baby sleep

Pacifier 101

As a sleep consultant and mom, I hear so much debate about the pacifier.  While using and eliminating the pacifier is such a personal decision, I wanted to breakdown some of the factors you may want to consider.  

Pacifier Pros

  1. The AAP recommends offering a pacifier at naps and nighttime to reduce the risk of SIDS.

  2.  Non-nutritive sucking is a natural reflex for a newborn, usually manifested by sucking the hands and fingers. The pacifier has been used as a method for fulfilling this innate desire. 

  3. The pacifier is soothing. For many children, the pacifier is an instant soother and can be more comforting than the bottle, breast, or rocking. Additionally, the parent doesn’t need to physically be there to provide this comfort.

  4. It’s easier to take away the pacifier than their thumb/fingers. It can take a couple days to a couple weeks for children to adjust to the removal of the pacifier. Stopping a child from sucking their thumb or fingers can be challenging since parents have limited control (especially during nap/nighttime).

  5. It’s convenient.  If you’re out in the stroller and your baby is fussy- pacifier. If baby has trouble putting himself to sleep- pacifier. Long car ride and baby is antsy-pacifier. As a parent I know how appealing this is. It’s a quick and easy way to provide comfort to our children with little intervention.

What if my baby won’t take a pacifier?

That’s ok!  You shouldn’t force it. Give it a few weeks of trying and after that just throw in the towel.  While you won’t be able to use it for soothing, it will be one less thing to wean off of.  

What is the best age to take away the pacifier? 

While there is no right answer, most professionals (and parents who have been through it) say before age 1 is best.  As a sleep consultant, I always try and respect a family’s wishes.  If they have a 2-year-old who sleeps with a pacifier and we’re working on other sleep challenges, I usually don’t push the parents to drop it unless they really want to.  On the flip side, if I’m working with a client who’s having to replace a baby’s pacifier multiple times per night, I recommend eliminating it.  If you’re playing the role of “pacifier fairy” then it’s not working for your baby (or you!). If your baby is old enough to replace it, you can try sprinkling multiple pacifiers in the crib so they can find it themselves but, I usually suggest just taking it away if the baby is young. It’s pretty quick and easy under 6 months. Again, I don’t push, I just make recommendations but let the family ultimately decide.

Expert Opinion: Pediatric Dentist Dr. Ela Jamiolkowski

To get further insight I spoke with Board Certified Pediatric Dentist Dr. Ela Jamiolkowsi of Tribeca North Dentistry for her expert opinion.

“The AAPD (American Academy of Pediatric Dentistry) recommends children stop any non-nutritive sucking habits by the age of three.  This can include bottle use, pacifier use, finger sucking, etc.  That being said, in my office I tend to look at each child and see what social/environmental factors are surrounding them before explaining any hard and fast rules.  For example, if I see that pacifier use has already had a significant effect on a child's appearance and dentition, I might recommend trying to wean the child sooner rather than later.  On the other hand, if a three-year-old comes into my office and is using the pacifier sporadically and I can't tell by his or her occlusion (how the teeth fit together) that they are using the pacifier, I tend to be a little more lenient.”

“We have to remember that pacifier use/thumb sucking/etc. is a method of comfort for the kids.  They are using it to self soothe.” Dr. Ela and I both agree that its not recommended to take the pacifier away during times of change (transitioning from crib to bed, a new sibling, a new home). We want to give a little grace and not change up their routine so much that they can’t cope with everything going on around them.  

Let’s talk in more detail about the effects of the pacifier on the oral cavity aka their teeth and mouth. I’ve often heard people say they’re just baby teeth and will fall out anyway. According to Dr. Ela, the problem with this statement is it is NOT the teeth that are first affected- it is the bone that is remolded incorrectly, which then leads to the teeth becoming crooked.  So even when the baby teeth fall out, the adult teeth will continue to take the shape of the palate and erupt not in the proper occlusion.

“The reason the AAPD recommends stopping pacifier use by age 3, is because studies show if the habit ceases by then the mouth will naturally go back to its proper configuration.  The younger the kids are, the softer and more malleable their bone (palate) is, so the better chance for autocorrection.  If you are not able to stop the pacifier use by age 3, depending on the severity of the malocclusion you are setting yourself up for many years in ortho most likely starting with palatal expansion, then leading into traditional braces.”

“The photos below are good examples of what I see with prolonged pacifier use: you can see the teeth are pushed forward, they don't fit together (upper teeth and lower teeth are supposed to touch).

pacifier1.png

The below is an example of normal for comparison:

pacifier2.png

Other tips from Dr. Ela

  1.  Always be truthful with your pediatric dentist about what’s going on at home.

“A lot of times parents will flat out tell me their child is not using a pacifier when it is clearly evident they are relying on some sort of non-nutritive sucking method.  I think pacifier use/thumb sucking is a natural way for a child to learn to self soothe, and it's completely natural that every child transition out of that on their own clock.  I don't think parents should fear telling the dentist or any medical provider if they are having trouble transitioning their child out of that habit.  The whole role of a medical provider is to work together with the parents to help the child transition in a healthy manner.”

2. Visit your pediatric dentist early and often- Especially if your child uses a pacifier.

“American Academy of Pediatric Dentistry recommends a visit by first tooth or first birthday!  The first visit is definitely to check on the kiddo and make sure there are no abnormalities or problems with the whole oral cavity, but even more so, the visit is to speak with the parent and discuss some topics having to do with anticipatory guidance and how to help care for their child’s dentition.

Expert Opinion: Speech Language Pathologist and Feeding Therapist Niki Klein 

We’ve all heard that pacifiers can affect speech and language development. To further weigh in I also interviewed Niki Klein who’s a Pediatric Speech-Language Pathologist and Feeding Therapist. Learn more about her here: https://nikikleinspeech.com/meet-niki/

I asked her what evidence is there to support that pacifiers can cause speech delays or speech development issues.  In her words the answer is somewhat “complicated.”

 “There are many studies out there but the evidence is still inconclusive.” Says Klein. “That being said, pacifier use has been shown to be linked with several conditions that are considered risk factors for developing speech and language difficulties like ear infections and dental problems. Frequent or prolonged use of pacifiers has been shown to be linked with developing otitis media (or middle ear infection). Repeated ear infections can increase your child’s risk of hearing loss and can even cause temporary conductive hearing loss.  Children with hearing loss (permanent or temporary) have more difficulty learning spoken language.”

 “Further, it is important to consider that when a pacifier is frequently in a baby’s mouth, he/she just has less opportunities for vocal play and exploration.” “During vocal play, babies experiment with their mouths learning how to make different sounds (e.g., ga, ba, oo) and then eventually string those sounds together (e.g., ma ma ma, ba ba ba). In addition, when caregivers hear their babies making these sounds, they often react positively, reinforcing these types of vocalizations and helping babies learn that their voices have purpose and can be used to communicate their wants and needs.  If a baby frequently has a pacifier in his/her mouth, he/she is less likely to engage in this kind of play and if he/she does, sounds will be distorted.”

 I thought this was a particularly good point and one I had not thought of.  As a mom of an 11-month-old who does not use a pacifier, I notice she is constantly making noises while putting herself to sleep, waking up in the morning, or even out in the stroller.  I now wonder if she would have these opportunities if she took a pacifier.

Niki typically recommends weaning as soon as possible but at latest around the child’s first birthday.

As I mentioned above, it’s important to note that children under 2 could resort to sucking their thumb or fingers instead of the pacifier.  Niki says that “Prolonged finger/thumb sucking can have negative consequences equal to or greater than those generally associated with pacifier use and is eventually more difficult to stop as your child’s fingers are always there! It is important to try and avoid your little one becoming dependent on their fingers for self-soothing.”

More thoughts from Lauren

From my experience, many toddlers often stop napping or go on a nap strike when taking away the pacifier between ages 2 and 3.  Parents need to be prepared for this to happen. More often than not the nap comes back after a couple weeks.  However, some parents report that their child’s nap never returned.

This is another reason why I recommend taking it away as early as possible because the odds of a 1-year old boycotting naps are very slim.  They’re simply much too young to withstand a whole day without sleeping! I recommend children keep their nap until minimally 3 years old.  Most children phase out of their nap between 3 and 4 although there are some outliers.  If your child is over one then you should consider using an angel dear lovey as a transitional object (pacifier replacement). Incorporate the lovely into your bedtime routine and talk to it like it’s a member of the family. Children love soothing with these. If your child is under one please speak to your Pediatrician about this as the AAP recommends nothing in the crib until their first birthday.

 Ways to eliminate the pacifier

  1. Cold Turkey- For children under 18 months this is by far the quickest and easiest way. It’s usually no more than a couple tough days. Start at night and move into naps the following day.

  2. Gradual wean- For children over 18 months you may want to consider a more gradual approach. First limit the pacifier to the crib only. Then take away for nighttime for a few nights, then naps. 

    For older toddlers (2.5+) you may want to get creative with your approach. Below are some methods that Niki Klein recommends.

    • Cut the tips off of pacifiers. After the ability to suck is removed, many children quickly lose interest. You can even tell the child that the pacifiers are broken and help them throw them out.

    • Encourage your child that he/she is a “big” girl/boy and “send” the pacifiers to new babies who need them.

    • Have children trade their pacifiers in for a new toy.

    • “Lose” the pacifier or have “someone” (e.g., doctor, dentist, Santa, etc.) come and take them in the night. 

      The major takeaways are below: 

  1. If you’re having to replace the pacifier multiple times per night, it’s time to ditch it.

  2. The recommended time to take it away is before/at age 1.

  3. If your child is still taking a pacifier after age 3 there could be long term effects to their occlusion or speech.

  4. See your pediatric dentist early and often (especially if your child takes a pacifier or sucks thumb) as they will want to clearly monitor mouth development.

  5. Using a pacifier could limit opportunities for vocal exploration.

  6. There are several ways to kick the pacifier habit but if your child is under 18 months, cold turkey is the recommended approach.

I hope this post was helpful! If you have any questions or concerns please drop me a note in the comments, DM me on Instagram @lololullaby, or email me lauren@lololullaby.com