So what are the downsides? The biggest is that pacifier use could potentially interfere with breastfeeding, says Dr. Maria Tupas, medical director of Children's Hospital of Orange County Primary Care Clinics in California. It isn't clear from studies on nursing and pacifier use whether pacifiers actually cause breastfeeding problems or are simply a marker that such problems may be occurring. However, the interval between the introduction of the pacifier and weaning may be several months, says Dr. Tupas, which suggests that pacifier use might reduce stimulation from suckling, resulting in a gradual reduction in breast milk production.
This doesn't always have to be the case, says Dr. Hauck. "There's no question that frequent sucking on the breast is going to help maintain a good milk supply. So it is important that breastfeeding moms wait until baby is nursing well—it usually takes three or four weeks—before introducing the pacifier, and also that the breast always be offered first when the baby appears hungry."
Pacifier use has also been associated with a higher risk of ear infections, yet it's a fairly small increased risk, says Dr. Hauck. Ear infections generally are more common in infants over six months of age, which is one of the reasons the AAP suggests stopping pacifier use by one year.
Other downsides may include a baby relying on a pacifier for comfort. Hildee Weiss' son Seth was attached to his pacifiers from the moment he got his lips on one. "The pacifier definitely helped keep him calm and happy," says Weiss, an Ohio mom of five. "Unfortunately, he got so hooked on it that ... we found ourselves constantly going back and forth to his crib in the middle of the night, plugging his pacifier in when it would fall out."
And unfortunately, pacifiers can affect a child's teeth when used improperly. Consequences seen may include cavities, malocclusion (crooked teeth), and gingival (gum) recession, says Dr. Adriana Modesto, DDS, assistant professor of pediatric dentistry at the University of Pittsburgh School of Dental Medicine. These problems are seen when a child has been using pacifiers for a long time during the day, over many months, and especially if the pacifier has been dipped in sugar or other sweeteners.
However, many of these issues can be avoided by using a pacifier the right way.