The Pros and Cons of Pacifiers
Amy Movius MD
Pacifier use is seen worldwide. The rate of pacifier use varies between and within different countries. Pacifiers are usually used for soothing infants with “non-nutritive” sucking. Many people have strong opinions about whether or not infants should use pacifiers at all. It turns out there are both risks and benefits to their use.
The main objection to pacifier use is “nipple confusion” in breast fed infants. The concern is that these infants may wean earlier from the breast, though the evidence for this is not conclusive. It is generally recommended that pacifiers not be introduced to breast fed infants until 1 month of life, at which time the infant-mother “mechanics” of breastfeeding as well as maternal milk supply should be well established.
Pacifier use has also been associated with a slight increase in ear infections (about 1/yr) as well as oral yeast (thrush) presumably from contamination of the pacifier with these organisms. As pacifiers are a manufactured products there have been cases of choking on the devices, and strangulation on pacifier cords with certain (recalled) models. Lastly, vigorous sucking of pacifiers (or thumbs/fingers) can alter the structure of the roof of the mouth and teeth over time, resulting in malocclusion.
Benefits of pacifier use include decrease of gastro esophageal reflux and soothing during medical or other stressful procedures. Pacifiers are also shaped to minimize dental impairment and have less orthodontia impact than thumb or finger sucking.
The most compelling benefit for pacifier use is a decrease in the incidence of SIDS by about 50%. The exact mechanism for this finding is unknown but the result has been reported in several studies from different countries. For this reason, pacifier use is generally neither discouraged nor encouraged by pediatricians. If parents are interested in using a pacifier, it may be wise to use it only for sleeping and to phase it out after 1 year of age.
For toddlers and older children who still use pacifiers or suck their thumb or fingers, the best approach is to ignore it. Most children will eventually stop the behavior on their own. Interventions to encourage stopping these behaviors should first focus on breaking the habit during daytime. These efforts should be positive, not punishing; such as star charts, small rewards and general encouragement. Some children will do sucking behaviors out of boredom. Actively engaging these kids with hands-on activities when you notice them sucking may be helpful. If you have concerns that your child’s “bite” is suffering from the habit, consult your dentist. They may recommend use of more aggressive interventions such as a dental appliance. Whatever approach (if any) is needed, explain it to your child and back off if they appear to be very tense or upset with it. Most children who still have the habit will stop on their own once starting school. In the meantime, if it doesn’t bother them, try not to let it bother you!