While pacifiers have taken on a standard appearance, with teat, mouth shield, and handle, there have always been things which a baby can suck on for comfort.

Pacifiers were settling into their modern form around 1900 when the first teat, shield and handle design was patented in the US as a "baby comforter". Rubber had been used in flexible teethers sold as "elastic gum rings" for British babies in the mid-1800s, and also used for feeding-bottle teats. In 1902 Sears Roebuck advertised a "new style rubber teething ring, with one hard and one soft nipple", and in 1909 someone calling herself "Auntie Pacifier" wrote to the New York Times to warn of the "menace to health" (she meant dental health) of "the persistent, and, among poorer classes, the universal sucking of a rubber nipple sold as a 'pacifier'." In England too, dummies were seen as something the "poorer classes" would use, and associated with poor hygiene. In 1914 a London doctor complained about "the dummy teat": "If it falls on the floor it is rubbed momentarily on the mother's blouse or apron, lipped by the mother and replaced in the baby's mouth."

Early pacifiers were manufactured with a choice of black, maroon or white rubber, though the white rubber of the day contained a certain amount of lead. One of the best-known brands was the Binki, which became a general name for pacifier in the US. Binky (with a y) was first used as a brand name for pacifiers and other baby products in about 1935.

Pacifiers were a development of hard teething rings, but they were also a substitute for the softer sugar-tits, sugar-teats or sugar-rags which had been in use in 19th century America. A writer in 1873 described a "sugar-teat" made from "a small piece of old linen" with a "spoonful of rather sandy sugar in the centre of it", "gathered ... up into a little ball" with a thread tied tightly around it. Rags with foodstuffs tied inside were also given to babies in many parts of Northern Europe and elsewhere. In some places a lump of meat or fat was tied in cloth, and sometimes the rag was moistened with brandy. German-speaking areas might use Lutschbeutel: cloth wrapped round sweetened bread, or maybe poppy-seeds. A Madonna and child painted by Dürer in 1506 shows one of these tied-cloth "pacifiers" in the baby's hand.

In the 1800s, the expression "born with a silver spoon in his mouth" could be taken almost literally – silver soothers/teethers were often given to babies born to wealth. Other expensive materials were also used, with mother-of-pearl or coral being thought to ward off sickness. Coral was believed to guard against all kinds of evil, and in England in the 17th-19th centuries, a coral meant a teething toy made of coral, ivory or bone. A museum curator has suggested that these substances were used as "sympathetic magic" and that the animal bone could symbolise animal strength to help the child cope with pain.