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Writer's pictureHaleigh Lunas
May 5, 20216 min read

When should I introduce a pacifier?

A symbol of expecting in many cultures, but should they be used as routinely as their image may imply?


Historical Context

In the United Kingdom they are called "dummies." In the US they are usually called "binkys." Noted for the first time in a book entitled "Caring for Children" written by a German Physician in 1473, a "pacifier" could be anything from a rag-tied cloth soaked in brandy or with food stuffed inside for the child to gum on.


The Madonna and child painted by Dürer in 1506 shows one of these cloths tied in a knot. It looks like today's lollipop. At the time it was meant to be a substitute for the mother's breast when the breast was not available, hence the word "dummy" in place of the real thing, the breast. Unfortunately in recent years, some have begun to consider this paradoxically. That a mothers breast is in fact the thing that babies use as a "human dummy" and that mothers should not "pacify" an infant by nursing for comfort.


What is the concern?

Have you heard of "nipple confusion?" Basically this is thought to be when a baby gets frustrated at switching back and forth between a mother's natural nipple and an "artificial nipple" or what I will henceforth refer to as a "teat." There are many ways in which the breastfeeding relationship might be negatively impacted by this and can cause the following complications for baby and mother.

  1. Suckling from a teat is very different from the natural breast. The shape, material and gravity of a plastic teat in the mouth can handle the strong, uncoordinated, sporadic bursts of suckling that often take place with their use. The mother's nipple, however, requires coordinated or synchronized, rhythmic movements of suck and swallow to facilitate the flow of milk. If an infant tries to suckle as they would with a pacifier, over time, the mother will end up with nipple trauma and pain. Infants might cause the mother so much pain and trauma to the nipples trying to latch on, that they make the tough choice to prematurely stop breastfeeding all together because it is just to stressful and they do not have support to navigate it.

  2. Some babies develop such a significant level of frustration that they have to "work" hard at the breast, so they simply end up refusing the breast, which is very tough for the mom. (This is most common with bottle teats, but that's a post for another day.)

  3. Studies have shown that early and frequent dummy or pacifier use, is linked to an increased risk of a drop in mother's milk supply, because whenever baby is suckling at something other than the breast, the mothers body adjusts milk supply based on its decreased demand.

  4. Early and frequent dummy use is also linked to the early cessation of exclusive breastfeeding because of a downward spiral caused by any of the potential factors listed above.

NOTE: It is also true that some babies have no problem with alternating from the breast > bottle teats > pacifier teats, and the breastfeeding relationship is not impacted in the slightest.


So...when is a pacifier helpful?

There are certain babies for which a pacifier is very useful. It is, after all, a very natural and reflexive way for an infant to self-soothe to sleep and to feel a sense of security. Some babies need this more than others.


For example, infants who need temporary:

  • Comfort when separated from their mother and are not hungry (i.e. in the car, sleeping, etc).

    • Frequent use (all day, hours in mouth) --> Higher risk above complications

    • Infrequent use (1-2x/day or less) --> Lower risk above complications -- RECOMMENDED

Pacifiers have been shown through studies to be beneficial for some medical purposes.

For example, infants who need:

  • Pain relief during minor procedures or vaccinations.

  • Constant salivary gland stimulation (i.e. GER(D) and colic).

  • Help with oro-moter skills or who are learning to feed by mouth (i.e. premature, hypotonia).


Pacifiers also provide an additional strategy to reduce the risk of SIDS for infants medically high-risk or for those sleeping in unfavorable sleep environments. It should be noted that breastfeeding also reduces the risk of SIDS.


The biggest consideration is HOW often you allow the infant to use it for general comfort.


So...when is it ideal to introduce for comfort?

When the breastfeeding relationship is "well-established." What does this mean?


The American Academy of Pediatrics (AAP) recommends to wait to use a pacifier until after the first month of life, so around 4 weeks old. This is the average time it takes for an infant to develop the muscles and coordination required for effective nursing.


I like to make this more specific. I recommend to wait until your baby is at least 4 weeks old, (the older the better) AND your baby is a pro at latching on properly, every time, without causing you nipple pain and/or trauma. You also must always make sure it is cleaned with soap and warm water when it drops (which is a pain and rarely done) or you risk infection.



The Long-Term Concerns:

As a pediatric primary care provider, the concern I commonly have with routine use past the child's 1st birthday (or when they start to develop teeth) is cavities. Cavities (or dental decay) are one of the most common chronic childhood diseases and they are preventable! Some people incorrectly think that if a child gets cavities in their baby teeth, no big deal, they will get new adult teeth. This is NOT true. The healthy of the baby teeth is directly correlated to the health of their adult teeth. There can also be issues with overbite, open-bite, buck teeth, crooked teeth and changes to the roof of the mouth. Also just as side note, children are recommended to have their first dental visit by their 1st birthday :)


After the child's 1st birthday, I often recommend to parents that they begin the process to wean off the pacifier (and the bottle-but that's a separate topic for another day). If they do see a dentist before then, this is something they will no doubt encourage as well. This recommendation is grounded not only in consideration of the child's dental health, but for the child's speech, language and social development. Children who use pacifiers well into their toddler years are more likely to have issues with eating and talking, which then can lead to delays in socialization. Beyond the age of 1, most children have the capacity to self-soothe by other, healthier coping mechanisms if they are offered to them. Parents can teach coping and soothing strategies that are not potentially detrimental to growth and development long-term, but instead are actually helpful to their overall social and emotional development.


The other most common thing I see in practice-- STRESSED out parents who wish they had never given their child a pacifier because they just turned 3 years-old, they have tried everything to get rid of it and they just can't. Trust me (or don't!- just ask any parent that has had to do it). It is a whole lot easier to take it away from a crying 1 year-old than a 3-5 year-old, preschool age child in a full blown tantrum!




References:

For the dental patient. Thumb sucking and pacifier use. Journal of the American Dental Association. 2007;138(8):1176.


Howard CR, Howard FM, Lanphear B, et al. Randomized clinical trial of pacifier use and bottle-feeding or cupfeeding and their effect on breastfeeding. Pediatrics. 2003;111(3):511–518.


Kaufman GE, Cimo S, Miller LW, Blass EM. An evaluation of the effects of sucrose on neonatal pain with 2 commonly used circumcision methods. American Journal of Obstetrics & Gynecology. 2002;186(3):564–568.


Moon RY, Tanabe KO, Yang DC, Young HA, Hauck FR. Pacifier use and SIDS: evidence for a consistently reduced risk. Maternal Child Health Journal. 2012 Apr;16(3):609-14.


Ponti M, Leduc D. Canadian Paediatric Society statement. Recommendations for the use of pacifiers. Paediatrics & Child Health. 2003;8(8):515–519.


Righard, L and Alade, M. Breastfeeding and the use of pacifiers. Birth 1997; 24(2): 116-20.


Victoria, C et al. Pacifier use and short breastfeeding duration. Cause, Consequence or Coincidence. Pediatrics 1997; 99(3): 445-453.


Viggiano, D, et al. Breastfeeding, bottlefeeding, and non-nutritive sucking: Effects on occlusion in deciduous dentition. Arch Dis Child 2005; 89: 1121-23.


Zempsky WT, Cravero JP, for the American Academy of Pediatrics. Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics. 2004;114(5):1348–1356.

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