How Safe Is Your Baby's Pacifier?

The good news is that strict and comprehensive pacifier standards exist in the U.S. and are enforced by the Consumer Product Safety Commission. Under federal safety rules, pacifiers sold in the U.S. must meet specific requirements regarding their guard and shield, ventilation holes, nipple strength, and more. They also aren’t allowed to have detachable small parts that can pose choking hazards. 

Additionally, in 2008, the Consumer Product Safety Improvement Act was passed, and this added additional surface coating requirements, lead and phthalate content limits, requirements under the mandatory toy standard, testing and certification, and tracking label requirements. The CPSIA also requires that children’s products meeting a mandatory standard be tested by an accredited third-party laboratory approved by the CPSC.

On eBay, you can purchase used pacifiers ranging from vintage designs to nearly 20-year-old ones. (The AAP warns that pacifiers fall apart over time and that some manufacturers have expiration dates that should be adhered to, so buying an old design to save money or appeal to your love for vintage isn’t a safe choice.) On Amazon, glitzy rhinestone-encrusted pacifiers are sold by unknown manufacturers like Luqeeg and Bnineteenteam Store. In the past, the CPSC has recalled pacifiers that contain Swarovski crystals because the crystals can separate easily and pose aspiration and ingestion hazards. CR’s experts caution against using pacifiers with rhinestones or crystals because they pose a choking hazard.

The CPSC’s rule says that a pacifier should not be sold or distributed with any ribbon, string, cord, chain, twine, leather, yarn, or similar attachments due to strangulation hazards, and that the length of clips should not exceed 7 to 8 inches. Yet we found several pacifiers on Amazon and other online shopping sites sold with stuffed animals or chains (some of which exceeded the suggested length), as well as pacifier clips that are sold alone but are made from materials like ribbon and beads. 

Parent communities are popular on social media apps like Facebook and WhatsApp, and some of them also allow parents to make and save money by selling, buying, and donating secondhand baby products. It’s one thing to be the lucky recipient of an unopened pack of pacifiers that your neighbor’s toddler didn’t use after weaning, and another to take chances with pacis in suspicious packaging. It’s never a good idea to purchase used or secondhand pacifiers that are not in their original packaging and cannot be verified as following pacifier standards. “I often see unsafe baby products in my parents’ WhatsApp buy-sell-give group,” says CR’s Angela Lashbrook. “People sell pacifiers all the time. Sometimes they list the brand. Sometimes they don’t.”

In September 2020, U.S. Customs and Border Protection (CBP) officers in Pittsburgh seized a shipment of 25 counterfeit pacifiers from Hong Kong. The pacifiers featured bejeweled Chanel and Mercedes-Benz logos, metallic link chains, and clips. CR contacted the CBP to find out how many counterfeit pacifiers or pacifiers that violated consumer protection safety laws had been seized at U.S. borders since 2020, and the results are surprising. 

Between 2020 and March 2025, there were seven pacifier seizures. The first, in 2020, involved counterfeit products. The remaining six seizures were due to violations of consumer safety laws enforced by the Consumer Product Safety Commission. In total, 2,031 pacifiers were confiscated. The two largest seizures occurred in New Orleans—625 pacifiers from China were seized in 2022, and 974 more Chinese pacifiers were seized in 2023.

Gabe Knight, a CR senior policy analyst, stresses the vital role that the CPSC plays in protecting the public from unreasonable risks of injury or death associated with over 15,000 different types of products, including baby products like pacifiers. 

“The CPSC creates and enforces safety standards to keep babies safe and prevent unsafe baby products from making their way into families’ homes,” Knight says. “In a market increasingly dominated by online shopping, this work is more important than ever. The CPSC also needs retailers and online marketplaces to be cooperative partners in safety, especially by clamping down on the presence of misleading or dangerous products on their platforms.”

Knight adds that the CPSC also works to stop dangerous or illegal products at U.S. ports of entry before they can enter consumers’ homes. “This work is especially important for products that enter the U.S. in large quantities at a time, and pacifiers certainly qualify,” Knight says.

From 2014 to 2024, the CPSC received reports of 178 pacifier incidents—to put this into context, that’s fewer than 18 reported incidents each year. (By contrast, in 2023, the CPSC reported an estimated 60,400 nursery-product-related injuries among children younger than 5 treated in emergency departments, and 64 percent of them were associated with high chairs, cribs/mattresses, infant carriers, and strollers/carriages). Of the 178 pacifier reports, one child died, 62 involved injuries, and 115 did not. “Non-injuries” can include reported problems with the pacifier’s design or incidents in which the pacifier was broken or faulty but did not injure the child. 

Trends in pacifier safety reports over time indicate a rise in recent years, however. Pacifier-related safety incidents reported to the CPSC peaked in 2015 and then steadily declined over the following years, reaching a low of nine in 2020. However, the trend reversed, with reports rising from 10 in 2021 to 22 in 2022. It then decreased again to 16 in 2024—which is still nearly as high as the average number of incidents per year.

There are several good reasons to give your baby a pacifier—for example, offering your baby a pacifier at naptime and bedtime can help reduce the risk of sudden infant death syndrome, according to the American Academy of Pediatrics. Here are some helpful tips from the AAP and experts we consulted on using a pacifier safely.

• The AAP recommends looking for a one-piece pacifier with a soft nipple that is dishwasher-safe.
• Adhere to a manufacturer’s recommended ages for use. (A too-small pacifier is a choking hazard for a toddler, and a too-large one can overwhelm a newborn.)
• Boil the pacifier or run it through the dishwasher before your baby uses it. Make sure you squeeze the nipple with clean hands to release any trapped water.
• Follow the manufacturer’s instructions for cleaning your pacifier. If instructions aren’t given, the AAP recommends boiling/putting it in the dishwasher frequently until your baby is 6 months old; after that, you can regularly wash it with soap and rinse it in clear water.
• Do not use the nipple from a baby bottle as a pacifier (this can be a choking hazard).
• Do not use a pacifier to replace or delay meals. 
• Never tie a pacifier to a child’s crib or around their neck or hand. 
• Follow the manufacturer’s expiration date.
• Inspect pacifiers often and toss your baby’s paci if it shows signs of damage, cracking, or discoloration.

Many parents have two pressing concerns about pacifier use: Will pacifiers interfere with breastfeeding, and can they damage a baby’s teeth? Let’s clear up any misconceptions. 

CR contacted Maya Bunik, MD, MPH, professor of pediatrics and chair of the section on breastfeeding at AAP, who directed us to the Tech Report AAP 2022. According to the report, giving healthy, full-term babies pacifiers (either before or after breastfeeding is well established), doesn’t shorten how long they breastfeed during the first four months of life. However, there isn’t enough information yet to determine for certain any potential downsides for babies or mothers. 

Although there is no evidence that offering a pacifier to your baby at a very young age can impede nursing, the AAP still recommends waiting until breastfeeding is going well (which can take up to three to four weeks) before offering a pacifier. 

“Generally, we want to make sure that we are not masking hunger cues when using a pacifier,” Mona Gabbay, a physician and breastfeeding expert at thebreastfeedingdoctor.com, tells CR. “In babies who are not gaining weight properly, parents should speak with the pediatrician before introducing a pacifier. If using one, we usually recommend a fully round one, not one that is flattened or slanted.”

In some cases, Gabbay says pacifiers can be very helpful in soothing babies, especially babies who are very fussy and suffer from increased gas. “Excessive crying increases air intake and gas,” Gabbay says. “Minimizing crying will help decrease gas, and in some cases, pacifiers are very helpful for these babies.”

CR spoke with Scott Smith, DDS, president of the American Academy of Pediatric Dentistry, about the potential link between pacifier use and pediatric dental issues, and why it’s important to wean babies off their pacifiers sooner rather than later. Aggressive pacifier suckers can pull the front teeth forward, which causes an overbite, Smith says. Sucking on pacifiers pulls the cheek muscles down, he says, and that can sometimes cause the upper jaw not to widen and grow outward. When the upper jaw is narrower than the lower jaw, it can cause a “crossbite,” which may require a corrective expansion appliance when the child is older.

The American Academy of Pediatric Dentistry says pacifier use is a risk factor for otitis media (ear infection), and this may be reduced by decreasing or eliminating pacifier use in the second six months of life. The AAPD also says that using a pacifier at 36 months of age or after had a significantly higher risk of anterior open bite (when your upper teeth overlap your bottom teeth and leave an opening in between) compared with those not using a pacifier. 

Even though all signs point to stopping pacifier use early, Smith doesn’t provide a specific age for weaning babies off pacifiers and says that it depends on the child; taking it away too soon and having them compensate with thumb-sucking is worse because it “orthopedically pulls the jaw or upper jaw forward more aggressively.” 

The AAP recommends limiting or discontinuing pacifier use around 6 to 12 months, while the AAPD advises that pacifier use beyond 18 months may affect orofacial development, and recommends stopping pacifier use by 3 years of age to prevent dental issues. 

Pacifier use is a perfectly safe, normal, and even recommended practice. When you feel your little one is ready to wean from the paci, talk to your pediatrician for tips.