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I never would have thought this would be my first blog post after having a baby but here it is! What a controversial topic, people either really love them or hate them! So let's dive in and to see what's up. The following is not medical advice, please consult a medical professional for specific guidelines.
Resources and Sources
Pacifiers. Soothies. Binkys. It's like every baby's got one.
Does every baby need one?
Not exactly, some babies don't like them and never take one. Other babies love them and that's okay too! When I first gave a pacifier to Izzy around 5 weeks, she wasn't really interested in it. She was exclusively breastfeeding and never had a bottle. So every time I give her the pacifier she just spit it out after a few seconds. At the time she would suck on my finger for soothing or during her oral exercises for her tongue tie, or at the breast after feeding. I wanted to introduce the pacifier at 5 weeks because we were driving to Atlanta which is a 13 hour car ride. I knew being in the car for so long would be hard on her so I wanted her to have a pacifier in case she needed comfort when we couldn't stop. Even though she never took the pacifier before the car trip she finally did within the first few hours of the car ride. The pacifier helped soothe her when she was frustrated that she was strapped in a car seat and it also helped her fall asleep. Now at 5 months we still use it in the car, which is by far her least favorite thing ever! We also use it when we are out doing something special, like at a concert (hey Ed!), when she needs a little extra help falling asleep, or when I just need some time too but she needs soothing. Pacifiers have a place but is there too much of a good thing?
Three reasons I love pacifiers
To soothe and calm: Babies go through tremendous periods of growth and change in a very short amount of time. They come out of a dark warm womb with a 24/7 feeding tube and into this big world where they now trust in someone else for food and comfort. Sometimes babies just get sad and they need extra help regulating their emotions. Pacifiers can help soothe babies so they can stay better regulated and to decrease their stress. Regulation and decreased stress are HUGE for development!
Helps with falling asleep: The rhythmic sucking motion provides comfort to help babies fall asleep. Sometimes we are in situations where we need a little more support to help our baby fall asleep and that's when pacifiers come in handy.
A break for parents: Taking care of a baby 24/7 is difficult and demanding. No matter how much we love our babies, sometimes we need a little time to ourselves even if it is just for a few minutes to gather our own emotions and thoughts.
Reasons to mindful of pacifier use during the first 6 months
Impact of facial and oral development: Babies’ oral cavity, jaw, and roof of the mouth (palate) develops drastically during infancy, as does their sucking and swallowing patterns. With over use of a pacifier, the development of these structures and movements can be impeded. (more below)
Decrease in feeding cues and nutritional intake: Babies utilize oral movements for their feeding cues! But if there is a pacifier in their mouth they are unable to show the cues. The pacifier also inhibits the cues because baby is already sucking, almost tricking them away from being hungry, which leads to a decrease in nutritional intake whether you are breastfeeding or formula feeding.
Long term dependence: When pacifiers are over used during the early months, babies can quickly come to rely on them for that comfort and to sleep. Especially if it is used most of the time when baby needs comfort or sleep.
Parental Reliance: If we use the pacifier every time baby starts to get fussy, we as parents can begin to rely on it. But it also means we miss out on the bonding opportunity to soothe our babies and that oxytocin release which is key to bonding and attachment.
Facial and oral development
At birth, babies’ tongues are large in comparison to the inside of their mouth, the tongue fills the oral cavity and rests on the roof of the mouth. Babies also naturally breathe through their nose (yay!) and their eustachian tubes are horizontal to their ears. As the months go by their sucking pattern changes (the tongue develops new movements), their mouth expands, their palate widens, and their eustachian tubes move more vertically like an adult’s (when everything goes right!)
Starting in utero, the tongue makes constant contact with the roof of the mouth in order to shape the palate properly. If the palate does not expand wide, it will expand up and narrow, which impacts the space in the nose. If we do not have enough space in the nose, we end up breathing through our mouths. What can cause this to happen? Tongue ties and long term use of bottles, sippy cups, and pacifiers. Why do we not want to avoid mouth breathing? Mouth breathing is linked to cavities, poor sleep, weaker immune systems, changes in teeth alignment, nasal congestion, enlarged tonsils and adenoids, changes in the development of facial structures, and distorted speech.
Feeding and facial development: Breastfeeding promotes optimal development of these structures as well. The baby takes in the breast to fill the oral cavity, the sucking motion on the breast helps shape the roof of the mouth. Breastfeeding and in conjunction with the tongue resting on the roof, will provide the most optimal development of your baby’s facial features. Just look at this picture above!
So what about pacifiers? When pacifiers are over used it causes the tongue to stay low in the mouth instead of on the roof. It also can decrease the frequency of feedings on the breast. Sucking on the pacifier will not shape the mouth in the same way that sucking on the breast will. The breast is soft and fills the mouth, a pacifier is stagnant and puts a firmer pressure on the roof of the mouth in the same place every time.
Sleep, breathing, and pacifiers: Sleep is such an important time to be breathing properly (tongue on the roof of the mouth, mouth closed, breathing through the nose). When a baby sleeps with a pacifier, that tongue is now on the floor of the mouth. Because sleep is such a chunk of our days, that can set the stage for the rest of the time baby is awake. We don’t want the tongue hanging low with the mouth open, ever. By being mindful of when and how we use the pacifier we can promote optimal breathing all the time.
TLDR: Sucking on the breast and the tongue resting on the roof of the mouth shape the palate. If the palate expands up and narrow it impacts nose breathing (bad!). Over using a pacifier can keep the tongue low in the mouth and further promoting open mouth posture and mouth breathing. Can you really breathe through your nose if your mouth is wide open and your tongue is hanging down? (not really)
But what about SIDS prevention??
After looking through research and what various organizations say, it’s pretty up in the air, I even asked ChatGPT! There are no randomized control studies proving this and it is an ongoing area of research. However, there is speculation as to why a pacifier may reduce SIDS, which I’ll get into more below. See below for what various organizations actually say, quoted straight from their sites.
“A pacifier might help reduce the risk of sudden infant death syndrome (SIDS)” -Mayo clinic
“Pacifiers May Protect Against SIDS” -Nationwide Children’s hospital
“studies have reported a protective effect of pacifiers on the incidence of SIDS. The protective effect of the pacifier is observed even if the pacifier falls out of the infant’s mouth” -AAP. However, their citations for this are lacking controlled studies (more below)
The WHO recommends pacifier use in the hospital WHEN the mother is not available for skin to skin or breastfeeding.
Listed in the 10 steps to successful breastfeeding guide written by the WHO for facilities that provide maternity and newborn care, step number nine states “Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants” they also recommend teaching mothers alternative ways to calm and soothe their baby.
Other points to think about:
The CDC and AAFP recommend not introducing a pacifier for the first month while establishing breastfeeding and weaning around 6 months. But SIDS affects babies under one year.
Many infant deaths classified as SIDS are most likely suffocation deaths, but could not be proven to be suffocation at the time of the autopsy.
AAP recommends not re-inserting a pacifier while a baby is sleeping if it has fallen out
Each organization was found to be citing the same article, which was an analysis of research that had been performed and published in 2005. It only included 7 case controlled studies, meaning they did not perform randomized control trials but looked at exposure and outcomes. In their recommendation they stated that pacifier use outweighs the risk but they also recommended it for up to 1 year in age. This study is nearly 20 years old and the recommended age for weaning now is based on new information (6 months). They also concluded that “one SIDS death could be prevented for every 2733 babies who use a pacifier” (Hauck 2005).
Other safe sleep environment factors are more likely to prevents SIDS than the use of a pacifier (firm bedding, room-sharing, sleeping on back, avoidance of smoke, etc). One study cited by the AAP concluded that the use of a pacifier may prevents SIDS in situations where other safe sleep guidelines are not followed (this makes so much sense!)
“We found no randomized control trial evidence on which to support or refute the use of pacifiers for the prevention of SIDS” (Psaila 2017).
In situations that you use a pacifier, you will eventually have to navigate without the pacifier
Using a paci past 1 can have more negative outcomes for baby
Increased chances of ear infections
Reliance for soothing
Impacts face and mouth development (see above)
Can prolong the use of a tongue thrust sucking pattern, further impacting feeding development
Increased impact to speech development
Pacifier use recommendations
Be mindful of frequency of use: Ask these questions, Does baby need the pacifier right now for regulation? Can I provide regulation and soothing in some other way?
Do not reinsert a pacifier if a baby is sleeping
Make sure baby sleeps with mouth closed and tongue up when not using a pacifier
Follow other safe sleep guidelines to prevent SIDS, do not rely solely on a pacifier
Begin weaning around 6 months of age, the earlier = the easier!
Couple tips for choosing a pacifier
There's no such thing as an orthodontic pacifier, eventually all will impact development!
Look for rounded pacifiers such as the Avent soothie
Avoid pacifiers that are flat or with a wider tip
Other possible soothing techniques
Feeding at breast: breastfeeding is one of the most comforting tools we have as mothers! Babies can enjoy non nutritive suckling at the breast after eating.
Cosleeping following safe sleep 7: I am a huge advocate of safe cosleeping. Cosleeping provides many of the same benefits to preventing SIDS as a pacifier does (more on that later!)
Physical touch: often babies get upset from being so far away from their caregivers such as in a car seat or stroller. Providing physical touch, (picking them up, rubbing their hand or belly) can help soothe them
Babywearing: keeps baby close for comfort and easy soothing
Singing: can be used to distract and comfort baby
Mother’s ease: using a soft voice to talk with baby
Rocking, swaying, patting: more physical touch and another way to tune into your child's needs!
I am here to provide information so other caregivers can make informed decisions and I hope you feel more informed after reading this! Please leave any questions below or find me on instagram and send a message! @connecting_SLP
Resources
Newborn and early mouth development, more in depth information https://dysphagiacafe.com/2015/09/03/newborn-and-early-mouth-throat-development-feeding-swallowing/
Sources
Hauck, F. R., Omojokun, O. O., & Siadaty, M. S. (2005). Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics, 116(5), e716–e723. https://doi.org/10.1542/peds.2004-2631
Psaila, Foster, J. P., Pulbrook, N., & Jeffery, H. E. (2017). Infant pacifiers for reduction in risk of sudden infant death syndrome. Cochrane Database of Systematic Reviews, 4(4), CD011147–CD011147. https://doi.org/10.1002/14651858.CD011147.pub2
Victora CG, Behague DP, Barros FC, Olinto MT, Weiderpass E. Pacifier use and short breastfeeding duration: cause, consequence, or coincidence? Pediatrics. 1997 Mar;99(3):445-53. doi: 10.1542/peds.99.3.445. PMID: 9041303.
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