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Pacifiers

Why use a pacifier?

The amount of extra sucking babies do when they are not feeding varies. This extra sucking is a beneficial self-comforting behavior. Some babies suck on their thumb or fingers almost constantly. If you have a baby like this, you may want to try to interest him in a pacifier.

To be accepted as a substitute for the thumb, the pacifier has to be introduced during the baby's first 2 months. The larger orthodontic type of pacifier may prevent tongue-thrusting during sucking, but the smaller regular type also is fine. You will probably need to try different pacifiers to find the shape your baby prefers.

The biggest advantage of a pacifier is that if you can get your child to use one, he won't suck his thumb. Thumbsucking can cause a severe overbite if it continues after your child's permanent teeth come in. A pacifier exerts less pressure on the teeth and causes much less overbite than the thumb. Also, you can control your child's use of a pacifier as he grows older. In contrast, it is much more difficult to stop your child from sucking his thumb because the thumb belongs to him.

When should I give my baby the pacifier?

Start the pacifier by 1 to 2 months of age if your baby shows a tendency to become a thumbsucker. Otherwise one is probably not needed. Some babies can soothe themselves without sucking. The peak age for thumbsucking or using a pacifier in infants is 2 to 4 months. In the following months, the urge to suck normally decreases. A good age to make the pacifier less available is when your child starts to crawl. A pacifier can interfere with normal babbling and speech development. This is especially important after 12 months of age, when speech should increase dramatically. It's hard for a child to talk with a pacifier in his mouth.

To make sure your child doesn't become overly attached to a pacifier (for example, walk around with it in his mouth all the time), consider the following recommendations:

  • During your child's first 6 months, give him the pacifier whenever he wants to suck but isn't hungry. The only exception is during the first month when breast milk is coming in. At that age, we want most of the sucking energy to go towards milk production, so don't offer the pacifier if it's been more than 90 minutes since last nursing. Be careful not to offer a pacifier every time he cries. Crying has a number of causes besides hunger and a need to suck.
  • When your baby is unhappy, first use cuddling to provide comfort instead of offering the pacifier. Some infants like massage. Try not to overuse the pacifier while you are comforting your baby.
  • After 6 months of age (or when your baby starts crawling), offer the pacifier less often. Keep it out of sight when not in use.
  • If you allow your child to use a pacifier all the time, his interest in it will increase rather than decrease. If your child seems to want a security object while he is awake, offer something besides the pacifier, such as a stuffed animal.
  • If your baby uses a pacifier, don't forget to take it with you when you travel. Keeping a spare pacifier in the car can save you some trouble. In air travel, sucking a pacifier or swallowing fluids during descent can prevent ear pain.
  • Do not use the pacifier to help your child fall asleep. Never use a pacifier as a sleep transition object (except in cases for calming a colicky newborn). It will become a bad habit that requires you to locate the pacifier following normal awakenings at night. When your baby starts to fall asleep, the pacifier will start to fall out and your child will awaken and try to grasp it with his mouth. Also following normal awakenings at night, infants can't find, pickup and re-insert a pacifier until 10 to 12 months old. Help your child learn to put himself to sleep. Keep the pacifier out of the crib.

What safety precautions should be taken?

Observe the following precautions for using a pacifier:

  • Use a one-piece commercial pacifier. Don't try to make one yourself by taping a nipple to a plastic bottle cap. A homemade pacifier can be pulled apart, get caught in your baby's throat, and cause choking.
  • Don't put the pacifier on a string around your baby's neck. The string could strangle your baby. The "catch-it-clips" that attach the pacifier to your child's clothing on a short ribbon are practical and safe.
  • Don't use a pacifier with a liquid center. (Some have been found to be contaminated with germs.)
  • Don't coat the pacifier with sweets, which may cause dental cavities if your child's teeth are coming in. Honey may cause a serious disease called botulism in children less than 1 year old.
  • Rinse off the pacifier each time your baby finishes using it or if it drops to the floor.
  • Buy a new pacifier if the old one becomes damaged.

How can I get my child to stop using a pacifier?

If pacifier use has been restricted to times you are holding your child, he will usually lose interest in it by 9 to 12 months of age. A pacifier can interfere with normal speech development. It's hard to talk with a pacifier in your mouth. Your child is more likely to lose interest in her pacifier if it becomes worn out and you don't replace it. You can accelerate this process by cutting the end off the pacifier. Sucking on a defective pacifier is hardly worth the trouble. Your child will probably toss it.

If he has been allowed to use it frequently and is very interested in it, your child will usually agree to give it up completely by the age of 3 or 4 years. Pick a time to give it up when your child is not coping with new stresses or fears. Sometimes giving up the pacifier on a birthday, holiday, or other special occasion is easier for your child.

Make the transition as pleasant as possible. You may need to offer incentives. If your child is strongly attached to a pacifier, offer to replace the last nighttime pacifier with a new stuffed animal or encourage him to trade it for something else he wants. Never use punishment or humiliation to force your child to give up the pacifier.

Give your child the choice of throwing the pacifier away or leaving it out to be picked up (for example, by Santa Claus or the "pacifier fairy"). Putting the pacifier away somewhere in the house is usually not a good idea, because your child will be more likely to ask for it during times of stress. At such times, comfort your child with cuddling instead. Help your child talk about missing the pacifier. Praise your child for this sign of growing up.

Written by Barton D. Schmitt, MD, author of “My Child Is Sick,” American Academy of Pediatrics Books.
Pediatric Advisor 2013.2 published by RelayHealth.
Last modified: 2010-06-04
Last reviewed: 2012-05-14
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
© 2013 RelayHealth and/or its affiliates. All rights reserved.
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