Most likely, your baby is gagging on a pacifier because the nipple is too long and it is triggering the gag reflex. Other common reasons include:
- The baby doesn’t want a pacifier.
- Tongue-tie, teething, or other physical issue.
- The baby doesn’t like the pacifier’s taste, smell, shape, or texture.
- The pacifier was inserted too abruptly.
According to Anna Houseman, a speech pathologist and orofacial myologist:
“Think about the gag reflex as a protective instinct. It is something that your body does naturally to help keep you from swallowing something that is too large or shouldn’t be there.
As a newborn, the gag reflex is really far forward on the tongue. It is going to be activated if you touch anywhere on the back 3/4 of the tongue.”
With my first baby, I was not as educated about different pacifier sizes and shapes.
Gagging on the pacifier was a struggle we had in the beginning until we found the right one for him.
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When To Be Concerned
If your child is making any sort of gagging or choking sounds, remove the object from their mouth immediately.
If you observe persistent and severe gagging, difficulty coordinating sucking and swallowing, or any signs of distress in your baby, have your baby evaluated by a professional right away.
While gagging is not something to be concerned about, choking is.
Remember that choking is a silent killer—it is not at all like what is seen in the movies, and the same is certainly true for babies.
Signs of choking that you should look for include:
- Difficulty breathing
- Change of skin and/or lip color
- High-pitched sounds or signs of needing air
- Inability to cry
Depending on the kind of pacifier that’s being used, the nipple may have dislodged from the base, or your child may be having an allergic reaction.
Why Baby Gags on Pacifier
Rest assured that babies gagging on pacifiers is common, and you’re not a bad parent for offering a pacifier.
There are many possible reasons that your baby is gagging on their pacifier, but you’ll find the most likely culprits below.
1. Naturally Strong Gag Reflex
The first year or two of life is about experiencing the world through touch and taste, so babies have a naturally strong gag reflex that is triggered when something touches the middle of their tongue.
This is a natural reflex meant to protect them from choking.
When a baby is first introduced to the pacifier, she may gag simply because it is something new and her brain is trying to get used to the new object in her mouth.
This is normal as the gagging reflex is a natural design to block anything that enters the mouth and is not meant to be eaten.
Because a baby’s gag reflex is so sensitive, it’s easy to trigger. As the baby grows, the reflex will become less sensitive.
Around 7-12 months of age, the trigger point for the gag reflex moves further back on the tongue toward the throat and becomes less sensitive.
2. Pacifier Put in Mouth Too Abruptly
Your baby’s gag reflex will react to foreign objects, like a pacifier or food, being put into the mouth too abruptly.
Sometimes, babies even gag themselves by doing this with their fingers.
It can be quite jarring to have an object suddenly jammed in your mouth, especially when you are new to the world and fairly helpless.
Be sure to introduce a pacifier slowly and with care each time.
3. Nipple Too Long
Pacifiers come with different nipple sizes that are conducive to the depth of the baby’s mouth at different ages.
There are four main nipple sizes:
- Size 1 is meant for 0+ months
- Size 2 is meant for 6+ months
- Size 3 is meant for 18+ months
- Size 4 is meant for 18-36 months
If the nipple is too long for the depth of your baby’s mouth, it will end up triggering their gag reflex.
This typically occurs with newborns and infants. If you notice this happening often, try a smaller-size pacifier.
Keep in mind that the way nipple length is measured and labeled varies between brands.
4. Doesn’t Like Pacifier Shape or Texture
Not all pacifiers are made equally.
Pacifiers come in many shapes to fit different mouth anatomies and sucking styles. The main nipple shapes are:
- Bulb: The tip is bulbous while the base is cylindrical.
- Round: The whole thing is cylindrical from the base to the tip.
- Flat/Orthodontic: The nipple is flat and sits between the roof of the mouth and the tongue. It’s designed to mimic the natural shape of a mother’s nipple.
- Slanted: The tip of the nipple is bulbous with a slanted tongue side.
If the shape of your baby’s pacifier is bothering them, they may try to push the pacifier out of their mouth, which might trigger their gag reflex.
Pacifiers also come in different textures. Some have softer nipples while others are more firm.
Babies can be particular about texture just as they are about form.
If you have given your baby a smaller pacifier and they are still gagging, you may need to experiment with different shapes and textures.
There is a lot of variety in the different brands of pacifiers as well.
Sometimes it is a game of trial and error to find the best pacifier shape, texture, and brand for your baby.
5. Doesn’t Care for Pacifier Taste or Smell
Make sure the pacifier is clean and odorless when you give it to your baby.
Keep in mind that pacifiers should be replaced every 4-6 weeks for hygienic purposes.
6. Doesn’t Want Pacifier
It doesn’t always have to be complicated! Perhaps gagging is your baby’s way of communicating that they simply do not want the pacifier.
7. Tongue-Tie or Other Oral Issue
Tongue-ties or other oral issues such as a high palate, can make it difficult for a baby to suckle correctly or push the pacifier out of their mouth.
This can lead to the pacifier dipping too far back into the throat, thereby triggering the gag reflex.
If you believe your child may have a tongue-tie or other oral health issue, it’s best to contact their pediatrician for an evaluation.
Most tongue-ties can be resolved via minor surgery or snipping.
8. Teething or Sore Throat
Teething or a sore throat can make a baby more sensitive or irritable, potentially affecting their willingness to suck on a pacifier.
Gagging might occur if their mouth is sore or they have increased saliva due to teething, making them more prone to a gag reflex.
How To Prevent Gagging on a Pacifier
While at times it may be inevitable, there are a few steps you can take to try and prevent your baby from gagging on their pacifier.
- Proper introduction: “Play” with the pacifier on your baby’s tongue and around her mouth for a few minutes to introduce it for the first time. Try to ease the pacifier into your baby’s mouth rather than forcing it in abruptly.
- Proper positioning: Try to position the pacifier toward the front of her tongue, just inside of her mouth rather than toward the back.
- Use the right shape and size: While the shape might be something you determine from trial and error, definitely make sure you are using the correct size pacifier and not one with a nipple that is too long.
- Consider texture and material: Think about what textures or materials you would and would not want in your mouth when trying to pick out a pacifier for your little one.
- Assess for wear and tear: Check your child’s pacifiers frequently for tears or stretchiness.
- Thoroughly clean and sanitize pacifiers: Wash pacifiers daily with gentle soap, and rinse well. Sterilize once per week in boiling water for 5 minutes.
When To Introduce a Pacifier
The American Academy of Pediatrics recommends waiting until breastfeeding is well established before introducing the pacifier.
“Well established” typically means that the mother has a sufficient milk supply, the baby is able to consistently and comfortably latch on the breast, and the baby is gaining weight appropriately.
Are Pacifiers Good for Newborns?
Pacifiers pose positive health benefits specifically for newborns.
Not only do pacifiers help babies learn to self-soothe when upset, but they can also aid in pain relief when teething.
In infants under one year of age, pacifiers reduce the risk of SIDS when used during sleep periods.
However, the American Academy of Pediatrics (AAP) recommends only introducing a pacifier after breastfeeding is well established.
Pros and Cons of Pacifiers for Newborns
Although pacifiers are widely used, they are not a requirement for your baby.
Some babies will shy away from pacifiers altogether. Some parents prefer that their child not have them in the first place.
Pacifiers do pose positive health benefits specifically for newborns, such as reducing the risk of SIDS.
However, there are some understandable drawbacks to them as well.
Deciding what’s best for your family and your little one is no easy task. Here are some pros and cons of using a pacifier:
- Pacifiers reduce the risk of SIDS.
- Pacifiers help babies learn to self-soothe.
- Pacifiers can provide pain relief.
- Pacifiers can cause nipple confusion in breastfed babies.
- Pacifiers used for too long can cause dental issues between the ages of 2-3.
- Pacifiers are linked to more frequent ear infections.
- Children may form an attachment to or reliance on the pacifier.
When To Stop Pacifier Use
The American Dental Association recommends that children stop using pacifiers prior to the age of 2, and the American Academy of Family Physicians recommends discontinuing pacifier use before the age of 6 months.
However, most parents wean their children from the pacifier between the ages of 2 and 4.
Charley is a mother of three with a passion for raising good humans. With her children in tow, she studies English and has made a career creating content about motherhood. In her free time, she enjoys traveling within the states to kayak, camp, and hike.