The Great Pacifier Debate

You'd think something as small as a pacifier wouldn't cause such a big ruckus. But it seems that moms and dads either rave over them or revile them. But who's right? Pediatricians, parents, therapists, and dentists weigh in on the pros and cons of baby pacifiers.

A Few Reasons to Use a Pacifier

There are lots of good reasons to use pacifiers -- just ask any parent who's gotten a moment of quiet with the judicious use of one. But a bit of peace isn't the only good thing that comes from using a pacifier.

• Protection against SIDS. The American Academy of Pediatrics recommends parents consider letting their child fall asleep or nap with a pacifier for their first year. Doing so has a protective effect against sudden infant death syndrome (SIDS). Use the pacifier when putting baby down to sleep, but don't put it back in baby's mouth once he's already asleep.
• Helping babies pacify themselves. Infants need ways to soothe themselves, says pediatrician Jennifer Shu, co-author of Heading Home with Your Newborn: From Birth to Reality. A pacifier can be a source of comfort for a crying or colicky baby.
• It satisfies the suck reflex. Pediatrician Laura Jana, co-author with Shu of Heading Home with Your Newborn, says some babies have a need to suck that exceeds the time they get on the bottle or breast. For these infants, a pacifier can meet this very real need.
• Easier weaning. When you're ready for a child to stop, it's much easier to wean him from a pacifier than from his own thumb, Shu says.

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Reasons to Avoid a Pacifier

While some parents hope to avoid pacifiers all together, Jana doesn't think that's necessary. Yet there are a few issues to watch for when using a pacifier:

• According to a study reported in Pediatrics, pacifiers may lead to 40% more ear infections (called acute otitis media). Though researchers aren't sure why this happens, they suspect it may be due to a change in pressure between the middle ear and upper throat. One study showed that "children who stopped using pacifiers regularly after the age of six months had more than a third fewer middle ear infections than children who use them," Rod Moser, PA, PhD, writes in his WebMD blog "All Ears."
• If a pacifier is introduced too early, there's the risk of nipple confusion for a baby who's just learning to nurse, Shu says. If you want to give your baby a pacifier, wait until breastfeeding is well established before starting (usually a few weeks).
• Parents can mistakenly offer a pacifier when baby really needs nutrition-based sucking, such as on a breast or bottle.
• Babies who are overzealous suckers may change their tooth alignment or delay speech. This especially becomes important when the child becomes a toddler and does not give up the pacifier. Sucking a pacifier at this stage can lock the mouth into an unnatural position and cause dental problems later on. Additionally, talking around a pacifier may delay speech development.

If you decide your baby should have a pacifier, make sure to buy one that states the same age on the label as your child's age. Buying pacifiers that are meant for younger infants could pose a choking hazard. Lastly, you may want to get a bisphenol A-free plastic pacifier as there have been studies showing that endocrine-disrupting hormones found in some plastics can be harmful to infants.

Nah nah, sucky, paci, binky, nuk-nuk, tooky -- whatever kids call them, one of the most important facets of successfully using a pacifier is knowing when to stop using it. Though some pediatricians suggest weaning from the pacifier at about nine to 12 months -- the same time you banish the bottle -- others believe aiming to wean by about 3 years is fine.

Whenever you choose to wean baby, you can make the transition to being pacifier-free a little easier on you and your little one with these tips from the pros:

• State your intentions. "My first tip is to always, always prepare your child in advance for what you're going to do," says family therapist Mark Brenner, author of?Pacifiers, Blankets, Bottles, and Thumbs. "For example, I'll say, 'Jordan, in three days we're going to be done with the pacifier, and I know you understand and that you can do it.' You don't want the thing to just disappear."
• Try the limit rule. Take the weaning a little slower by setting limits. Pick rooms that the pacifier can be used in, for example, maybe the bedroom but not the living room. Or try limiting the time the pacifier is used. If you need to, Shu says, "give a substitute comfort object such as a small lovey toy or book that the child can carry around for security."
• Leave it out. Refrain from going into the baby's room to put the pacifier back in when your baby uses it at night. The recommendation for using pacifiers to help prevent SIDS only applies to a baby falling asleep. There's no suggested benefit once a baby is asleep.
• Love the lulls. Take advantage of the natural lulls in a child's attraction to the pacifier. For many babies, that's in the second half of the first year. Be aware that often babies don't ask for a pacifier "as much as parents are quick to offer" it, Jana says.
• Go snippety-snip. When your child's not around, cut the pacifier's nipple a little, Brenner says. "Then show your child that the nipple has been damaged." Explain that the pacifier is now dangerous and has to be thrown away. Never cut a pacifier and give it back to your child -- a step some parents take in an effort to wean -- because it poses a very real risk as a choking hazard.?
• Don't plan for emergencies. Some parents and pediatricians suggest cold turkey is the best way to go, especially for older children. But don't keep an "emergency" pacifier on hand, Jana says. This only reinforces the idea that if your little one cries long enough the beloved binky will magically reappear.

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Precautions for Pacifier Safety

• Never put the pacifier on a cord around baby's neck or crib because of the risk of strangulation.
• Look for a pacifier with ventilation holes?in the shield, recommends the Academy of General Dentistry. The holes permit air passage.
• Look for pacifiers with symmetrical nipples, which help the pacifiers stay in the right sucking position. Also look for those with a shield wider than your baby's mouth.
• Don't share a pacifier between children, and don't clean a dropped one with your own mouth. "Parents' mouths have plenty of germs," Shu says, and can transmit viruses and bacteria to the baby. Shu recommends washing a pacifier with soap and water or at least giving it a good rinse.
• Don't dip a pacifier in something sweet before giving it to your baby, especially not honey. Honey can be a source of botulism, a serious disease, in children under the age of one year.

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