Dr. Greene

Are Pacifiers Good for Baby?

By Alan Greene, MD

Infants are hardwired to need and enjoy sucking, not just during feeding, but as a separate experience. Infants turn to sucking most when they are tired, bored, or in need of comfort. Some infants appear to need non-nutritive sucking more than others. With the dawn of prenatal ultrasounds, we’ve learned that some babies enjoy non-nutritive sucking even before they are born.

Some form of non-nutritive sucking has been common in every society we know. Thumb sucking is one way for babies to pacify themselves. The advantage of a thumb is a baby can find it whenever she feels a need to suck and practice self-soothing. But there are potential downsides. If thumb sucking becomes a long-term habit it can be difficult to break and can impact proper tooth development.

The American Academy of Pediatric Dentistry solidly prefers pacifiers to thumbs for meeting children’s sucking needs (because pacifiers are easier for parents to control).

I think pacifiers and thumbs are both fine – but bottles should never be used as pacifiers (this can cause terrible tooth decay). Nor should pacifiers be used to say, “quiet down!” without words, or as replacements for noticing babies or their needs.

Research indicates that there is an association between pacifier use and a reduction in the risk of sudden infant death syndrome (SIDS). The American Academy of Pediatrics (AAP) recommends the use of pacifiers at nap time and bedtime throughout the first year of life.

One caveat is that the AAP recommends waiting one month for breastfed infants before introducing pacifiers in order to firmly establish breastfeeding. I agree that it is best to wait until nursing is firmly established before starting a pacifier, whether this is shorter or longer than a month. Some studies have shown a link between increased pacifier use and decreased nursing, but this is probably not a cause, just a correlation.

All in all, I think pacifiers can be a good solution for non-nutritive sucking. Pacifiers come in many shapes and sizes. Orthodontic pacifiers, like Born Free’s Bliss, have been designed to support the shape of babies’ developing palates and jaws. The flattened shape not only simulates the shape of a mother’s nipple when flattened in the mouth, but also encourages the most natural sucking action to help proper oral development.1

Studies suggest that children who use orthodontic pacifiers have a smaller chance of developing an open bite or an overbite than those who use conventional round pacifiers.2

Most pacifiers come in different sizes to accommodate babies’ different sizes. Most newborns do best with pacifiers designed for newborns, and preemies with those designed for preemies.

While babies decide which pacifiers they like, you decide which are safe and convenient. Choose sturdy pacifiers with a shield that is at least 1 1/2 inch across to prevent choking. I like dishwasher-safe pacifiers for extra convenience. Replace your child's pacifiers as they become worn.

Another important feature to look for is vented shields to protect the skin around your baby’s mouth. Without them, saliva can collect behind the shields, irritating the skin and causing a rash.

Used correctly, pacifiers can be a wonderful choice.

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Footnote References:

1Turgeon-O'Brien H, Lachapelle D, Gagnon PF, Larocque, I., Maheu, R.L.F. (1996). Nutritive and nonnutritive sucking habits: a review. ASDC: Journal of Dentistry for Children, 63(5), 321-327.

2Adair SM, Milano M, Dushku JC, Evaluation of the effects of orthodontic pacifiers on the primary dentitions of 24- to 59-month-old children: preliminary study. Pediatr Dent 1992 Jan-Feb;14(1):13-8

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Dr. Greene

Dr. Greene is a practicing pediatrician, author, speaker, children’s health advocate, and father of four.

Dr. Levine

Dr. Alanna Levine is a New York based pediatrician and a mom of two children.