Pacifier. Yes or No? The Essential Information You Need to Know.

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Dr. Sandro Cantoni. Updated: 20 September 2021

With the collaboration of Dr. Francesca Veronesi, Dentist, Outpatient Clinic of Pediatric Dentistry in Novellara (RE – Italy).

The sucking of the pacifier or thumb, or other fingers, is a way that the baby uses to calm down or to fall asleep or to play and explore with the mouth.

Actually, finger sucking can begin before birth, in utero.

However, it is necessary to know the benefits and possible harmful effects of the pacifier, especially if it is used incorrectly and for too long.

Is it better for the baby to suck his thumb or the pacifier?

My baby sucks his thumb, but he also takes the pacifier well. Which is better?

If possible, the pacifier is better.

If possible, because some babies always spit out the pacifier and put their fingers in their mouth.

The pacifier is better because it is much easier to lose the habit. Children who suck their thumbs are more likely to keep the habit even around the fourth or fifth year of life.

Pacifier and Teeth Problems

If the pacifier or thumb habit persists for several years there may be problems with your child’s teeth.

Malocclusion

This problem can appear as early as the baby’s teething years.

One of the most common malocclusions is the “open bite”. In this case, the upper and lower incisors do not overlap well and an open “window” remains.

Another condition is when the upper teeth, when closing the mouth, are inside the lower ones. Basically the opposite of what normally occurs.

And there can also be malocclusion problems when permanent teeth erupt.

The best way to detect them early, or better try to prevent them, are regular visits to the dentist, already from the first year of life.

Caries

The pacifier is not associated with caries problems unless it is dipped in a sweet drink. Or if the parent has a habit of putting it in his or her mouth before giving it to the baby.

The best way to avoid cavity or gum problems is to brush the baby’s teeth properly, from the appearance of the first tooth.

Newborn pacifier. Are there problems with breastfeeding?

Several studies from a few years ago have shown that the introduction of the pacifier is associated with the earlier termination of exclusive breastfeeding. However, more recent studies have shown that the use of the pacifier does not interfere with breastfeeding when it is well established.

Pacifier yes or no?

My opinion is … YES.

In fact, it is true that it can give some inconvenience, such as dental problems if used wrong and too much, but it has a fundamental benefit.

If the pacifier is offered to the baby before falling asleep, this clearly reduces the risk of SIDS.

However, it is important to know the pros and cons of the pacifier before offering it to the baby.

Let’s see what they are.

Pros

When the baby is irritable, crying, inconsolable, sucking the pacifier can calm him down.

If the baby has difficulty falling asleep, the pacifier can help him. It has no influence on sleep duration or nighttime awakenings.

Research has shown that using a pacifier at bedtime reduces the risk of SIDS significantly.

In an airplane, during takeoff or landing, your baby may have ear discomfort from pressure changes. He is not yet able, as we are, to “pop” his ears by swallowing or yawning. Sucking on the pacifier achieves the same effect.

The pacifier can calm and distract the baby on some occasions. For example, during a visit to the pediatrician, or during and after vaccinations.

The pacifier is not very difficult to discontinue. When you have decided that it is the right time to do so, and the baby accepts it, it can be thrown away.

Cons

While limited use in the first 2-3 years of life generally does not lead to complications, heavy or prolonged use can be detrimental to the teeth, as mentioned above, with problems of altered tooth alignment.

Sucking the pacifier is not the same sensation the newborn experiences during breastfeeding, therefore it is better to wait until this is well established before introducing the pacifier.

Several studies have shown that pacifier use moderately increases the risk of otitis media.

Some babies get used to having the pacifier in their mouth all the time. Even during the night, and then they wake up if it falls out of their mouth.

When to give or not to give the pacifier to the newborn? The do’s and don’ts.

But when do I start giving my baby a pacifier? Right from birth? Can he keep it all day long? What kind do I use?

Don’t use the pacifier right away as soon as your baby starts crying.

Maybe he needs to be changed or wants to be held, or a short cuddle time can calm him down. Remember that the pacifier should never be used alone, in a crying baby, but always along with your caresses, or cuddles.

Do not use the pacifier to delay feeding time.

If the baby is crying or showing signs of hunger, you must feed him or her as soon as possible.

Wait until breastfeeding is well established.

It is better not to give the pacifier after a few days from birth.It is best to wait until breastfeeding is well established, usually after a few weeks.

It is best to wait until breastfeeding is well established, usually after a few weeks.

Let your baby be the one who wants to use it.

If the baby is quiet and does not seem interested, do not offer the pacifier. If your baby is sleeping and the pacifier has fallen out, don’t put it back in his mouth.

Try to use it for as little time as possible.

Only at the moment of falling asleep and if he cries inconsolably. That way it will be much easier to remove it later.

Choose a silicone or rubber, one-piece, safe pacifier.

The two-piece pacifier can break and lead to suffocation. When you’ve found a suitable pacifier, buy another identical, spare one.

Clean the pacifier often.

Perform a thorough cleaning every time you give your baby a pacifier.

Until 6 months of age, your baby’s immune system is not fully mature, so it is best to boil it often, or use a sterilizer, or put it in the dishwasher.

This reduces the risk of thrush, an infection of the mouth due to a mushroom called candida.

After 6 months, you can wash it with soap and water.

Do not put sugary foods or drinks on the pacifier.

Your baby gets used to the sweet taste and increases the risk of cavities when baby teeth have come out.

Check the pacifier often and keep it safe.

Change the pacifier often, every 1 to 2 months, and buy one that is age-appropriate. Each time you give it to your baby, check for cracks or cuts, which can put him at risk of choking.

Do not use necklaces or strings around your baby’s neck to hold the pacifier.

If the baby falls or rolls over, such as while sleeping, there is a risk of choking or serious injury. Instead, you can use clips attached to the dress, with a very short strap.

Don’t make “homemade” pacifiers.

Don’t make your own pacifiers using bottle nipples, or anything else. There is a risk of suffocation. 

Types of pacifiers

Your baby may not necessarily like the first pacifier you buy him right away.

His oral sensations may be different and a baby may prefer one shape or another.

Also depending on the age, a baby may suck on the pacifier to comfort himself, to explore and play with his mouth, to relieve teething discomfort, or to fall asleep.

Cherry pacifier

This shape is resembling the mother’s nipple so this pacifier is good for newborns

Teardrop pacifier

The teat has a slightly elongated structure and a tip that goes downward.  This allows the pacifier to fit between the tongue and palate more naturally, reducing pressure on the palate.

Pacifier Materials

Rubber

Caoutchouc is a natural rubber, which has the characteristics of elasticity and strength. For this reason, it is particularly suitable for older babies with their first teeth.

It is not ideal for infants, as this material can be easily contaminated, as it is not waterproof.

Silicone

It is a less resistant material than the previous ones, but it becomes less easily contaminated and is suitable for sterilization.

For this reason, it is appropriate for infants, especially before the appearance of teeth.

Removing the pacifier. When should it be done and how?

After a few years of using the pacifier, to avoid dental problems, it is advisable to help the toddler get used to using it.

When to remove the pacifier?

It is convenient to begin to dishabituate the pacifier after the first year of life, even if it is not easy to remove it before the second birthday.

To avoid dental problems, it is better not to exceed three years of age.  

How to remove the pacifier?

Never force your child to give up the pacifier, for example with punishments or humiliations (e.g. “you’re already big, only babies use it, etc. ….”).

In this way, you get exactly the opposite effect of what you want. In fact, it increases the stress of the baby, and therefore the need to suck the pacifier. 

Instead, it is necessary to involve the toddler in the choice of taking off the pacifier.

But how to do this?

First of all, try to find a period that is as calm as possible.

If you are going through an important change, for example, if you move house or if a new brother or sister arrives, it is better, if possible, to postpone the removal of the pacifier for a few months.

Each family will find a suitable way to proceed, but positive reinforcement that makes the child happy is effective.

For example, using a calendar with star stickers or something else to support progress. Or exchanging the pacifier for a beautiful gift.

Sometimes it is the child himself who wants to throw away the pacifier because “he has become a big kid.”

Express to the child your admiration for his effort, that you are truly happy.  Support even his moments of anger or agitation with an extra dose of cuddling.

But it’s not always easy and simple…

Everything seemed to be going well. Now my toddler is crying his eyes out, fussing, and wanting his pacifier back. What do I do?

Almost all children who leave the pacifier behind do this.

However, once the pacifier is removed, even in the face of the most insistent cries of the child, you absolutely must not give in.

Explain calmly and firmly that the pacifier has been removed forever and that he has now grown up.

Clearly, it is essential that those who take care of the child, grandparents or babysitters, do the same thing and do not give in to the child’s insistence.

Conclusions

You can safely give your newborn a pacifier because the benefits outweigh the disadvantages.

Just follow the directions above for safe and pleasant use.

However, it is necessary to be prepared, after the first year of life, for the moment of removing it, around 2-3 years at the maximum, to avoid dental problems.

References

American Academy of Pediatric Dentistry. Guideline on management of the developing dentition and occlusion in Pediatric Dentistry. Pediatr Dent. 2014;36(6):251.

Canadian Pediatric Society. Pacifiers (soothers): A user’s guide for parents. Paediatr Child Health. 2003 Oct; 8(8): 520–521.