PACIFIERS: THE GOOD, THE BAD & THE UGLY

To use a pacifier or to skip the pacifier, is an ongoing question and debate among moms. In the end it is a personal decision, however the more information you have the better equipped you are to make the decision that is right for you and your little one.

Before we discuss the details of the pacifiers, I will offer you a little neurological background on non-nutritive sucking and suck-swallow-breath, because they are both big justification for the use of a pacifier. Suck-swallow-breath, which is vital for feeding success, is typically fully developed by 36 weeks gestation, but some babies take a little longer especially preemies or newborns with more medical needs. Non-nutritive sucking is a precursor to nutritive sucking and has many benefits.

Benefits of Non-Nutritive Sucking

1.     Improved oral strength & coordination of sucking for nursing and feeding.

2.     Stimulates absorption of nutrition and aids in digestion.

3.     Improved self-soothing skills.

4.     Decreases sudden infant death (SIDS) risk, when used during nap and bedtime.

5.     Helps decrease GERD and prevent aspiration.

6.     Add something sweet, and sucking decreases pain during medical procedures.

7.     Preemies: pacifier use may decrease hospitalization time, increase success with oral feeding/breast feeding, and increase weight gain.

All the non-nutritive suck benefits are also the positive justifications for the use of a pacifier. The alternative option to a pacifier is often thumb or finger sucking, which has the same non-nutritive sucking benefits, however, is often harder to extinguish when the risks start to outweigh the benefits. Most sources find pacifier use for the first year of a baby’s life has more pluses than minuses.

What is the Down Side of Pacifier Use?

1.     The extra sucking is not good for babies who have chronic ear infections, due to the increased pressure.

2.     Beyond 12 months, pacifier use may impact speech development, per multiple speech and language pathologist. This is especially true if a pacifier is used for several hours during the day, or an abnormal tongue placement results due to dental changes.

3.     Prolonged sucking of a pacifier or a thumb, especially beyond 1-2 years increased the risk of an overbite, posterior cross bite & an open bite.

4.     Some sources report decreased breastfeeding duration with pacifier use, although the evidence is not strong.

Using an orthodontic pacifier, trying to eliminate pacifier use after 12-month-old, focusing more of its use during sleeping vs. waking hours, will all help mitigate most of the negative aspects of pacifier use. If you have a premature baby, pacifier use seems to have even more benefits, and once breastfeeding is established for term infants there is little evidence breastfeeding will be significantly impacts, however listen to your own judgement as everybody and situation is different, and as a previous breastfeeding mom I know breastfeeding can be stressful and not for the weak of heart.

The moral of the story is that there are many benefits to non-nutritive suck, including decreasing SIDS risk and better self-regulation, among others. Using a pacifier beyond a year may increase your baby’s risk of future orthodontic issues and may impact their language development, but an orthodontic pacifier is easier to remove than thumb sucking. The pacifier choice is yours, having the information, knowing your baby and what your gut says are the key to finding what decision is right for you.

With Luck, Love & Light! XO Rachel

REFERENCES

1.     Ling HTB, Sum FHKMH, Zhang L, Yeung CPW, Li KY, Wong HM, Yang Y. The association between nutritive, non-nutritive sucking habits and primary dental occlusion. BMC Oral Health. 2018 Aug 22;18(1):145. doi: 10.1186/s12903-018-0610-7. PMID: 30134878; PMCID: PMC6106723.

2.     Jullien S. Sudden infant death syndrome prevention. BMC Pediatr. 2021 Sep 8;21(Suppl 1):320. doi: 10.1186/s12887-021-02536-z. PMID: 34496779; PMCID: PMC8424793.

3.     Lubbe W, Ten Ham-Baloyi W. When is the use of pacifiers justifiable in the baby-friendly hospital initiative context? A clinician's guide. BMC Pregnancy Childbirth. 2017 Apr 27;17(1):130. doi: 10.1186/s12884-017-1306-8. PMID: 28449646; PMCID: PMC5408445.

4.     Orovou E, Tzitiridou-Chatzopoulou M, Dagla M, Eskitzis P, Palaska E, Iliadou M, Iatrakis G, Antoniou E. Correlation between Pacifier Use in Preterm Neonates and Breastfeeding in Infancy: A Systematic Review. Children (Basel). 2022 Oct 19;9(10):1585. doi: 10.3390/children9101585. PMID: 36291521; PMCID: PMC9600199.

5.     Schmid KM, Kugler R, Nalabothu P, Bosch C, Verna C. The effect of pacifier sucking on orofacial structures: a systematic literature review. Prog Orthod. 2018 Mar 13;19(1):8. doi: 10.1186/s40510-018-0206-4. PMID: 29532184; PMCID: PMC5847634.

6.     Strutt C, Khattab G, Willoughby J. Does the duration and frequency of dummy (pacifier) use affect the development of speech? Int J Lang Commun Disord. 2021 May;56(3):512-527. doi: 10.1111/1460-6984.12605. Epub 2021 May 3. PMID: 33939239.

7.      Tolppola O, Renko M, Sankilampi U, Kiviranta P, Hintikka L, Kuitunen I. Pacifier use and breastfeeding in term and preterm newborns-a systematic review and meta-analysis. Eur J Pediatr. 2022 Sep;181(9):3421-3428. doi: 10.1007/s00431-022-04559-9. Epub 2022 Jul 14. PMID: 35834044; PMCID: PMC9395499.