Does a pacifier or dummy help with baby sleep?

Pacifier use doesn't improve babies' sleep

Pacifier use doesn't improve babies' sleep. However, many parents have told me over the years that they find the pacifier is a useful tool for making their days and nights manageable.

I don’t usually recommend pacifiers, though I quite understand when parents tell me they are using one. As with most things when it comes to baby care, it seems to me that you just need evidence-based information, and then you’ll work out what’s right and safe for you, your baby, and your family.

Your baby has a powerful biological drive to suck

Babies love to suck. Actually, babies need to suck. Neuroscience tells us that multiple areas light up in brain imaging when babies suckle, with waves of motor and sensory stimulation rippling throughout the neuronal networks of the cerebral cortex.

From an evolutionary perspective, babies attach themselves to their mothers' breasts just as strongly as possible with sucking, in order to be as close to her as possible and to draw in milk. Suckling the breast is a powerfully hardwired reflex driven by millions of years of mammalian evolution. To suck is to draw in life. To suck is to live. This is why sucking is profoundly soothing for babies. Sucking dials down their sympathetic nervous system - which also helps the sleep regulators (the body clock and sleep pressure) do their job easily.

The newborn's earliest drive to suck is not because he needs a great deal of milk in his tummy, but because he has a powerful neurological need to suck. If all goes well, responding to the baby and allowing very frequent suckling at the breast in the first hours and days of a baby’s life secures the mother’s breast milk supply. The suckling of exclusive breastfeeding is also the biological norm which optimises a little one's facial bone development.

Why do some parents use a pacifier?

It’s as if babies are hardwired to expect a certain amount of sucking to remain dialled down. Sometimes

• There is a mismatch between the baby’s drive to suck, and the amount of time a woman is able to have the baby suckle at her breast

• There is a mismatch between the baby’s drive to suck and the amount of time a baby is able to suck from the bottle

• Baby needs more sensory motor nourishment than the primary carer is able to provide at a particular time of day (for instance, when managing older children late afternoon into the evening).

In these situations, dummies or pacifiers might help dial the baby down, and make life easier for everyone.

Things you need to know if you do use a pacifier

The pacifier and breastfeeding

If you decide to include pacifier use in your toolbox for getting through the days and nights, there are things to be aware of.

• If you're breastfeeding, your baby needs very frequent and flexible breastfeeds to stimulate your milk supply and to maintain adequate weight gain. When using a pacifier, especially in the first weeks of life, make sure your baby

  • Suckles at the breast frequently enough for you to maintain a good supply

  • Suckles enough milk from the breast to sustain her weight gain.

• When used in the night, pacifier use can result in decreased breast milk production, because women usually need at least one night feed, and often more, to maintain a supply that meets their baby's needs.

The research tells us that pacifier use doesn’t interfere with breastfeeding success. But this could be because breastfeeding women are educated about how to use pacifiers in a way that protects their milk production. Pacifiers don't teach babies the wrong sucking biomechanics. (There are lots of misunderstandings about how babies suck. You can find out about this here.)

• Babies who use pacifiers in the first year of life may be more likely to have buck teeth in adolescence.

The pacifier and infant development

Here are other useful things to know from the research about how pacifiers might affect babies and toddlers.

• Children under four years of age who use pacifiers are nearly twice as likely to develop recurrent middle ear infection.

• After six months of age, pacifier use for several hours or more during the day may interfere with opportunities to babble or make playful sounds, and to experiment with imitating sounds.

• The more the pacifier is used before one or two years of age, the greater the chance that the little one's vocabulary will be affected (with less vocabulary development than would otherwise be the case). Prolonged use of pacifiers throughout the first three years of life or longer results in speech development problems.

My suggestions on pacifier use

I recommend weaning from the pacifier or dummy after the first six months, if you've been using it, just as soon as you think you can get by without it.

Some parents I've worked with over the years who use the pacifier or dummy after six months keep it as a back-up for when baby is dialled up and they can't get outside, or for when they are particularly exhausted, or for when they are in the car and the baby cries. This occasional use still protects speech development. Living with a baby really is about workability, not perfection!

But many other families I've worked with over the years simply decide never to use pacifiers at all, and they get by just fine.

Selected references

Alm B, Wennergren G, Molborg P. Breastfeeding and dummy use have a protective effect on sudden infant death syndrome. Acta Paediatrica. 2016;105:31-38.

Balaban R, Camara AC, Filho ABRD. Infant sleep and the influence of a pacifier. International Journal of Paediatric Dentistry. 2018;28(5):481-489.

Feldens CA, Petracco LB, Nascimento GG. Breastfeeding protects from overjet in adolescence by reducing pacifier use: a birth cohort study. Nutrients. 2023;15:3403.

Jaafar SH, Ho JJ, Jahanfar S, Angolkar M. Effect of restricted pacifer use in breastfeeding term infants for increasing duration of breastfeeding. Cochrane Database of Systematic Reviews. 2016;8:CD007202.

Kanellopoulos A, Costello SE. The effects of prolonged pacifier use on language development in infants and toddlers. Frontiers in Psychology. 2024;15:1349323

Munoz LE, Kartushina N, Mayor J. Sustained pacifier use is associated with small vocabulary sizes at 1 and 2 years of age: a cross-sectional study. Developmental Science. 2024:https://doi.org/10.1111/desc.13477.

Rovers MM, Numans M, Langenbach E. Is pacifier use a risk factor for acute otitis media? A dynamic cohort study. Family Practice. 2008;25:233-236.

Shandley S, Capilouto G, Eleanora T. Abnormal nutritive sucking as an indicator of neonatal brain injury. Frontiers in Pediatrics. 2021;8:599633.

Strutt C, Khattab G, Willoughby J. Does the duration and frequency of dummy (pacifier) use affect the development of speech? Inernational Journal of Language & Communication Disorders. 2021;56(3):512-527.