At what age is it recommended to introduce a pacifier to an infant?

From the Guidelines

It is recommended to introduce a pacifier to an infant after breastfeeding is well established, typically around 3-4 weeks of age, as stated in the most recent and highest quality study 1. For breastfed infants, delaying pacifier introduction until breastfeeding has been firmly established is crucial to prevent interference with proper latch and feeding techniques. In contrast, for bottle-fed babies, pacifiers can be introduced right from birth. When introducing a pacifier, ensure it is clean, structurally intact, and an appropriate size for your baby's age. Pacifiers can help soothe fussy babies, potentially reduce the risk of Sudden Infant Death Syndrome (SIDS) during sleep, and satisfy non-nutritive sucking needs. Some key points to consider when using a pacifier include:

• Never force a pacifier if your baby refuses it
• Avoid coating it with sweet substances
• Replace it when it shows signs of wear
• Begin weaning from the pacifier around 6 months to 1 year to prevent potential dental issues and ear infections associated with prolonged use, as suggested by 1. The protective effect of pacifiers on SIDS is still unclear but has been reported in multiple case-control studies and meta-analyses, with decreased risk of SIDS ranging from 50% to 90% 1. Overall, introducing a pacifier at the right time and using it correctly can have benefits for the infant's health and well-being.

From the Research

Pacifier Introduction Age

• The American Academy of Pediatrics recommends delaying pacifier use until breastfeeding is well established 2.
• There is no specific age recommended for introducing a pacifier, but it is suggested to wait until breastfeeding is established, which is usually around 3-4 weeks of age.
• A study found that pacifier use at 1 month of age was associated with a higher risk of early weaning 3, 4.
• However, another study found that recommending pacifier use at 15 days did not modify the prevalence and duration of breastfeeding 5.
• A systematic review found that pacifier use in healthy breastfeeding infants had no significant effect on the proportion of infants exclusively breastfed at three and four months of age 6.

Guidelines and Recommendations

• The American Academy of Family Physicians discourages pacifier use by 6 months to 1 year of age 2.
• The World Health Organization recommends total avoidance of artificial teats or pacifiers for breastfeeding infants to successfully initiate and maintain breastfeeding 6.
• However, the evidence suggests that pacifier use may not have a significant effect on the duration of breastfeeding, and the decision to introduce a pacifier should be based on individual circumstances and medical advice.

Key Findings

• Pacifier use is associated with reduced incidence of sudden infant death syndrome, making it a potentially beneficial practice 2, 5.
• The relationship between pacifier use and breastfeeding duration is complex, and more research is needed to fully understand the effects of pacifier use on breastfeeding outcomes 3, 4, 6.