Pacifiers: Yes or No?

Baby with pacifierI love pacifiers.  Or, I guess I should say I loved pacifiers.

In our family we called them ‘suckers’, and all three kids had them.  None (at 15, 20, and 22) are still using them today.  No, they didn’t interfere with breastfeeding, they didn’t cause early weaning, and they didn’t ruin anyone’s teeth (though younger son, who used them the longest and had the hardest time giving them up, is the only one of the three who didn’t contribute to sending our orthodontist’s son to Stanford).

What they DID do was comfort them when they were fussy, help them drift off when they needed to sleep, and offer me whatever small shred of sanity was possible in my baby-raising, multi-tasking, life-juggling world.  Did I tell you? I loved them.

Babies are born to suck.  The suck reflex is life sustaining and tenacious.  A fetus will suck his thumb in the womb as early as the second trimester, long before he has any chance of survival in the outside world.  This kind of sucking, without any prospect of food in the picture, even has a technical name: the non-nutritive suck.

One of the things that drew me to pediatrics (besides the fact that kids who don’t feel well are much more appealing than adults who don’t feel well) was the sensation of a brand new human being, just seconds outside of mom’s body, sucking on my pinky finger with incredible force as I did a quick exam and added up an Apgar score.  It was an unforgettable miracle that was part of my daily routine.

Newborns with a poor suck are at a huge disadvantage.  They have trouble latching onto the breast, and when they do they tend to tire easily.  They may nurse for a shorter time and take in fewer calories.  They need more supplementation with infant formula.

Researches have even found an association between babies put to sleep with a pacifier and lower rates of sudden infant death syndrome (SIDS).

But, in the interest of presenting both sides of the question, there are some cons to consider.  Sucking on a rubber nipple is different than the real thing, so infants who use a pacifier (or a bottle, for that matter) before breastfeeding is well established may have trouble learning to nurse.

Babies can become dependent on them, and may not be able to go back to sleep without your help if the pacifier falls out of their mouths during the night.

Some research indicates that pacifier use may increase the risk of ear infections due to pressure changes in the middle ear.  And finally, prolonged use may contribute to dental problems later on.  And some moms just think it looks awful.

Even I, pacifier-lover that I am, start to squirm when I see a 4 or 5 year old walking around chomping on one.

A few tips to consider for you and your babe:

  • If you’re breastfeeding, make sure your feeding routine is well-established before offering the pacifier.
  • Try several shapes and brands before deciding which yours prefers, then buy several to have around when you need them.  There’s nothing worse than a fretful baby and a misplaced pacifier.  I was still finding them in hidden corners when my youngest was 13 and we moved to a new house.
  • Offer, but don’t force it.  She’ll take it if she needs it.  Resist the temptation to use the pacifier as a plug.
  • Keep it clean and watch for signs of wear.  After awhile the rubber may begin to feel sticky or look cracked.  Throw it away and replace the whole batch.
  • Know when to say ‘no more’.  Most toddlers will give them up by age 2, but if not there are several ways to encourage the transition.  My favorite: gradually start to limit pacifier use.  Stroller, car, crib, then car and crib, then just crib.  Finally (and if it coincides with the switch to the big kid’s bed, even better) put them in a beautifully wrapped box and ceremoniously send them off to the ‘pacifier fairy’, who will give them to new babies who need them.  Paci Party, anyone?!!

In any case, the decision is yours.  There’s no right or wrong here, so don’t let those know-it-alls with strong opinions on one side or the other sway you.

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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?

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