It seems like a simple question, but many parents are confused about whether their child should use a pacifier. Generally, it’s best to avoid introducing a pacifier during the first month until breastfeeding is well established. Doing so may cause nipple confusion. This was one of the reasons I was concerned when the NICU nurse offered a pacifier to my newborn son, who required incubation because of his jaundice. She told me not to worry, if I was persistent with breastfeeding, there shouldn’t be a problem. In my case, she was right. The pacifier helped my little guy soothe himself when I couldn’t hold him. The pacifier also wasn’t something that my son had great difficulty parting with either, although I do understand that other children may develop a strong attachment to it.
All over the world, there is a lot of variation in the amount pacifiers are used. There certainly are benefits, but there are risks too. However, while some parents are aware of the health risks associated with pacifier use, we often hear most parents voicing their concern about long term dependency on pacifiers and this being the main issue affecting their decision on whether or not to introduce one. An excellent recent literature review in the Journal of Pediatric Nursing, describes the benefits and risks of pacifier usage. Many other sites will also give reasons for the pros and cons of pacifier usage.
So what are the benefits?
- Sucking is widely acknowledged to be a healthy reflexive means for an infant to self soothe, calm, reorganize, and deal with stress.
- Pacifiers may serve as a transitional object to decrease separation anxiety for toddlers.
Reduces the risk of SIDS
- A number of studies have been conducted and consistently show that there is a reduction in the risk of SIDS associated with pacifier usage, especially if used when putting an infant to sleep.
- Theories for why there is a “protective effect” are that there may be increased arousal responsiveness in frequent pacifier users, the position of the tongue when using a pacifier reduces the risk of oropharyngeal obstruction, and it may encourage mouth breathing if nasal obstruction should occur during sleep.
- Although it is not clearly understood how pacifiers may provide a “protective effect,” the American Academy of Pediatrics does recommend pacifier usage in infants during sleep in the first year of life.
- Sucrose has been documented to relieve pain in neonates undergoing painful procedures, and the use of a pacifier along with sucrose appeared to have a synergistic effect — although of course, Health Canada doesn’t really recommend you put anything sweet on a pacifier, especially NOT HONEY!
- Another meta-analysis suggested that either sucrose or breast milk, with or without non-nutritive sucking appears to be safe and effective in relieving procedural pain.
What are the Risks?
Oral health — malformation of the teeth.
This is a major concern for a lot of parents, but as Nelson’s review indicates, a recent meta-analysis shows that pacifier usage doesn’t significantly impact the teeth if discontinued by age 2-3 years.
Negative impact on breastfeeding
- As you’re probably well aware, the World Health Organization recommends that babies be exclusively breastfed for the first 6 months of life.
- There are worries about nipple confusion as some studies indicate an association between the usage of pacifiers and poor breastfeeding outcomes (all cited in Nelson’s review).
- In regions where breastfeeding rates are low, pacifier usage may be discouraged before breastfeeding is well established.
Otitis Media — Ear Infections
- While no meta-analysis conducted to date, still accumulating data
- There are some convincing studies that there is a causal relationship between pacifier usage and acute otitis media (AOM).
- One study followed infants for 5 year and found that pacifier usage was associated with a 1.8 times great risk of AOM.
- The AAP also has a subcommittee on the management of AOM and they recommend that parents reduce or eliminate pacifier usage in the second 6 months of life. However, it hasn’t been reaffirmed due to the more recent recommendation to use pacifiers as a means to reduce the risk of SIDS.
Parents are much more cautious of materials in baby products these days. There have been findings of latex allergy. Thankfully there are options in terms of materials to choose from.
Introduction of Infection
- The aseptic nature of pacifiers has recently been called into question — Silicone is slightly more resistant to fungal colonization than latex, but not significantly different & pacifiers may act as passive vectors of disease.
- Dentists would also discourage parents with active dental caries from “cleaning” soothers that have fallen on the ground and giving it to their children for risk of passing caries onto their children’s developing teeth.
So as you can see, the debate on pacifier usage is still on going. In the end, my personal opinion is that pacifiers are an excellent tool to help young babies self soothe before it is age appropriate to use a transitional object or lovey at night or nap time. Parents will have to make their own personal decision based on the available information on benefits and risks associated with pacifier use. Most of the risks can be avoided with ensuring that there is no nipple confusion early on, using materials that are hypo-allergenic, and using proper sanitation to avoid possible transmission of infection. As far as sleep goes, pacifiers are not a problem, unless you have to go in all night and replace them when you child is perfectly capable of doing this for him/herself.
Guest blog written by Luanne Bruneau of Baby Sleep Right
Luanne Bruneau, M.Sc is a graduate of the Family Sleep Institute, a top child sleep consultant certification program, and founder of Baby Sleep Right, a child sleep company in Nova Scotia, Canada. She believes that because her family was able to find a sleep solution, there are solutions for other families too. That’s why she decided to take the certification course offered at the Family Sleep Institute, which is recognized by the International Association of Child Sleep Consultants, to educate herself on the elements that affect healthy sleep habits. Luanne has got a passion now for teaching and helping other families find sleep solutions that work, and she can help yours too.
Visit www.babysleepright.com for more information.
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