Most of the parents that come to me for help regarding their baby's sleep wonder whether they should be giving their child a pacifier. General recommendations are not to introduce one for the first four weeks of life, until breastfeeding is well established, so as not to cause nipple confusion. Around the world, there is a large variation in the amount of pacifier usage in infants and toddlers. While I often hear parents voicing their concern about long-term dependency being the main issue affecting the decision, there are other risks and benefits to consider, too. An excellent recent review in the Journal of Pediatric Nursing describes the benefits and risks in greater detail, but below are the main points to consider.
What are the benefits?
- Sucking is widely acknowledged to be a healthy reflexive means for an infant to self-soothe, calm, reorganize, and deal with stress.
- Pacifiers may serve as a transitional object to decrease separation anxiety for toddlers.
Reduces the risk of SIDS
- A number of studies have consistently shown a reduction in the risk of SIDS associated with pacifier usage, especially if used when putting an infant to sleep.
- Theories for why there is a "protective effect" are that there may be increased arousal responsiveness in frequent pacifier users and that the position of the tongue when using a pacifier reduces the risk of oropharyngeal obstruction. Using a pacifier may also encourage mouth breathing if nasal obstruction should occur during sleep.
- While the protective effect is not well understood, the American Academy of Pediatrics does recommend pacifier usage in infants during sleep in the first year of life.
- Sucrose has been documented to relieve pain in neonates undergoing painful procedures, and the use of a pacifier along with sucrose appeared to have a synergistic effect. Even so, Health Canada doesn't recommend you put anything sweet on a pacifier, especially not honey!
- Another meta-analysis suggested that either sucrose or breast milk, with or without non-nutritive sucking, appears to be safe and effective in relieving procedural pain.
What are the risks?
Oral health and malformation of the teeth
- Malformation of the teeth and potential detriments to oral health are major concerns, but a recent meta-analysis shows that pacifier usage doesn't significantly impact the teeth if discontinued by age 2-3 years.
Negative impact on breastfeeding
- There are worries about nipple confusion as some studies indicate an association between the usage of pacifiers and poor breastfeeding outcomes.
- In regions where breastfeeding rates are low, pacifier usage may be discouraged before breastfeeding is well established.
Otitis media/ear infections
- So far there isn't enough evidence to be sure of a link between pacifier usage and acute otitis media (AOM).
- There are some convincing studies that there is a causal relationship between pacifier usage and AOM.
- One study followed infants for five years and found that pacifier usage was associated with a 1.8 times greater risk of AOM.
- With regards to AOM, the AAP recommends that parents reduce or eliminate pacifier usage in the second six months of life. However, the recommendation hasn't been reaffirmed due more recent suggestions to use pacifiers as a means to reduce the risk of SIDS.
- Parents are much more cautious of materials in baby products these days, but latex allergies still exist. There are, however, alternative materials from which to choose.
Introduction of infection
- Silicone is slightly more resistant to fungal colonization than latex, but it is not significantly different, and pacifiers may act as passive vectors of disease.
- Dentists would also discourage parents with active dental caries from "cleaning" soothers that have fallen on the ground with their own saliva for risk of passing caries onto their children's developing teeth.
So as you can see, the debate on pacifier usage is still ongoing. Parents will have to make their own personal decision based on the available information on benefits and risks associated with pacifier use. Most of the risks can be avoided by ensuring that there is no nipple confusion early on, using materials that are hypoallergenic, and using proper sanitation to avoid possible transmission of infection. As far as sleep goes, I feel that pacifiers are not a problem, unless you have to go in all night and replace them when your child is perfectly capable of doing this for himself.