baby's pacifier use

What You Need to Know About Pacifiers

If you’re a new or expectant parent, whether or not you should give your baby a pacifier is one of many decisions you’re probably weighing—and one that’s yours for the making. Though you’re in the driver’s seat with this decision, knowing which route to take is not always clear or easy. On one hand, you may be considering that pacifiers have been used to comfort babies throughout human history. On the other, you may question a pacifier’s necessity, or how it may impact your baby’s development or ability to breastfeed.

While the answer may not always be straightforward, you can help inform and support your decision with scientific research, a knowledgeable pediatric dentist, and a hearty dose of your own parental instincts. As you consider your options, check out what the research has to say about the pros and cons of pacifier use, and know that we’re here to support your decision and your child’s best oral health at every age.

Pros

Comfort

During the first few years of their lives, your baby may instinctively seek something to suckle on beyond feeding and nursing, such as their fingers or thumbs. Known as non-nutritive sucking, sucking on a pacifier, finger, or thumb can help your baby cultivate a sense of comfort, fall asleep, and manage their mood state. Non-nutritive sucking can also help your baby feel calm and relaxed, especially during medical appointments. Some parents also find that pacifiers are an indispensable tool for calming a fussing baby. So long as the behavior isn’t excessive, non-nutritive sucking is generally considered normal during the first two to three years of your child’s life.

Potential SIDS Prevention

Pacifier use at bedtime and naptime has been associated with a decreased risk for SIDS (sudden infant death syndrome), though researchers are still working to understand why. Some studies suggest that a pacifier keeps the tongue forward for unobstructed breathing, while others point to a pacifier’s ability to help an infant stay asleep, thus minimizing the likelihood of rolling onto their stomach or sides.

Developmental Aid for Preterm Babies

The suckling reflex is one of your baby’s very first milestones. Suckling is an infant’s only means to receive nutrition, which is why most babies are born with, or soon develop, a strong suckling reflex. This infant sucking reflex starts developing around eight weeks of pregnancy, matures around 36 weeks, and continues to develop until birth. Some babies even suck their fingers or thumbs in the womb!

For babies who are born prematurely, the suckling reflex may not be as developed as it needs to be to support adequate feeding. Pacifier use has been shown to help preterm infants maintain and mature their suckling reflex, so they’re able to transition from enteral (tube) feeding to oral feeding more rapidly and effectively. Additionally, pacifier use can provide comfort during medical procedures and has been associated with shorter hospital stays for preterm babies.

Easier Airplane Flights

For adults and babies alike, the change in barometric pressure that occurs during airplane takeoff or landing can cause uncomfortable ear pain (known as airplane ear, or ear barotrauma). While many older children and adults can deal with airplane ear through yawning, swallowing, or chewing gum, babies don’t know how to alleviate their symptoms through yawning or swallowing. If it’s not time for your baby to feed or if they won’t take the bottle or breast during takeoff or landing, a pacifier can help prevent or alleviate airplane ear.

Disposable

While your baby’s fingers and thumbs will always be with them, pacifiers can be easily removed from the environment to limit use and to help them transition away from non-nutritive sucking. For this reason, the American Academy of Pediatric Dentistry recommends pacifiers over a thumb for comforting your baby.

Cons

Breastfeeding Challenges

The potential for breastfeeding challenges is one of the main concerns new moms have about pacifier use—and the evidence is somewhat conflicting. While some evidence implicates pacifier use in early weaning and breastfeeding difficulties, other studies have indicated that pacifier use had no impact on breastfeeding in healthy, full-term babies.

While the relationship between pacifier use and successful breastfeeding is still being investigated, the American Academy of Family Physicians (AAFP) and many breastfeeding experts recommend that a pacifier only be introduced to a full-term breastfeeding baby after three or four weeks of age. Alongside ensuring that breastfeeding is fully established, this guideline aims to help prevent nipple “confusion” or preference. Other experts recommend waiting until your baby is at least six to eight weeks old before introducing a pacifier, to ensure your supply-and-demand lactation is fully established.

Infection Risks

Oral Thrush

Oral thrush (also known as oral candidiasis) is an infection that’s caused by an overgrowth of Candida albicans, a yeast that naturally lives in the human mouth, digestive tract, and vagina. A common fungal infection in babies under two-months-old, oral thrush is often transmitted to babies as they pass through the birth canal. Oral thrush can also be caused after your baby has gone through a course of antibiotics, or if mom’s breasts aren’t properly dried after breastfeeding.

As oral thrush usually presents on the parts of the mouth used during suckling, pacifiers (and bottles) can exacerbate oral thrush in two ways. By promoting salivation, pacifier use increases the moisture level in your baby’s mouth, creating the ideal environment for yeast to survive. Furthermore, prolonged sucking on a pacifier can create friction against your baby’s delicate oral tissues, which may make feeding more painful and difficult for mom and baby alike.

Middle Ear Infections

Middle ear infections (also known as otitis media) is a common childhood infection that causes inflammation in the ear canal that connects the ear to the throat. While a middle ear infection can be caused by colds or allergies, some evidence also suggests that they may be caused by pacifier use. Though the reasons why aren’t fully understood, researchers believe that prolonged pacifier use may alter ear canal’s structure or cause fluids from the nose or throat to push into the middle ear.

To help prevent middle ear infections, the American Association of Pediatrics (AAP) recommends limited to no pacifier use after your baby turns six months, as middle ear infections are most common between six and 24 months of age.

Dental and Orthodontic Problems

All types of non-nutritive sucking can cause dental or orthodontic problems if a child sucks on a pacifier, finger, or thumb too often and for too long. Prolonged non-nutritive sucking can contribute to a host of long-term dental and orthodontic problems, including changes to the position of your child’s teeth, jaws, and lips. The longer the child maintains a sucking habit, the more likely they are to need otherwise preventable orthodontic interventions.

The good news is that routine visits and an early orthodontic evaluation with an experienced kids’ dentist can help detect potential issues early—even in newborns. Your pediatric orthodontist can evaluate your newborn’s tongue and lips for ideal development, monitor changes in your child’s jaw and dentition, and offer solutions to break a non-nutritive sucking habits in toddlers and older children.

Dependence

While many infants or toddlers will naturally stop using a pacifier between ages two and three years of age, some children may become attached to their binky and be very resistant to seeing it leave. Alongside making it hard for your child to cope with transitions or boredom without their binky, pacifier dependence may make it difficult for your child (and you) to stay asleep.

If you’re currently trying to wean your child off their pacifier or thumb, know you’re not alone. Your pediatric dentist is available to help encourage your child to break a non-nutritive sucking habit and can provide you with techniques to support your child in making this behavioral change. You can help ease the process by choosing a time when travel, life changes, or other stressors are at a minimum. Try providing your child with a transitional comfort object, like a doll or stuffed toy, which you could even let your child pick out and “trade” for their pacifier when you’re ready to wean. Another option for weaning from a pacifier is to introduce your child to the Binky Fairy.

When it comes to whether or not you should give your child a pacifier, always do what’s best for your child and for you. It may be tempting to offer your child a pacifier out of routine or when a situation arises that in past has always been soothed away with a binky. But it is best to let your child decide whether, and when, to use pacifiers.

Safety

As per the American Academy of Pediatrics recommendations, always use pacifiers that are one piece. The two-piece models can come apart and pose a choking hazard. Never tie a pacifier to your child’s crib, or around your child’s neck or hand. This could cause a serious strangulation injury, or even death.

When your child reaches one year of age, you may want to talk with your pediatrician or pediatric dentist about how and when to start weaning your child from the pacifier. As your pediatric dentist and orthodontist in Vancouver, WA, we’re here to support you and your child’s smile in every way. To provide your child with the benefits of developing an early relationship with a kids’ dentist, contact our office today to schedule an appointment.