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Pros and Cons of Pacifiers

The pacifier—that time-honored baby accessory—is back in the news, being reexamined in light of a review of studies showing a relationship between pacifier use and a significantly reduced risk of sudden infant death syndrome, commonly known as SIDS. In fact, new American Academy of Pediatrics (AAP) guidelines state that pacifier use should actually be encouraged in children younger than one year of age. Here are some pros and cons of pacifiers.

According to review author Dr. Fern Hauck, MD, an associate professor of family medicine and public health sciences at the University of Virginia Health System in Charlottesville, Virginia, the benefits of pacifiers outweigh the risks. “We’re not telling people they have to use a pacifier, but we want them to have the information to know that it is potentially protective, [so] they can make an informed choice whether to offer one,” she says.

The Pros

“We’re seeing a consistent protective effect from SIDS from use of a pacifier,” says Dr. Hauck, stating that pacifier use offered a 61-percent reduction in risk of SIDS—clearly a lifesaving benefit, although experts aren’t sure exactly how pacifiers lower risk. “There are several theories that have been proposed. None have been proven, of course, and also we still don’t know the exact cause of SIDS.”

“A leading theory is that the pacifier actually helps improve the arousability of infants who are potentially faced with a life-threatening challenge,” says Dr. Hauck. “There are other theories that say that it might have a more direct mechanical effect.” For example, the pacifier may actually help keep the oral airway open by pushing the tongue forward.

In addition, pacifiers make a baby feel good, says Dr. Cathryn Tobin, MD, pediatrician and author of The Lull-A-Baby Sleep Plan. Sucking stimulates the release of chemicals from the brain that actually decrease stress.

Of course, babies can self-soothe with their fingers or thumb as well, and both can become a habit—a habit that may damage teeth if allowed to continue when permanent teeth come in. But while it’s not always easy to break a pacifier habit, it’s a whole lot easier than breaking a thumb-sucking one, notes Dr. Hauck.

Before having her twin sons, Karen Spring had heard a lot of negative talk about pacifiers, but after deciding to use them to help her boys settle, she was pleasantly surprised. “One son used a pacifier for a couple of weeks, and the other used one for about three or four months,” says Spring, of Deptford, New Jersey. “I had no problems whatsoever and would definitely use a pacifier again if I had another child.”

The Cons

So what are the downsides? The biggest is that pacifier use could potentially interfere with breastfeeding, says Dr. Maria Tupas, medical director of Children’s Hospital of Orange County Primary Care Clinics in California. It isn’t clear from studies on nursing and pacifier use whether pacifiers actually cause breastfeeding problems or are simply a marker that such problems may be occurring. However, the interval between the introduction of the pacifier and weaning may be several months, says Dr. Tupas, which suggests that pacifier use might reduce stimulation from suckling, resulting in a gradual reduction in breast milk production.

This doesn’t always have to be the case, says Dr. Hauck. “There’s no question that frequent sucking on the breast is going to help maintain a good milk supply. So it is important that breastfeeding moms wait until baby is nursing well—it usually takes three or four weeks—before introducing the pacifier, and also that the breast always be offered first when the baby appears hungry.”

Pacifier use has also been associated with a higher risk of ear infections, yet it’s a fairly small increased risk, says Dr. Hauck. Ear infections generally are more common in infants over six months of age, which is one of the reasons the AAP suggests stopping pacifier use by one year.

Other downsides may include a baby relying on a pacifier for comfort. Hildee Weiss’ son Seth was attached to his pacifiers from the moment he got his lips on one. “The pacifier definitely helped keep him calm and happy,” says Weiss, an Ohio mom of five. “Unfortunately, he got so hooked on it that … we found ourselves constantly going back and forth to his crib in the middle of the night, plugging his pacifier in when it would fall out.”

And unfortunately, pacifiers can affect a child’s teeth when used improperly. Consequences seen may include cavities, malocclusion (crooked teeth), and gingival (gum) recession, says Dr. Adriana Modesto, DDS, assistant professor of pediatric dentistry at the University of Pittsburgh School of Dental Medicine. These problems are seen when a child has been using pacifiers for a long time during the day, over many months, and especially if the pacifier has been dipped in sugar or other sweeteners.

However, many of these issues can be avoided by using a pacifier the right way.

Best Pacifier Practices

If you’re breastfeeding, wait until nursing is well established (usually by around one month) before offering a pacifier, recommends Dr. Tupas. Because SIDS is less common in the first month of life, it’s reasonable to delay pacifier introduction during this lower-risk period. If you are formula feeding, it’s OK to offer a pacifier at birth. Never use a pacifier as a substitute for nursing or feeding, and never coat a pacifier in sugar, honey, or other sweet substances.

While there’s no one brand of pacifier that is recommended, well-known brands tend to be well-tested. “In some ways, you get what you pay for,” says Dr. Hauck. “I would avoid the five-for-a-dollar pacifiers or anything that looks kind of flimsy.” Make sure to choose an age-appropriate size, too.

There is no best shape or type of pacifier, so give your baby the pacifier he enjoys most, says Dr. Tobin. This may mean allowing him to try out several kinds. She adds that pacifiers with clear silicone nipples tend to last longer than the old-fashioned rubber nipples, which break down over time.

Try to keep pacifiers clean, says Dr. Hauck. While the old “stick the pacifier in mom’s mouth” trick is still around, Dr. Hauck advises against it. “Running under water is better!” Check your baby’s pacifiers frequently, and if they are cracking or showing signs of wear and tear, replace them. Clean new pacifiers before first use according to package directions.

Never tie a pacifier around a baby’s neck, says Dr. Hauck. Clip-on tethers that don’t go near the neck should only be used while you are observing your baby. Babies should go to bed with a plain pacifier.

Offer the pacifier to your baby at naptimes and bedtime, suggests Dr. Tupas. In fact, many breastfeeding families choose to offer a pacifier only at those times. Once your baby is asleep, the pacifier should not be reintroduced if it falls out of the mouth.

Finally, keep in mind that it’s best to start phasing out pacifier use by around one year of age.

And what if your baby wants nothing to do with the pacifier? There’s no reason to force her to take it, says Dr. Hauck. “If you try it, and Baby doesn’t like it, wait a few weeks and try again. And if the baby still doesn’t want it, then just don’t worry about it. Just make sure you are following all the other SIDS risk reduction measures. Having your baby sleep on her back is still the most important thing.”

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