Pacifier use: Benefits and side effects

There is a lot of confusion regarding pacifier use these days, and for good reason. Even among physicians, there is an ongoing debate, as there has not been strong evidence favoring use or avoidance of pacifiers. Many practices are also dictated by regional customs and cultural influences. There is ongoing research regarding the benefits and unintended negative side effects of the pacifier. Le Bonheur Pediatrician Rana Khaznadar, MD, weighs in on some of these benefits and side effects.

SIDS: There have been studies with strong evidence showing that pacifier use in infants decreases the risk of sudden infant death syndrome (SIDS). It is unclear why pacifiers have this protective effect, but some theories suggest the possibility that babies are more easily awakened while sucking on a pacifier.

Pain: It is also believed that pacifier sucking (a form of sucking that doesnot provide nutrition) can be beneficial in pain reduction especially when combined with other soothing measures such as rocking or swaddling.

Ear infections: There have been some studies – but with limited data – about the association between ear infections and pacifiers, stating some evidence that it does increase the risk. This association is weak, and until further studies are performed, it is not a reason not to use apacifier.

Dental problems: In general, oral health advocates report that infants who are weaned off pacifiers and formula bottles sooner tend to have fewer “bite” problems or malocclusion (misalignment of teeth) than children who use them for longer periods of time. I generally recommend weaning from both around 1 to 2 years of age, but the official American Academy of Pediatric Dentistry’s policy on oral habits recommends stopping by the age of 3 years.

Here are some other basics about pacifier use:

  • Some sources state pacifier use should be delayed in infants whose mothers plan to breastfeed, so that breastfeeding can be firmly established. The American Academy of Pediatrics recommends pacifier use no earlier than 3 weeks of age for that purpose. However, some studies have shown that delaying pacifiers may make mothers more inclined to stop breastfeeding all together. More research is being done in this area.
  • As great as pacifiers can be, parents must also clean and inspect them regularly. If the color changes or you notice cracks in it, then it is time to change it. It is highly discouraged to suck on your infant’s pacifier as a way to “clean” it. This transmits bacteria or viruses that may harm your child. Also, if your baby develops thrush (a yeast infection in the mouth), and it appears to be resistant to treatment, consider the pacifier as a place that may be harboring the yeast in addition to bottle nipples.
  • If you do use a pacifier, do not tie a ribbon or string to the infant’s neck or hand, as this poses a strangulation risk