Pacifiers - pros & cons


What is a pacifier?

Pacifiers are "peacemaker" devices used to satisfy a baby's need for sucking. Other names for pacifiers include soothers, dummies or "Binkies".

Pacifiers in one form or another have been used for centuries. Today's pacifiers come in different shapes and sizes. Some are almost a square orthodontic-shaped, and some are shaped like the nipple on a baby bottle.  Consumer standards in most countries legislate that infant pacifiers are made from non-toxic materials.


Benefits of using a pacifier

1. Pacifiers can satisfy your baby's need for non-nutritive sucking

Sucking is a normal infant reflex. All babies have a need to suck, but the amount of sucking varies from baby to baby. For many babies the urge to suck seems to be more than what's needed for nourishment. Many babies want to suck when they are tired, bored or in need of comfort. If your baby wants to suck beyond what nursing or bottle feeding provides, a pacifier may satisfy that need.

2. Pacifiers may help your baby go to sleep

Many babies enjoy sucking as they drift off to sleep. Sucking is a self comforting behavior. The pleasurable stimulation of sucking on a pacifier, fingers, hand or breast helps babies to cope better with the many distractions of a big and confusing world.

3. A pacifier may reduce the risk of overfeeding for bottle fed babies

The urge to suck for comfort is often mistaken as a sign of hunger for both bottle fed and breastfed babies. This misunderstanding is not of concern for a breastfed babies as they can control the flow of milk while breastfeeding. However, young babies cannot control the flow of milk from a bottle in the same way, so the risk of overfeeding is greater when a baby is fed from a bottle.

Bottle fed babies with an already full tummy may end up overfed, with gas bubbles and spitting up soon to follow if they are offered further feeding too soon. Reducing the risk of overfeeding in a bottle fed baby is where a pacifier can fill an important need.

4. Its easier to stop using a pacifier than it is to stop thumb sucking

Many parents worry about thumb sucking becoming a habit that may be difficult to break in the future, and may opt for a pacifier in preference. One advantage a pacifier has over thumb sucking is a parent can control the use of a pacifier. When it's time to stop using a pacifier, you can throw it away. You can't throw away a thumb!

5. Pacifiers may reduce the risk of Sudden Infant Death Syndrome (SIDS)

There are a number of studies which have identified a substantially lower incidence of SIDS in babies who use pacifiers compared to those who do not. Just as the cause of SIDS is not clearly understood, the positive effects provided by the use of pacifiers remains unclear. Further research is needed before pacifier use would be recommended to reduce the risk of SIDS.

6. Pacifiers can provide comfort during medical procedures

The comfort from sucking on a pacifier provide security and comfort can reduce the amount of stress a baby experiences. Studies have shown clear benefits are seen with pacifier use during painful medical procedures. The use of a pacifier is a simple, noninvasive and effective addition in pain management.


Problems associated with pacifier use

1. For some infants pacifiers may interfere with growth

Sucking requires energy. Small, ill or jaundiced infants can tire easily. Overuse of a pacifier may result in poor feeding and poor weight gains in frail babies. Babies of easy going temperaments may also not gain as effectively if feeding is frequently delayed by the use of a pacifier.

2. Pacifiers increase the risk of ear infections

Pacifier use appears to be a risk factor in the development of middle ear infection (otitis media). A Finnish study published in the journal of Pediatrics found that children who sucked continuously on a pacifier had more ear infections, compared to children who did not. Authors speculate that the continuous sucking on a pacifier might alter the pressure within the middle ear chamber where ear infections can form. (However, this study does not suggest the use of pacifiers is the only factor involved when it comes to ear infections.)

It was also identified in this study that prolonged or more frequent use of pacifiers was related to a higher incidence of middle ear infections than restricted use. The results suggest that between the ages of 6 and 10 months, restricting pacifier use to the moments of falling asleep would reduce the risk of middle ear infections.

3. Overuse of pacifiers may lead to delayed speech

Frequent use of pacifiers can create little "addicts" who are rarely seen without a pacifier in their mouth. The use of pacifiers after 12 months of has been show to interfere with normal babbling and speech development because it's hard to talk with a pacifier in your mouth!

4. A pacifier can become a sleep association

Some babies regularly use a pacifier to fall asleep. This can then become a sleep association, meaning it is what a baby associates with falling asleep. In the deep part of sleep the pacifier will fall out of her mouth. As waking between sleep cycles a natural occurrence, your child will want the pacifier returned so that she can go back to sleep. She will either find it for herself if she's old enough (somewhere around the age of 12 to 18 months) or she will cry out for you to come and find it for her; which may mean you are woken multiple times through the night. This is one area where thumb sucking has an advantage over pacifiers. Thumbs are easy for babies to find!

NOTE: Removing your child's pacifier one she has fallen asleep does not help.

5. Prolonged or inappropriate use of a pacifier may lead to dental problems

Use of pacifiers (or thumb sucking) beyond the age of 5 years can affect the shape of your child's mouth or teeth, leading to protruding or crooked teeth. Pacifiers which are frequently dipped in sweet substances such as sugar, corn syrup, glucose or honey can lead to an increase in tooth decay. 


Frequently asked questions about pacifiers

1. Will using a pacifier cause 'nipple confusion' for my breastfed baby?

Although many babies switch effortlessly between breast and bottle from day one, some may experience 'nipple confusion' if artificial nipples are introduced during the early days of nursing. Many breastfeeding experts tend to warn against the use of both bottles and pacifiers for all breastfeeding babies before breastfeeding has been fully established.

A report form Swedish pediatrician Dr. Lennart Righard concluded that pacifiers would contribute to incorrect breastfeeding technique. "If a baby sucks incorrectly from the start and also uses a pacifier, it's a catastrophe. They will never learn how to open their mouth and take the breast fully."

Another study on the effects of using pacifiers with preterm infants showed that pacifiers have no affect on the likelihood that preterm infants will be successfully breastfeeding by the time they left the hospital, or for several months later. However Carmel T. Collins and colleagues from the Women's and Children's Hospital in North Adelaide, South Australia, reported that these results were not the same for preterm babies who were bottle fed prior to or while attempting to establish breastfeeding.

Not all babies are troubled by nipple confusion but it's impossible to tell beforehand. The use of bottle feeding is more likely to cause nipple confusion than the use of pacifiers. It is recommended to not offer a pacifier before breastfeeding is fully established (3 to 4 weeks). It would be advisable to avoid the use of pacifiers completely if your baby is experiencing trouble learning to latch on or to suck correctly.

2. Do pacifiers lead to early weaning?

There are conflicting views from a number of different studies. A criticism of many studies is that they may not be examining the 'cause and effect' relationship between pacifiers and early weaning and the conclusions of such studies should not be accepted uncritically.

Some observational studies have concluded that the early introduction of pacifiers leads to early weaning. In a study published in Pediatrics in 1997, Dr. Cesar Victora of the Federal University of Pelotas in Brazil suggested "Pacifiers are related to shorter durations of breastfeeding".

A new study out of McGill University in Montreal (published in the July 18, 2001 Journal of the American Medical Association) shows that mothers don't have to worry that a pacifier will turn their baby off the breast.

"The use of the pacifier, in and of itself, is not likely to have anything to do with how long the infant can, will, or will want to breastfeed" says Ronald Barr, professor of pediatrics and psychology at Montreal's McGill University and co-author of the study. "Rather, early weaning and pacifier use may indicate other breastfeeding problems". Professor Barr suggests, the best thing new mothers can do to avoid problems with breastfeeding that lead to early weaning is consult a breastfeeding expert and to exercise patience with nursing.

3. Should I avoid pacifiers altogether if my baby is breastfed?

Pacifiers and comfort sucking at the breast both have their place. As long as pacifiers are not used as a substitute for meeting a baby's needs, they can be offered to soothe fussy young babies without interfering with nursing.

There are times when a pacifier can provide a valuable service by standing in for a mother's breast e.g. when a mother is not able to nurse at that moment because she's busy, or when a colicky baby is too distracted or too frantic to nurse at the breast.

4. Will using a pacifier cause dental problems later on?

Parents may hear controversy over pacifier use. Crooked teeth is the most commonly cited problem associated with pacifiers. Most studies have found that these problems occur only with prolonged use (after age 5 years). Tooth decay is more likely if pacifiers are frequently dipped into sweet substances.

5. Should I encourage my baby to use a pacifier rather than suck on her thumb or fingers?

Many parents encourage the use of thumb sucking over a pacifier. Other parents favor the use of pacifiers to meet their baby's need for extra sucking, as an alternative for thumb sucking. Each has advantages and disadvantages.

A thumb is easily found in the middle of the night, it doesn't fall on the floor, it feels and tastes better, and a baby can satisfy her own sucking needs at will. Pacifiers get lost (at the most inconvenient times); it is more difficult for a baby to find a pacifier when she wakes during the night. However, it may be easier to stop the use of a pacifier than it is to stop thumb sucking because it is easier for a parent to control the sucking habit.

Both pacifier and thumb sucking may lead to orthodontic problems with prolonged use. But don't worry, 95% of children will abandon thumb-sucking by the age of 4 years, well before permanent teeth come in.

6. Do pacifiers harbor germs that cause infections?

It is frequently suggested that pacifiers are "dirty" and potentially carry germs that cause all sorts of infections. One study which examined this cultured 40 recently used pacifiers and found microorganisms on only 52.5% of pacifiers, meaning approx half of the pacifiers were surprisingly uncontaminated.

Based on the above study, pacifiers can be considered as potential "germ carriers". but their potential to cause significant infections remains questionable. The appropriate care and cleaning of pacifiers will limit contamination.

7. What is the best time to introduce a pacifier?

Babies appear more willing to take a pacifier between the ages of 2 weeks and 4 months old. This appears to be the peak age in the need for extra sucking. After this age the sucking drive usually decreases. It is advisable to avoid using a pacifier until breastfeeding is well established, generally at 3 or 4 weeks.

8. When is the best time to stop using a pacifier?

Babies tend to loose their natural sucking urge around the age of 5 - 6 months. Up until this age it is recommended that pacifiers be provided as necessary. Pacifier usage after this age is generally nothing more than a habit and it is recommended that due to the associated risk of middle ear infections that the use of pacifiers between the age of 6 and 10 months is restricted to just before sleep. It is also recommended that pacifier use and discontinued completely after 10 months, an age where pacifiers may begin to interfere with speech development.

9. Are orthodontic pacifiers better than the rounded ones for teeth and jaw development?

The orthodontic shaped pacifier is often recommended by dentists and healthcare providers because it may prevent tongue thrust. However, any significant advantage of one shape over another has not been demonstrated because neither shape tends to cause problems unless sucked intensely for years.

Babies have their own preference and it's important to choose a shape your baby enjoys. Try different shapes until you find the one your baby prefers.


Do's and Don'ts of pacifier use

Do

  • Do sterilize the pacifier by boiling it in water for 5 minutes before the first use
  • Do have identical back up pacifiers available. Pacifiers have a way of getting lost or falling on the floor or street when you need them most. Having spares will also allow sufficient time for cleaning.
  • Do clean your baby's pacifier frequently by washing with hot soapy water, rinsing in clear water and allowing it to air dry. (Additional boiling is required if your baby has oral thrush.)
  • Do rinse your baby's pacifier after it drops on the floor, to decrease the exposure to germs.
  • Do discontinue pacifier use well before the age of 5 years, as it may cause problems for her teeth after that time.

Don't

  • Don't keep trying to plug your baby's cries with a pacifier if she doesn't want it. Try other ways to calm her.
  • Don't let your older baby crawl or walk around with a pacifier all day long; this may interfere with speech developments and increase the risk of middle ear infections.
  • Don't dip your baby's pacifier into sweet substances as this may lead to tooth decay.
  • Don't attempt to "clean" your baby's pacifier by putting it into your own mouth first, this will spread bacteria from your mouth into your baby's mouth. (Your baby's immune system is not as strong as yours).

Safety tips when using pacifiers

  • Pacifiers come in a number of different sizes for different age groups. Choose a pacifier that is suitable for your child's age and size.
  • Look for a one-piece model that has a soft nipple (some models can break into two pieces).
  • The shield should be at least 1 1/4 inches across, so that your baby cannot put the entire pacifier into her mouth. Also the shield should be made of firm plastic with air holes.
  • Do not tie your child's pacifier with ribbon or string longer than 6 inches as it may become entangled around your child's neck and can cause strangulation and death.
  • Check the pacifier regularly for signs of damage. Small pieces can break off causing a choking risk. Replace your child's pacifier every few months rather than wait for it to breakdown.
  • Never make your own pacifier out of bottle nipples, caps or other materials; these can cause choking and death.

How to encourage your child to stop using a pacifier

Most children will give up the pacifier on their own somewhere around the age of 3 or 4 years. However, some parents may choose to discontinue the use of a pacifier earlier than this due to some of the problems/disadvantages listed above.

Stopping the pacifier habit, as with any behavioral change, is not a simple matter and will take time and patience. Remember as your child is not a willing participant, she will resist your efforts by crying or for an older child by displaying temper tantrums.

Pick a time to discontinue pacifier use when your child is not coping with new stresses, such as traveling, moving house or adjusting to a new baby in the house or a new carer. A child should not be forced to give up a pacifier through punishment or humiliation.

Up to 6 months

  • Look for other ways to comfort your baby.
  • When your baby cries, show her, her fingers or thumb.

6 months to 2 years

  • Restrict pacifier use to bed times only.
  • Don't use the pacifier as a way to keep your child quiet.
  • Try distraction, playing games, holding your baby and talking to her  during stressful times as she adjusts to no longer having her pacifier.

Over 2 years

  • Use star charts, daily rewards and gentle reminders, to limit pacifier use during day time hours.
  • Throw away all but one pacifier.
  • To make the pacifier less appealing poke a hole in the end or clip the end off. Your child may toss it when it has no pressure.
  • Everyday cut a tiny piece of the end without your child seeing you. Eventually there won't be enough to comfortably hold in her mouth.
  • Picking a special occasion or way of giving up the pacifier may make the transition of getting rid of the pacifier smoother.
  • Offer to trade your child's pacifier for a new toy. Take your child to the toy store and let her pick out a toy to trade for her pacifier. Experienced store clerks are used to this trading game.
  • When your child does give up her pacifier, offer her lots of praise for doing a grown up thing.

NOTE: These tips will not work every time for every child. In the end it may come down to going 'cold turkey'. You may need to taking a firm stance, ride through a few sleepless nights and patiently waiting as your child adjusts to no longer having her pacifier, which may take from 24 hours up to a week.

OR you may decide the stress is not worth it and choose to wait until your child willing gives it up the pacifier on her own accord. Which ever option you choose, don't get frustrated with your child as this tends to make the situation worse. Think about how difficult it would be for you to give up something you enjoy.

Written by Rowena Bennett

RN, RM, RPN, CHN, IBCLC, Grad Dip Health Promotion and author of 'Your Sleepless Baby: The Rescue Guide'.

© Copyright www.babycareadvice.com 2003. All rights reserved. Permission from author must be obtained to reproduce all or any part of this article. 

Added July 2004. Reviewed 2008; Sept 2013.