Are pacifiers and thumb sucking safe for babies?

Yes, a pacifier (dummy or soother) is safe for most babies when used sensibly. Used at sleep time, it is linked with a lower risk of sudden infant death.¹ For breastfed babies, wait until feeding is well set up, usually 3 to 4 weeks.² Thumb sucking is normal too. The main risks of both come from long use beyond the toddler years.

Is it okay to give my baby a pacifier?

Yes. Sucking calms babies, and a pacifier is a reasonable way to soothe a fussy baby, as long as it is not used to delay feeds.

Babies are born with a strong urge to suck, even when they are not hungry. The American Academy of Pediatrics (AAP) includes a pacifier at sleep time among its steps to lower the risk of sleep-related infant death.³ Many grandmothers in India dislike the "chusni", and some are right to worry about hygiene. But a clean pacifier, used well, does no harm to most babies.

Always check for hunger first. A pacifier should never replace a feed.

When can I start a pacifier for a breastfed baby?

Wait until breastfeeding is going well, which usually takes about 3 to 4 weeks.²

In the early weeks, your baby learns to latch, and your milk supply is being built by frequent feeds. Experts who reviewed the evidence on pacifiers and SIDS advised introducing them to breastfed babies only once breastfeeding is established.¹ Formula-fed babies can start sooner if needed.

Does a pacifier affect breastfeeding?

For healthy term babies, pacifier use did not reduce exclusive or partial breastfeeding up to 4 months in a Cochrane review.⁴

The review included two trials with over 1,300 breastfed babies. Pacifier use, started from birth or after breastfeeding was established, made no meaningful difference to breastfeeding rates at 3 and 4 months.⁴ There were no good data on other effects, such as cracked nipples or long-term health.⁴

Still, if your baby is not gaining weight, or you have concerns about supply, put her to the breast instead of offering a pacifier. Early on, frequent sucking at the breast is what makes milk.

Do pacifiers reduce the risk of SIDS?

Yes. Babies who use a pacifier when put down to sleep have a lower risk of sudden infant death syndrome (SIDS).¹

SIDS is the sudden, unexplained death of a baby during sleep. A meta-analysis (a study that pools several studies) found that pacifier use during the last sleep was linked with a risk roughly 60 percent lower.¹ By the authors' estimate, if 2,733 babies use a pacifier at sleep time, about one SIDS death would be avoided.¹

A pacifier is one part of safe sleep. The others matter more: always on the back, on a firm flat surface, in your room but not in your bed, with no pillows or soft bedding, and no smoke exposure.³

How do I use a pacifier safely?

Choose a one-piece pacifier, keep it clean, and never tie it to your baby's neck, hand or cot.²

• Pick a one-piece design with a soft teat; two-piece ones can come apart and cause choking.²
• Sterilise it often until about 6 months, then wash it well with hot soapy water.²
• Check it regularly. Throw it away if the rubber is torn, sticky or has changed colour.²
• Never use a string, ribbon or chain around the neck. It can strangle a baby.²
• Do not clean it in your own mouth. This passes on your mouth germs.
• Keep a few spares, as one always gets lost under the bed.

Is honey or sugar on a pacifier safe?

No. Never dip a pacifier in honey for a baby under 1 year, because honey can carry the germ that causes botulism.⁵

Infant botulism is a rare but serious illness that causes weakness and breathing trouble. Cooking, boiling or "pure" labels do not make honey safe for infants. Sugar, jaggery, glucose powder and sweet syrups on a pacifier also bathe the teeth in sugar, which causes early tooth decay. Some families give honey or ghuti at a birth ritual. Please speak to your paediatrician beforehand so the custom can be kept in a safe way.

Do pacifiers cause ear infections?

Pacifier use is linked with more ear infections, especially in babies and toddlers who use one all day.⁶

In a Finnish trial, parents were advised to limit pacifiers to the time when the child was falling asleep. Continuous pacifier use dropped, and middle ear infections fell by 29 percent in that group.⁶ Children who did not use a pacifier all the time had a third fewer ear infections than those who did.⁶

My advice: in the second half of the first year, keep the pacifier for sleep time rather than all day.

Do pacifiers or thumb sucking damage teeth?

Both can change how the teeth line up if the habit goes on for years. The longer the habit lasts, the higher the risk.⁷

A review of 15 studies confirmed a link between sucking habits and malocclusion (teeth that do not meet properly).⁷ Strong sucking beyond about 2 to 4 years of age can affect the shape of the mouth and how the teeth line up.² The good news: if the habit stops before the permanent front teeth come in, the bite often corrects itself.²

Is a pacifier better than thumb sucking?

Each has trade-offs. A pacifier can be taken away when it is time to stop; a thumb cannot.

The dental effects differ. In the review above, thumb or finger suckers were more likely to develop protruding upper front teeth. Pacifier users were more likely to develop a crossbite of the back teeth.⁷ A pacifier also gives the SIDS benefit in the first year.¹ My view: if your baby needs to suck to settle, a pacifier used at sleep times in the first year is a reasonable choice, with a plan to stop it later.

When should I take the pacifier away?

A good target is around the first birthday. The SIDS experts recommended pacifier use up to 1 year, which covers the peak ages for SIDS.¹

Before that, cut back gradually. In the Finnish trial, keeping the pacifier only for falling asleep in children aged 7 to 18 months lowered ear infections.⁶ Stopping well before 2 to 4 years protects the teeth.² If your toddler is very attached, aim to stop by age 2 at the latest.

How do I get my toddler to give up the pacifier?

Go gradually: first limit it to sleep time, then to bedtime only, then remove it, with lots of praise along the way.

• Keep the pacifier in the bedroom, not in the pocket or bag.
• Offer a soft toy or cloth as a new comfort object.
• Choose a calm week, not during illness, a new sibling or a house move.
• Some families let the child "give" the pacifier to a new baby or to a favourite character, with a small reward.
• Agree on the plan with all carers, including grandparents.

Expect a few tough nights. Throw away any pacifier that is torn or has changed colour.²

Why does my baby suck her thumb?

Thumb sucking is a normal way for babies to calm themselves. Many babies even suck their thumbs in the womb.

Most children stop on their own before they are well into school, often because of friends' comments.² Sucking for comfort at bedtime may continue quietly for a while and is generally harmless.² Interestingly, a long-term study that followed children into adulthood found that children who sucked their thumbs or bit their nails had fewer skin-test allergies in childhood and adulthood.⁸ That is not a reason to encourage the habit, but it is one less thing to worry about.

How do I stop my child sucking her thumb?

For a toddler or preschooler, ignoring the habit often works best. For an older child, praise, rewards and gentle reminders help, while scolding and punishment do not.²

• Do not tease, shout or slap the hand away. This makes the habit stronger.²
• Praise and reward the times she does not suck, for example with a star chart.²
• Keep hands busy if she sucks when bored, such as during screen time.²
• Notice triggers like tiredness or worry, and offer comfort in other ways.

A Cochrane review found low-quality evidence that reward-based approaches and, for older children, dental appliances fitted by an orthodontist can help children stop.⁹ Appliances are only for older children with a persistent habit.

When should I see a doctor or dentist about sucking habits?

See your paediatrician or a children's dentist in these situations:

• Thumb or pacifier sucking still strong after about 4 years of age.²
• Upper front teeth sticking out, or teeth that do not meet when she bites.²
• Changes in the roof of the mouth.²
• Sore, cracked or infected skin on the thumb.
• Frequent ear infections or ear pain.
• Your baby wants to suck constantly but is not gaining weight, which may mean hunger.
• Speech that seems unclear because the pacifier is always in.

Go to hospital straight away if your child chokes on a pacifier part, or has trouble breathing.