being soothed with a pacifier. 

Waiting around one month to introduce a pacifier to a bottle-fed baby can also help reduce the risk of nipple confusion, when your baby gets accustomed to one type of “suck” from a bottle nipple vs. a pacifier. 

Using a pacifier for premature babies

So far, studies have not shown any reason to avoid using a pacifier in premature babies. In fact, a 2022 analysis in the European Journal of Pediatrics found that premature babies who had to be admitted to the NICU and used pacifiers were discharged faster and transitioned to breast and bottle feeding faster. 

The one caveat with premature babies and pacifiers is that they may need a little more time before they get the hang of using it, so you might have to introduce the pacifier a few times before they accept it. 

What are the benefits of a pacifier?

While the studies are mixed, there is some evidence that using a pacifier may help reduce the rate of SIDS. For instance, a 2014 position paper in the Journal of Pediatrics and Child Health explained that it appears that the brains of babies who use pacifiers while sleeping stay more alert than the brains of babies who do not. 

This may explain why those babies are less likely to experience SIDS, which some theorize is a malfunction of the brain-to-breathing connection. Other potential benefits of using a pacifier include babies learning to self-soothe and reduced crying rates. 

What are the risks of a pacifier?  

For parents wondering if pacifiers are bad, the answer is no! Pacifiers are not bad and can be used safely and appropriately. 

The main things to keep in mind when using a pacifier with your baby are:

• Only introduce it once your baby has a firm grasp on bottle or breastfeeding 
• Make sure your breast milk supply is fully established before introducing the pacifier 
• Never attach the pacifier to your baby while they are sleeping  
• Regularly inspect pacifiers for breakage and replace them every 1-2 months or as needed 

The American Academy of Pediatric Dentistry (AAPD) also says that babies and toddlers who use pacifiers for long extended periods of time have a higher risk of ear infections, and any child who uses a pacifier constantly may also have a risk of some speech abnormalities or even changes to their mouth development. 

It’s also important to know that as helpful as pacifiers can be, some babies just won’t like them. So don’t force your baby to take a pacifier if they have repeatedly rejected it. Some babies will love them, others won’t, and it’s okay to learn what your own baby prefers. 

Tips for using a pacifier safely

To use a pacifier with your baby safely, the AAP says you should never hang a pacifier around your baby’s neck or attach it to their clothing or crib in any way while they are sleeping, because that could pose a suffocation risk. 

You’ll also want to inspect your baby’s pacifier regularly to check for broken or cracked areas—if any are found, replace it immediately. Also clean and sanitize pacifiers regularly and replace them about every month or more often, if needed. 

When to stop using a pacifier  

Ideally, the AAPD recommends children stop using a pacifier after 12 months of age and definitely by 18 months old to avoid the risk of any developmental problems. 

When to consult your pediatrician

You should talk to your pediatrician about using a pacifier with your baby, especially if you plan to use the pacifier with sleep or have any concerns about your breast milk supply or feeding. It’s important to make sure your baby is growing appropriately and not missing any vital nutrition because of a pacifier.

You should also talk with a pediatrician if your child is not able to stop using a pacifier after 12 months of age, or if you have any concerns about their speech or development as a result of prolonged pacifier use.