Can newborns choke on spit up with pacifier?

As a new parent, you have enough to worry about without adding another concern to the mix. But if your newborn uses a pacifier, you may wonder – could they choke on their own spit up while sucking away?

While rare, it is possible for infants to choke on regurgitation while sucking on pacifiers. Generally, things like lying flat, gastroesophageal reflux, and developmental factors make choking events more likely in newborns.

Frequent spit ups are common in infants with or without pacifiers. They are not always a sign of concern unless accompanied by choking, breathing issues or other symptoms warranting evaluation.

So you should watch for signs of gagging, coughing, breathing issues or sudden behavior changes after spitting up. Stop using the pacifier if choking occurs and seek medical advice.

With supervision and upright positioning after feeding, pacifiers can usually be used safely without increasing newborn choking risks significantly.

Can newborns choke on spit up with pacifier

Background on Newborn Reflux

Generally, frequent regurgitation, or spitting up, is completely normal in infants, even without using a pacifier, for several reasons:

  • The ring of muscles between the esophagus and stomach, called the lower esophageal sphincter (LES), is immature and weak in newborns. This allows stomach contents to flow back up easily.
  • Babies less than 6 months old lie predominantly in the supine (back) position. Gravity isn’t helping to keep food down.
  • Infant stomach anatomy is vertical versus horizontal in adults, making it easier for food to come back up.
  • The gastrointestinal system as a whole is still developing and maturing post-birth. Reflux is common until around 12 months old.

So due to these physical factors, regurgitation and spitting up on occasion is very normal and doesn’t necessarily indicate a medical issue in young babies. It’s simply a result of normal immature digestion. However, it can create choking hazards for your little one.

Can Pacifiers Increase Choking Risks?

Let’s get to the main question – do pacifiers cause babies to choke more frequently on their spit up?

The short answer is: it’s unlikely, but newborns are at higher risk of choking events overall compared to older babies.

Here are the main considerations:

  • Sucking on a pacifier does stimulate swallowing of extra saliva and air, which could theoretically make reflux and choking more likely. However, scientific evidence directly linking pacifier usage to increased choking is lacking.
  • Underlying physical factors like poor LES function, airway size, and neurological reflexes have a bigger impact on choking incidence than pacifiers themselves.

The American Academy of Pediatrics actually recommends pacifiers to reduce the risk of sudden infant death syndrome (SIDS) – though they advise selecting orthodontic pacifiers for babies over 1 month old. With safe guidelines followed, pacifiers themselves should not significantly increase reflux and spitting up alone.

So while more research is still needed, pacifiers themselves are not considered a significant culprit in newborn choking events related to spitting up according to current data. With some precautions taken, they can be used relatively safely even in babies with reflux.

Reducing Choking Risks

To minimize the chances of any choking episodes when using a pacifier:

  • Supervise your baby closely and be positioned where you can quickly intervene. Never prop bottles.
  • Pay attention to positioning – keep the baby upright for 30 minutes following feeding or pacifier use. Car seats or inclined sleepers can help.
  • Watch for signs of choking like unusual gagging, coughing, breathing difficulties, or sudden behavior changes.
  • Make sure the pacifier and guard are sized appropriately for the baby’s mouth anatomy.
  • Introduce orthodontic pacifiers around 1 month old to support proper dental development.
  • Avoid excessive pacifier use, and don’t force baby to take it if resisting or crying.
  • Ensure the nipple has ventilation holes but isn’t tearing or coming apart in baby’s mouth.
  • Stop using any pacifier your baby has choked on before – try a new style or brand.
  • Follow safe sleep guidelines and place babies on their back only, with no soft bedding that could obstruct airways.

Final Thoughts

By following pediatrician-recommended safety guidelines, using pacifiers does not have to significantly increase choking risks – even in babies prone to spitting up. That being said, all babies are vulnerable in the first year of life.

Take the necessary precautions, supervise closely, and respond promptly if any choking occurs. Your pediatrician can also check for signs of severe reflux and provide guidance if choking becomes problematic.

With some care taken, pacifiers can provide soothing and comfort to your little one without amplifying choking hazards.


  • Editorial team

    A team comprising oral health care professionals, researchers, and professional Writers, striving to impart you with the knowledge to improve your oral health, and that of your loved ones. 

  • Lilly

    Lilly, aka, Liza Lee, is a passionate community oral health officer and our lead writer. She's not only well-versed in performing a multitude of dental procedures, including preventive, restorative, and cosmetic, but also an avid writer. Driven by the significant oral health burden all around her, Lilly strives to build capacity and promote oral health. She envisions making a lasting impact by advancing research, prevention, and promotion efforts to alleviate oral health disparities. Please share your views and opinions on my posts.

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