Pacifier Pros and Cons

Binkies, nubbies, pacis, soothies, dummies–however you refer to them, pacifiers can be one of your baby’s favorite objects. But there are some caveats when it comes to pacifiers. So, should you give your baby a pacifier? Below we take a look at some pros and cons.

Pro: Pacifiers are soothing

This is, of course, pretty obvious, otherwise we wouldn’t have pacifiers. Babies have an innate sucking instinct and sucking is one of the earliest ways many learn to self-soothe.  Some parents even get to see their baby sucking their thumb on ultrasound as early as 15 weeks! Babies have even been observed to have blisters on their hands when born, indicating they’ve been busy sucking away during gestation. Some babies like to suck for comfort more than others, so if your baby is inclined to this so-called “non-nutritive sucking”, allowing a pacifier is a natural choice. Some babies of course will have nothing to do with them so the choice is made for you!

Con: Pacifiers can interfere with breastfeeding

If you are hoping to breastfeed your baby, it’s important not to introduce a pacifier until after breastfeeding and a good latch is well-established. This is because a baby must slightly adjust the way he sucks to keep a pacifier in versus getting milk from the nipple. A very young baby might not learn to readjust his sucking when he’s back on the breast (“nipple confusion”), and a bad latch and create chapped and painful blisters on the nipple–ouch! Plus, your baby’s suckling at the breast is important to establish milk supply, even when he’s comfort sucking and not getting any milk! If you choose to use a pacifier during the early weeks, pick one shaped like Philips AVENT Soothie. These pacifiers are straight and mimic the shape of the nipple. To ensure your baby still gets enough to eat, only offer the pacifier after he’s finished eating and don’t use a pacifier as a way to coax your baby back to sleep at night. In the early months, most babies need to eat frequently including in the middle of the night.

Pro: Giving your baby a pacifier at night lowers the risk of SIDS

Many studies have found an association between consistent pacifier use and reduced risk of SIDS (1-2). The mechanism by which pacifiers confer protective advantages against SIDS is not well understood, but theories involve expanded airway during sucking, an increase in arousability, and altered cardiovascular function which improves response to environmental stressors. Advocates for pacifier use suggest offering the pacifier consistently, both at night time and during all naps. Even if the pacifier falls out shortly after falling asleep, it still confers an advantage (3). It should be noted that all other guidelines to reduce SIDS risk should also be followed (back to sleep, no loose bedding, etc.). Breastfeeding is also associated with a decreased risk of SIDS, so mothers who breastfeed should be mindful of when the pacifier is introduced so it does not interfere with breastfeeding (see above). The AAP recommends waiting until 3-4 weeks (4), while IBCLCs on Kelly Mom recommend waiting until 6 weeks after the 6-week growth spurt and when milk is usually well-established (5).

If you offer your baby a pacifier, make it a habit to regularly check the integrity of the nipple and entire pacifier. Always replace pacifiers at the first sign of wear.

Con: Pacifier usage has been identified as a risk factor for ear infections

Acute otitis media, aka an ear infection, is one of the most common infections in children and is the #1 reason for doctor visits. Studies have consistently found an association between pacifier usage and ear infections, although the mechanism by which pacifier usage may increase the risk is not well understood (6). Many studies (7-8) have also found the risk for recurrent ear infections is significantly increased as well. The AAP subcommittee on otitis recommended in 2004 that pacifier usage be discontinued after 6 months of age to reduce ear infections. However, in light of the AAP recommendation for pacifiers to reduce the risk of SIDS (9), this 2004 policy has not been reaffirmed. So, unless your child has a history of recurrent ear infections, the benefits probably outweigh the risks. Parents can reduce their child’s risk of otitis by limiting pacifier usage to only sleep times, and remove them from sight during play time.

Pro: Pacifiers can be offered to infants for pain relief

Pacifiers can be used for what is termed adjunctive pain relief during invasive or otherwise painful procedures. Encouraging an infant to suck on a pacifier has been shown to reduce pain response and often times the pacifier may be first dipped in sugar water for added relief, although breast milk has been shown to work equally well (10).

Con: Your baby can become dependent on pacifiers to fall back asleep

Babies can become dependent on the pacifier to fall asleep. When your baby is still too young to put the pacifier back in his mouth after it falls (or if it falls out of the crib), then getting up in the middle of the night over and over to retrieve a pacifier for your baby every time he wakes can be pretty exhausting. Luckily Elizabeth Pantely, author of The No-Cry Sleep Solution, has some great tips to remedy this situation.

Pro: Pacifiers can serve as transitional objects

Pacifiers can be comforting. And not just in the way an infant is comforted by the instinct to suck. Binkys can serve as transitional objects that provide a sense of security and comfort to older babies and toddlers too.

Con: Pacifiers drop and can get lost

You won’t want to find yourself in a situation where your baby is having a meltdown and you can’t calm her any other way because you’ve lost the pacifier! You can buy a backup-pacifier, a backup-backup-pacifier, and a backup-backup-backup pacifier. But thanks to Murphy’s Law, there will come a moment when you’ve can’t find any of them! Plus, pacifiers can fall to the floor and land on a particularly dirty spot. On the other hand, a thumb can’t get lost (though they may get dirty too!).

In the early months, a baby may love his pacifier but may not yet possess the hand-eye coordination to get it back to his mouth once it drops, which can be quite frustrating—for both baby and parents! That’s why we love WubbaNub pacifiers.
WubbaNub is a line of adorable plush animals attached to an Avent Soothie. The plush animal has a little weight to it so it adds some stability to the pacifier while it rests on your baby’s body. Your baby will love playing with the plush animal as well, and it will motivate him to practice his hand-eye coordination! There are a TON of animals to choose from, so you’ll be sure to find the perfect one. (As with any other stuffed animal or toy, don’t leave your baby alone with extra toys in his crib. Don’t use pacifiers attached to anything during unsupervised sleep times (9)).

Con: Extended pacifier use increases the risk for cross-bite and other problems with teeth

Studies have found pacifier use beyond the age of 3 to contribute to cross-bite. However, if toddlers are weaned from their pacifier by around 18-35 months, the risk decreases and any adverse effects that have already occurred are likely to reverse themselves naturally (6).

Pro: Pacifier use is an easier habit to break than finger sucking

While one con of pacifiers is that they can be lost and dropped, the flip side is that pacifiers can be taken away while it’s more difficult to prohibit thumb or finger sucking. What’s more, finger sucking can actually be more likely to cause dental problems than pacifiers (3).

Choosing a pacifier

From materials, styles, to nipple shape, there are many pacifiers to choose from. As mentioned above, Philips AVENT Soothie pacifiers are good if you must offer a pacifier during the early weeks of breastfeeding because of their straight shape (and are used in NICUs). Never use any accessory long enough to reach around your baby’s neck. When it comes to materials, silicone pacifiers are popular, but natural rubber pacifiers are also an option. Silicone is harder than rubber so if your baby prefers something slightly softer, than rubber is the way to go.

Whichever you choose, look for pacifiers from reputable manufacturers that don’t use toxic plasticizers and other additives. Natursutten makes 100% natural rubber pacifiers without synthetics or additives such as parabens, PVC, phthalates, softeners, or artificial color. Furthermore, Natursutten pacifiers are manufactured without the protein that provokes latex allergies. The pacifiers are molded as one piece, so there are no crevices for bacteria to accumulate. The original design of the pacifier is designed to gently touch your baby’s nose, as the breast does during nursing (a “butterfly” design is also available that has room for the nose).

Whether or not to offer your baby a pacifier can be a difficult choice with many factors to consider. Of course, it’s always a good idea to talk to your child’s pediatrician to discuss your baby’s individual circumstances.

Ready to wean your child off pacifiers?
Check out Bye Bye Binky! 5 Ways To Get Rid of the Pacifier

1. Horne, et al. (2014) Dummy (pacifier) use and sudden infant death syndrome: Potential advantages and disadvantages. Journal of Paediatrics and Child Heatlh, 50:170-174. doi:10.1111/jpc.12402
2. Biello, David. Pacifier Greatly Reduces Risk of Sudden Infant Death. Scientific American, 9 Dec 2005.
3. Hauck, et al. (2005) Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics, 116(5):e716-e723. doi: 10.1542/peds.2004-2631
4. American Academy of Pediatrics: Policy Statement (2012) Breastfeeding and the Use of Human Milk: Section on Breastfeeding. Pediatrics, 129(3):e827-e841. (doi: 10.1542/peds.2011-3552)
5. Bonyata, Kelly. What should I know about giving my breastfed baby a pacifier?, 31 Jul 2011.
6. Nelson, AM (2012). A comprehensive review of evidence and current recommendations related to pacifier usage. Journal of Pediatric Nursing, 27(6):690-699. doi: 10.1016/j.pedn.2012.01.004
7. Rovers, et al. (2008) Is pacifier use a risk factor for acute otitis media? A dynamic cohort study. Family Practice, 25(4):233-236. doi: 10.1093/fampra/cmn030
8. Salah et al. (2013) Recurrent acute otitis media in infants: Analysis of risk factors. International Journal of Pediatric Otorhinolaryngology, 77(10):1665-1669. doi: 10.1016/j.ijporl.2013.07.022
9. American Academy of Pediatrics: Policy Statement / Task Force on Sudden Infant Death Syndrome (2011) SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment. Pediatrics, 128(5):1030-1039. doi: 10.1542/peds.2011-2284
10. Shah, et al. (2007) Breastfeeding or breastmilk to alleviate procedural pain in neonates: A systematic review. Breastfeeding Medicine, 2(2):74-82. doi:10.1089/bfm.2006.0031

Photo credits: Newborn with Soothie adapted from Family O’Abé (CC BY 2.0); Toddler in crib adapted from Donnie Ray Jones (CC BY 2.0); Toddler girl with pacifier adapted from nerissa’s ring (CC BY 2.0); all other photos  The Whimsical Photographer.

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Laura is a wife and a new mom living on the East Coast. She and her husband welcomed their first child in September 2013. She has a passion for photography and an incurable case of Wanderlust. In her spare time she enjoys blogging about photography, travel, married life, and motherhood at The Whimsical Photographer.

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