So your baby is fussy and yet he keeps spitting out the thing that used to soothe him, you know, the pacifier. Spoiler alert: If your baby won’t keep a pacifier in his or her mouth, it’s likely for reasons beyond the paci. As such, the best pacifiers for babies who spit them out might just surprise you.

We’ll be the first to admit that for something so small, it’s hard to decide ahead of time what kind of binky will best for your baby. First of all, there is no end to pacifier options (seriously, why are there so many?), and secondly, all your mom friends — and all of the internet — have varied, often strong, opinions. But we’re here to cut through the chaos to get you answers. Scary Mommy reached out to board-certified pediatrician and the Co-Founder & Chief Medical Officer of Modern Pediatrics, Dr. Tim Porter, MD, to find out why your baby is spitting out the paci, so you can get one that stays pleasantly in place.

The Expert

Dr. Tim Porter received his M.D. from the University of Rochester in New York, before completing residency training at Northwestern University in Chicago. He worked in private practice in Chicago for five years before pursuing his dream of co-founding his own practice, Modern Pediatrics, and moving to Austin in early 2020. In addition to providing primary medical care for infants and children, Dr. Porter is an expert in pediatric sleep, having conducted hundreds of individual sleep consultations in his career. Dr. Porter also teaches a free newborn prep curriculum to new parents to ease their minds and help them through their parenting journey.

Why does my baby spit out the pacifier?

If there’s one thing you learn as a new parent, it’s that your baby is a perplexing creature. One minute they like the binky, one minute they don’t. Or maybe they never did. But why? “There are not any medical reasons a baby would spit out a pacifier, except, perhaps, severe congestion,” Dr. Porter reveals. But what if they’re not congested? “The most common reason is actually that they’re still hungry. In the first four months of life, a crying/fussy baby is always hungry until proven otherwise, especially if they just finished feeding.”

Dr. Porter suggests offering babies 4 months and younger more to eat before pushing the paci. But if they’re older? “If a fussy/crying baby is older than 4 months and won’t take more food or the pacifier to soothe, my next assumption is that they’re overtired or sick (cough, runny nose, fever, etc.).”

Is there a pacifier that stays in the mouth?

If only there were a one-size-fits-all answer. Dr. Porter maintains that “if the baby is not hungry, overtired, or sick, any pacifier should stay in the mouth.” And when it comes down to it, you might just have to try a few options before you find the one your baby prefers. “Naturally, some families swear by one pacifier or another,” he says, “but there is no consensus, and these opinions are only anecdotal (though convincing!) evidence.”

So while it’s worth considering your mom’s best friend’s niece's advice, your baby might just disagree. In fact, your baby may never take to a pacifier. Perhaps they don’t like the shape or material. Maybe they’re mad it’s not a bottle or a boobie (back to the hunger point). Some babies never take to the paci and that’s okay, too — there’s more than one way to soothe a child.

Are there certain pacifiers to use for breastfed vs. bottle-fed babies?

“Many pacifier manufacturers claim to be better for breastfed babies, but this can generally be assumed to be a marketing ploy,” shares Dr. Porter. “There are no scientific studies verifying these claims.” What’s more, Dr. Porter reveals that barring a latex allergy, there is “no verified medical reason” to recommend any specific pacifier material (all pacifier nipples are free of BPA). There are, however, a few universal safety tips Dr. Porter points to, with reference to the American Academy of Pediatrics.

Pacifier Safety Tips

• Inspect pacifiers often. “Pacifiers fall apart over time. Some manu­facturers have expiration dates for pacifiers. Do not keep pacifiers past that time. Inspect them every once in a while to see whether the rubber has changed color or has torn. If so, replace them.”
• Make sure it can’t come apart. “Look for a 1-piece model that has a soft nipple (some models can break into 2 pieces).”
• Get the right size shield to avoid choking. “The shield should be at least 1½ inches across so a baby cannot put the entire paci­fier into her mouth. Also, the shield should be made of firm plastic with air holes.”
• Make sure the pacifier is dishwasher-safe. “Follow the instructions on the pacifier and boil it or run it through the dishwasher before your baby uses it. Be sure to squeeze the water out of the nipple with clean hands; otherwise, the hot water inside might burn your baby's mouth.”
• Clean it regularly. “Clean it this way frequently until your baby is six months old so that your infant is not exposed to germs. After that, you can just wash it with soap and rinse it in clear water.”
• Keep it free. “Never tie a pacifier to your child's crib or around your child's neck or hand. This is very dangerous and could cause serious ­injury or even death.”

Try These Pacifiers For Babies Who Spit Them Out

Now that you know the facts, you’re free to journey onward in search of your baby’s perfect pacifier. “Any pacifier which meets the above safety guidelines is safe and effective.” Dr. Porter adds, “I recommend a family try different kinds until they find the one their baby prefers.”

Not sure where to start? We found some favorite tried-and-trues to help you on your way. Behold, the binkies.