Abstract : Pacifier usage in paediatric age group, especially during the infancy stage, is common. The practice is widespread as it soothes the child and further supported by the fact that, it may relieve the pain and reduce the risk of sudden infant death syndrome (SIDS). Acute fatal complications are rare, but chronic complications are common. Fatal, life-threatening sequelae includes upper airway obstruction. We report a case of fatal upper airway obstruction due to pacifier in a 16-month-old baby boy. Early emergency airway management is crucial at the pre-hospital level as delays in securing a patent airway will end up with hypoxia and respiratory arrest. Failure to anticipate and initiate appropriate early interventions contribute to preventable death. Hence, it is recommended that appropriate acute airway management includes surgical airway at primary care should be taught regularly to ensure that all emergency health care providers are competent in managing airway obstruction. We want to suggest that pacifiers use in child nursery without closed supervision from baby sitter shall be prohibited