Age	Potential benefits	Potential complications	Recommendations
Preterm infants	Analgesia Decreased hospital stay, earlier transition to bottle feeding from enteral feeding, improved bottle feeding performance	—	AAP recommends pacifier use in infants up to six months of age to help prevent pain from minor procedures in the emergency department.4 AAP guideline on breastfeeding does not contradict pacifier use for oral training in preterm infants.5
Up to six months	Analgesia Reduced SIDS risk	Early breast weaning	AAP recommends pacifier use in infants up to six months of age for pain relief from minor procedures in the emergency department.4 AAP suggests offering pacifiers to infants at the onset of sleep to reduce the risk of SIDS.6 AAP recommends avoiding pacifier use until breastfeeding is well established (usually by one month of age).5 AAFP recommends educating mothers about the effect of pacifier use on breastfeeding in the immediate postpartum period.7
Six months to two years	—	Otitis media	AAFP/AAP joint guidelines recommend reducing or stopping pacifier use in the second six months of life to reduce the risk of otitis media.8 ICSI recommends avoiding pacifier use after 10 months of age.9
Two years and older	—	Dental malocclusion (misalignment of the teeth, such as open bite, crossbite, or overjet)	ADA and AAPD recommend actively discouraging pacifier use after four years of age.10,11