The Use of Pacifiers; Yea or Nea

on July 10, 2014 in Breastfeeding, Pacifiers

Many, many parents use pacifiers (also called dummies, binkys, paci’s or soothers) for their babies to suck on. But are they a good thing or not? So many babies use pacifiers, that there is an entire industry of not only for them, but for their accessories as well.

There’s no denying a pacifier can work very well at comforting your baby and ending her crying (especially if she has a strong need to suck but hasn’t mastered how to get her fingers into her mouth). Sticking a binky into your baby’s mouth can seem like the magic bullet!

But there are some potential pitfalls to be aware of before introducing your baby to a pacifier if you are considering using one. Here’s a look at some of the pros and cons of using pacifiers.

Giving a pacifier to a newborn can lead to difficulty in getting the baby to latch onto the breast and certainly can be a complicating factor if the baby is having difficulty latching. Pacifiers feel very different inside a newborns mouth than the mother’s soft, warm nipple that is shorter and also has a very different shape. Sometimes this is referred to as “nipple confusion”, but I think a better term is“nipple preference”.  The longer, stiffer pacifier doesn’t even require the baby to open wide and search for the nipple. It can just be pushed into the baby’s mouth.

If a baby is having problems gaining weight or if a mother is having a problem bringing in or maintaining the milk supply, it’s probably best to do without a pacifier .

Breastfed babies often do best when pacifiers are delayed at least until they are one month old, are latching well and are gaining weight normally.

Lactation consultants have all seen infants, even older babies, who fail to gain weight when the baby depends on a pacifier and the number of nursings decreases due to the lack of frequent breast stimulation and drainage. Most 4-6 month olds often will delay crying for a feeding when they are using a pacifier. Crying is actually a late feeding cue in babies around that age.

Frequent nursing is the best way to build and maintain a good milk supply, which remains a necessity long after the first month. Most babies drink a third of their daily milk intake during their night feedings, so using a pacifier to calm a crying baby at night can lead to poor weight gain as well as plugged ducts, mastitis, and a decrease in milk supply. In other words, pacifiers can easily sabotage nursing.

There are studies that have been done on the use of pacifiers. Studies have been linked the use of pacifiers with higher rates of ear infections by 33% or higher.

Experts on infant bonding also worry that a baby’s cry is meant to initiate connection, and pacifiers could take the place of love. From a bonding perspective, nursing is not just about feeding a baby, it’s about emotional nurturing. When a baby cries, she needs to be held and comforted.

Parents can become a bit addicted to pacifiers. I often watch alert, quiet babies whose mothers stick pacifiers in their babies’ mouth for some odd reason that I have never understood.  I have also seen hundreds of mothers bend over to pick up their infants dropped pacifier off the ground and place it back to the baby. Some mothers even pick up the dirty pacifier off the floor and put it in their own mouths to “clean it off” not understanding that adult saliva contains bacteria that can cause cavities in your baby’s teeth as soon as they begin to erupt from her gums.

Pacifiers can also become a sleeping crutch.  If the baby wakes without the pacifier in her mouth, you and your partner may get less sleep if you are needing to get up, find the pacifier, and give it back to her each time the baby wakes. Worse, unless you have extras, if you can’t find it, you may be heading to a late night drug store to replace it.

Some pacifiers can be dangerous. Old pacifiers are more likely to break off and become a choking hazard. They need to be replaced just as soon as it shows small cracks or other signs of wear. Using a bottle nipple as a pacifier, which usually lacks the wide base, can also cause choking. Pacifiers need to be washed often to keep them free from germs.

Pacifiers are usually made of latex or silicon. Latex can cause allergic symptoms for some infants. Also, latex pacifiers leak low levels of nitrosamines, a known carcinogen.   Some pacifiers are still made with diisononyl phthalate (DINP) or phthalate esters, which can be released during sterilization. Silicone pacifiers were considered safe for a long time, but are now highly suspect.  The only safe pacifier on the market is thought to be Natursutten’s rubber pacifier, which has no synthetics or additives, but the instructions say they have to be replaced every five to seven weeks to stay safe, which is costly and inconvenient.

Babies often become a dependent on a certain brand or shape of pacifier, making it difficult to replace in a pinch. And, many cheep off brand pacifiers have been re-called due to poor manufacturing.

Pacifier use can be hard to break, especially when your baby becomes a toddler or young child. While your child is unlikely to damage her teeth, jaw, or bite if she stops using a pacifier by the time she’s 2 years old, using a pacifier beyond this time may cause problems of slanting or tilting the top or bottom front teeth. The risk of improper dental development increases the longer your child uses a pacifier, too. If you ever become concerned about this, ask your baby’s doctor or dentist to check that your child’s jaw and teeth are doing fine. Pacifier use after age 4, the time when permanent teeth start to come in, can have major long-lasting effects on adult teeth.

On the flip side, babies who are put to sleep with a pacifier are thought to have a lowered risk of Sudden Infant Death Syndrome by some researchers. The reasons for this seem unclear. But still pacifiers are not suggested for use in breastfed infants under the age of one month, even by the American Academy of Pediatricians.

However, many breastfeeding experts are challenging the recommendation of the American Academy of Pediatricians.  They argue that SIDS is thought to result from an infant falling into too deep a sleep before his body has gained the ability to regulate its own arousal.  Sucking on a pacifier while sleeping keeps the baby from sleeping as deeply, thus guarding against SIDS.  However, breastfeeding is designed to be the perfect way to help babies regulate their arousal systems during the early months of life:  waking frequently at night to nurse, and sleeping near their mother. In fact, co-sleeping and breastfeeding have both been shown to have a protective effect against SIDS, because the baby’s physiology is kept at a higher level of arousal.  Her sleep cycles parallel the mother’s.  SIDS was probably unknown before separate bedrooms and cribs were invented, and as both co-sleeping and breastfeeding have increased since 1992, the incidence of SIDS has decreased.

One might argue that a thumb is more natural than a pacifier. But in the middle of the night, a baby can always find his thumb, when he almost certainly will not be able to locate his pacifier by himself. Most toddlers who suck their thumbs are often the best sleepers.  However, neither thumb nor pacifier should be used past the age of four, when the arrival of the permanent teeth nears. And that’s where the pacifier may be better than the thumb.  Of course, there are many kids who give up their thumbs easily.

Another recent study has suggested that boys who used pacifiers as babies may struggle later on with emotional expression.

Here are some additional comments and guidelines for using pacifiers:

If you don’t want your newborn to have a pacifier at the hospital, tell the nurses ahead of time – especially if you intend to breastfeed.

In 1991, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) launched The Baby-Friendly Hospital Initiative (BFHI), a world wide program that was launched by 1991 to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding and mother/baby bonding. It recognizes and awards birthing facilities who successfully implement the Ten Steps to Successful Breastfeeding and the International Code of Marketing of Breast-milk Substitutes.

The BFHI promotes and protects breastfeeding in hospitals by giving all mothers the information, confidence, and skills necessary to successfully initiate and continue breastfeeding their babies or feeding formula safely, and gives special recognition to hospitals that have done so.

One of the ten steps to becoming a Baby Friendly facility is not distributing pacifiers to mothers for their nursing newborns. The reason for this being that some infants who use pacifiers may develop difficulties in recognizing and latching onto the breast. Another reason is that pacifiers may mask the newborns early feeding cues that are so important in helping with early milk production.

As of this writing, there are 175 Baby Friendly Hospitals and Birth Centers in the U.S. with another 500 in the process of becoming Baby Friendly. So if you are lucky enough to deliver your baby at a Baby Friendly hospital or birth center, you won’t even see a pacifier.

Some babies will not suck on a pacifier. Let your baby guide this decision. If she takes to it, fine. But if she resists, don’t force it. You can try again another time or just respect her preference and let it go.

Whenever possible, don’t use a pacifier to delay your baby’s feedings or as a substitute for your attention. That said, sometimes your baby does have to wait to be fed or comforted like in the checkout line at a store, for example, or in her car seat just a few blocks from home). In these instances, a pacifier can be a godsend.

Never tie a pacifier around your baby’s neck or to her crib. She could strangle in the cord or ribbon. It’s better to attach the pacifier to her clothes with a clip made especially for this purpose.

It’s also not a good idea to dip your child’s pacifier in juice, sugar water because this can also lead to cavities if your baby has teeth. Using honey on a pacifier can lead to botulism, which can be fatal in some cases.

And even if when a baby is crying, the automatic turn to the pacifier may mask the real reason for the tears, like needing to be changed, an upset tummy, painful teething, or just needing to be held. A pacifier isn’t a substitute for nurturing or feeding, of course, but if your baby is still fussy after you’ve fed, burped, cuddled, rocked, and played with her, you might want to see if a pacifier will satisfy her. Keep in mind that swaddling, rocking and of course, nursing, can also be a very effective way to calm and soothe a fussy young infant.

The pacifier habit is probably easier to break than the thumb habit, simply because it doesn’t stay on your child’s hand, always present.  Pacifiers can be thrown away, the child has a rough few days, but then moves on.  But the thumb is always there, and the giving up the pleasurable sucking is so very hard to resist.

I often hear mothers say that the baby is using the breast as a pacifier. But others respond this by answering, “Which would you rather your baby see as her source of comfort: You, or a piece of plastic?”

Pacifiers can help babies learn to control their feelings, relax them, and make them feel secure.  The comfort factor can be a win-win: A calmer baby can mean happier parents.

In closing, understand that each and every baby is different and some simply have very strong comfort sucking needs.  Most of the time, those needs are met by breastfeeding, but there are plenty of breast-fed babies who still suck their thumbs.  In fact, some infants suck their thumb or fingers in utero and come out already sucking their thumbs. And while a thumb is definitely a more “natural” choice than a pacifier, there is one way in which a pacifier trumps a thumb.  It can simply get lost for good!