Pacifier use

Definition

A pacifier is an artificial nipple designed for babies to suck on for comfort.

Purpose

Infants have an intense need to suck that is separate from their need to eat. Fetuses may suck their thumbs before they are born, and some newborns begin to suck immediately. Infants suck when they are tired, bored, or in need of comfort. Some babies have a stronger need to suck than others and—next to eating and being held—sucking may provide the most comfort to an infant. Babies who do not suck their thumbs or fingers often rely on pacifiers.

In Western societies 75 to 85 percent of children use pacifiers. Hospital nurseries commonly give them to newborns. Premature infants seem to grow better when they suck on pacifiers. Professionals refer to a pacifier as a transitional object that helps children adjust to new situations and relieves stress.

Most infants cry because they do not yet have methods for soothing themselves. Some newborns do not have the coordination to suck their fingers or thumb. Although breastfeeding is the most effective way to calm infants, and their hands or thumbs can be placed in their mouths, pacifiers can be very helpful for discontented babies who cannot or will not suck their thumbs or fingers.

Arguments for pacifier use

Pacifier use is controversial. Some physicians are completely opposed to pacifier use, whereas others view pacifiers as helpful if used in moderation. Pacifiers can be particularly useful for unhappy babies who are difficult to comfort. The child's energy goes into sucking on a pacifier rather than crying. Although pacifiers can give children a sense of calm and security well into their toddler years, pacifier use may be most effective during the first few months of life when fussiness, colic , and the need to suck are at their peaks.

Pacifiers should only be used to satisfy the need to suck. They should never be used to delay or replace nurturing or feeding. As a child grows, a pacifier can be taken away, whereas it may be harder to discourage thumb sucking . For babies, pacifiers can be used for the following reasons:

• to sooth a baby to sleep
• to help a baby to stay asleep when disturbed
• to calm a frightened baby
• to keep the baby quiet

Arguments against pacifier use

The World Health Organization recommends against pacifier use. Disadvantages of pacifier use may include:

• They may get dirty and thus contribute to poor hygiene.
• If lost during sleep, the pacifier's absence may cause the baby to wake and cry.
• The pacifier may prevent babies from using their mouths to learn about toys and other objects.
• The pacifier may signal to a baby that crying is unacceptable even though crying is one of a baby's few means of communication.
• The pacifier is an easy fix that may cause parents not to seek to understand what is bothering the baby.
• Pacifiers may prevent children from learning how to comfort themselves.
• Older siblings may give the baby a pacifier to quiet a baby in situations where the parents would not use it.
• Many adults dislike the sight of babies with pacifiers.

The advantage of thumb sucking is that babies can adjust sucking to the feel of their skin. Some people believe that thumb sucking is an easier habit to break than pacifier use. Thumb sucking may be preferable to pacifier use because thumbs have the following benefits:

• Unlike pacifiers, the baby can find his thumb at night.
• Thumbs are more hygienic.
• Thumbs taste better.

Description

Types of pacifiers

Pacifiers consists of a latex or silicone nipple with a firm plastic shield and handle. Latex pacifiers are softer or more flexible but wear out faster than silicone. Silicone pacifiers are firmer, hold their shapes longer, and are easier to clean. The nipple should be knotted around the back of the handle and the shield and handle should be one piece. This prevents the nipple from falling off or the plastic from breaking in two and posing a choking hazard. The shield should be at least 1.5 inches (6 cm) across so that it will not fit in the baby's mouth. The shield should have air holes or vents to prevent saliva from collecting behind it and causing an irritation or rash. Large circular shields can obstruct an intensely sucking baby's nasal passages. Pacifiers should have easy-to-hold handles, be dishwasher-safe, and easy to clean.

Pacifiers come in several sizes designed for premature infants, newborns, babies younger than six months, and children older than six months. Pacifier nipples come in various shapes—long, short, flattened, or with a ball-shaped end. Some are shaped like bottle nipples and others resemble a breast nipple that is being sucked on. The latter may not always fit a baby's mouth. There is no evidence that one shape is preferable to another, although the baby may prefer a certain type. Some babies gag at the texture, taste, or smell of some pacifiers. A baby bottle nipple should never be used as a pacifier since the nipple could pop out of the ring and choke the baby.

Pacifier care

Infant pacifiers should be cleaned daily by boiling or washing in a dishwasher. Once a child is six months old, the pacifier can be washed daily with warm soapy water and rinsed with clean water. Children may be taught to wash their own pacifiers. Pacifiers should never be shared with playmates. They should never be stored in plastic bags where dampness can encourage fungal growth.

Pacifier nipples should be examined regularly for deterioration, including tears, frayed edges, holes, or a change in color. Emerging teeth can tear pacifiers. A worn or damaged pacifier should be replaced immediately. Since pacifiers are lost frequently, several should be kept on hand.

Precautions

Pacifiers are sometimes attached to a baby's clothing with a clip and a short cord or ribbon to prevent them from becoming lost or dirty. However a child can become entangled in even a short cord and should never be put to bed with a pacifier attached to a cord. A pacifier that is hung on a cord around the baby's neck, tied to the baby's hand, or attached to a crib can cause strangulation. Pacifiers should never be sweetened because sweetened pacifiers constitute a leading cause of tooth decay in babies under age three.

Pacifiers never should be used to replace a feeding, and children should never be given a pacifier if they are hungry. A hungry baby may become upset when there is no milk in the nipple and could develop feeding problems. Thus pacifiers should only be used between or after feedings.

Terminating pacifier use

Babies need their mouths for play and exploration. By the time a child is crawling and learning to walk, pacifiers are both unhygienic and limiting. Although many experts still recommend weaning a child from pacifier use at about age two, others suggest that six to ten months is the best time to end pacifier use. Before the age of two, children have short memories and may easily forget about a pacifier that has been lost for a few days. Pacifier use should not be terminated too soon or too abruptly since a baby may substitute thumb sucking or some other behavior such as hair pulling. A two-year-old is much less likely to revert to thumb sucking.

Sometimes severe stress or emotional upset causes a child to use a pacifier for a very long time. Even children who stop because of peer pressure at school may continue to use a pacifier to calm down at home or to go to sleep.

Risks

Breastfeeding

Pacifiers should never be given to a breastfeeding infant unless an efficient nursing routine is well-established. Pacifiers may cause nipple confusion. Newborns must learn to breastfeed effectively, and babies suck on breast nipples differently than on a pacifier. Pacifiers have a narrow base so that infants do not have to open their lips widely. Pacifier use may prevent infants from learning how to latch onto their mother's breast, resulting in poor feedings and sore nipples.

A number of studies have found that frequent pacifier use reduces the duration of breastfeeding and increases the likelihood that a baby will be weaned by six months. The earlier a pacifier is introduced the sooner breastfeeding ceases. The reasons for this include the following:

• Pacifier use causes babies to breastfeed less.
• Mothers may introduce a pacifier because they want to stop breastfeeding.
• Infants who are given a pacifier, with or without supplemental food, may lose interest in nursing.
• A reduction in breastfeeding decreases the mother's milk production.
• A reduction in nipple stimulation by a nursing infant decreases milk production.

Ear infections

Research has found that pacifier use increases a child's risk of ear infections—acute otitis media , the second most common childhood illness after colds. In one study pacifier use increased the frequency of ear infections by 50 percent. Another study found a 33 percent decrease in ear infections when pacifier use was limited to babies aged six to ten months and only used when they were falling asleep. It may be that pacifier use spreads infection or that intense sucking on pacifiers hinders proper functioning of the eustachian tube that normally keeps the middle ear open and clean. The studies suggest that pacifiers only be used with babies under ten months of age, when the need to suck is strongest and the incidence of ear infection is relatively low.

Dental development

Both dental cavities and misaligned teeth have long been associated with pacifier use. Neither pacifier use nor thumb sucking is likely to interfere with early dental development . However, if continued past about age three, either one can contribute to protruding front teeth and an overbite. Orthodontic pacifiers do not prevent dental abnormalities. Many dentists believe that neither pacifier use nor thumb sucking should continue once all of the baby teeth have erupted. A dentist may recommend devices that are designed to discourage pacifier use.

Other risks

Pacifiers can exacerbate any problems with developing speech and language. They have been shown to interfere with normal babbling and speech development in babies older than 12 months. A child learning to speak with a pacifier may have distorted speech. The child may replace "t" and "d" sounds—that require the front of the tongue to brush against the teeth—with "k" and "g" sounds that come from the back of the throat. Pacifiers also can interfere with children's willingness to talk and the development of their social skills.

Some research has suggested that babies exhibit fewer visually exploratory behaviors when using a pacifier; they look around less and can seem less alert. Some of these children receive less of the following:

• mental stimulation
• encouragement to explore and learn
• parental attention

Additional risks of pacifier use include the following:

• the transmission of thrush, a yeast infection, that can be difficult to eradicate in children with pacifiers
• product recall of pacifiers due to safety concerns
• children who are unable to give them up, even after years of use

Normal results

Many babies lose interest in their pacifiers at about four months of age, as the need to suck begins to subside. They suck on it less or spit it out. Failing to replace the pacifier after the baby cries or spits it out can be a good method for breaking the pacifier habit. It is easier to end pacifier use in a younger child. By the age of three most children have learned to communicate effectively and have other means of coping with stress. Preschool children may experience pressure from their peers to give up pacifiers. However, most children give up both pacifiers and thumb sucking long before they become social or dental concerns.

Parental concerns

There are numerous ways to console a crying baby other than using a pacifier. During at least the first six months of life, crying should always be responded to promptly. If infants have been well-fed within the past hour and do not need a diaper change, parents can comfort them by the following:

• placing their face directly in front of the baby's face and talking to the child
• picking the baby up
• rocking the baby
• placing a gentle hand on the baby's stomach
• swaddling a baby in soft blankets

Parents who choose to give their baby a pacifier should take the following steps:

• not use it every time the baby's mouth is open
• try alternative methods of calming a crying baby
• encourage the child to sleep without it
• remove it as soon as the need for extra sucking is gone—usually between 12 and 15 months of age

It may take several weeks for children to give up their pacifiers. Parents can encourage their children to give them up gradually by trying the following:

• ignoring the behavior
• reassuring them with affection
• limiting pacifier use to bedtime or stressful situations
• finding them a comforting alternative
• providing activities in situations where they are likely to be bored
• helping them to express their emotions in words
• gently reminding them to not to use their pacifiers
• praising them for not using a pacifier
• failing to take the pacifier to daycare or other activities
• using a calendar to mark down pacifier-free days
• rewarding pacifier-free days
• dipping the pacifier in pickle juice to make it is less appealing
• offering to trade in the pacifier for a "big kid's" toy
• not pressuring the child to give up their pacifiers
• not punishing or humiliating the child for pacifier use

KEY TERMS

Otitis media —Inflammation or infection of the middle ear space behind the eardrum. It commonly occurs in early childhood and is characterized by ear pain, fever, and hearing problems.

Overbite —Protrusion of the upper teeth over the lower teeth.

Thrush —An infection of the mouth, caused by the yeast Candida albicans and characterized by a whitish growth and ulcers.

Tooth eruption —The emergence of a tooth through the gum.

See also Dental development; Orthodontics.

Resources

PERIODICALS

Howard, C. R., et al. "Randomized Clinical Trial of Pacifier Use and Bottle-Feeding or Cup-Feeding and Their Effect on Breastfeeding." Pediatrics 111, no. 3 (2003): 511–18.

Kramer, M. S., et al. "Pacifier Use, Early Weaning, and Cry/Fuss Behavior." Journal of the American Medical Association 286, no. 3 (2001): 322—6.

Meyerhoff, Michael K. "Pacifiers and Breast-Feeding." Pediatrics for Parents 20, no. 8 (2003): 9.

ORGANIZATIONS

American Academy of Pediatric Dentistry. 211 East Chicago Avenue, Suite 700, Chicago, IL 60611–2663. Web site: <www.aapd.org>.

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007–1098. <www.aap.org>.

WEB SITES

Greene, Alan. "Pacifiers." Caring for the Next Generation, February 16, 2001. Available online at <www.drgreene.org/body.cfm?id=21&action=detail&ref=860> (accessed November 21, 2004).

Greene, Alan, and Khanh-Van Le-Bucklin. "Ear Infections and Pacifiers." Caring for the Next Generation, January 2002. Available online at <www.drgreene.org/body.cfm?id=21&action=detail&ref=303>(accessed November 21, 2004).

Hodne, Krista. "Pacifier Use Is Associated with Decreased Duration of Breastfeeding." University of Michigan Department of Pediatrics Evidence-Based Pediatrics Web Site, March 17, 2003. Available online at <www.med.umich.edu/pediatrics/ebm/cats/bfpaci.htm>(accessed November 21, 2004).

"Pacifier Use." BabyCenter. Available online at <www.babycenter.com/refcap/toddler/toddlerbeahvior/12254.html> (accessed November 21, 2004).

"Perils of the Pacifier." Available online at <www.kidsgrowth.com/resources/articledetail.cfm?id=94> (accessed November 21, 2004).

Margaret Alic, PhD