Pediatric Oral Health

Pacifier Pros and Cons: When and How to Use Baby Pacifiers

Of all the decisions new parents must make, pacifier use is one of the most controversial. I don't believe that pacifiers should be automatically vilified, and in this article, I share my perspective on pacifier pros and cons. There are also tips on pacifier shopping and weaning, should you decide to use one.

by Dr. Burhenne

Pacifiers

The baby pacifier debate has been raging for years, as parents try to sift through the conflicting information that suggests, on one hand, that pacifiers can be a source of comfort and save babies’ lives, while also claiming that pacifiers and can negatively impact oral development and make it difficult for breastfeed babies to learn to latch.

As a dentist, I have my own views of pacifiers, but the gist is this: Pacifiers can be beneficial to both parents and baby—if you know how and when to use them properly.

Why Pacifiers Should Come with a Warning Label

One of my favorite parts of being a dentist is getting to know my patients and their families over long stretches of time. I even get to see my younger patients grow up and go on to start families of their own. This transition into parenthood is a beautiful and unique time in a person’s life—it’s a time of discovery, revelation, and, in many cases, worry.

New parents want to do everything right for their baby, which can lead to worry and concern about whether they are making the right choices for their child.In fact, this tendency of new parents to question and analyze every baby-related decision can prevent future challenges and consequences. This is certainly the case with baby products we’ve come to accept as “normal”, including bottles, sippy cups, and, especially, pacifiers.

pacifier mouth
I have to admit…when I first saw my granddaughter with a pacifier, I cringed. Chronic pacifier use can cause chronic tooth decay, cavities, crooked teeth, narrow palate, and even sleep apnea in adulthood. But, as my daughter reminds me, pacifiers have tremendous upside as well.

Each of these baby products actually prevents the normal development of a child’s mouth, and it’s a widespread problem. In the last 50 years, there have been significant changes to our mouths, jaws, airways, and faces, and the prevalence of wisdom tooth, tonsil, and adenoid removal is a direct result of this shift. Dentists across the country are noticing it, and I see it daily in my patients. Our profiles are weaker, our jaws aren’t fully developing, and this is due, in part, to pacifiers.

In my article, Why Your Toddler’s Sippy Cup Should Come with a Warning Label, I exposed the problems with sippy cups and how they are interfering with normal oral development. This same warning could be applied to pacifiers.

Pacifiers are directly contributing to commonplace dental problems, which have implications beyond crooked teeth. Underdeveloped mouths and jaws are causing smaller airways, and smaller airways are causing a silent, sleep-disordered breathing epidemic, which is believed to impact over 80 percent of Americans.

All in all, it’s important for every parent to understand that there are many factors to consider before giving a pacifier to their children. Despite this, there is no need to be overwhelmed!In an effort to give you one less thing to worry about, I’m going to examine every consideration behind the pros and cons of using a pacifier, and also share tips on how to minimize pacifier consequences and how to choose the best pacifier for your child.

The topic of pacifier use is fraught with conflicting advice, emotions, and even shaming, but by the end of this article, you’ll feel empowered, informed, and know how to use a pacifier with confidence.

Big Picture: Should You Give Your Baby a Pacifier or Not

In an ideal world, it would be best not to use pacifiers at all because they seriously impact the oral facial development of your child. As a dentist, this fact is incredibly important to impress upon new parents because there are grave consequences that can occur later in life. (More on this later.)

That being said, there are other factors to consider. Primarily, using pacifiers in the first year of life reduces the risk of Sudden Infant Death Syndrome (SIDS) by 90 percent. Pacifiers have also been shown to strengthen jaw muscles at an early age, help prevent mouth breathing, provide emotional comfort for baby, and, perhaps more importantly, provide new parents a much-needed reprieve.

It’s also important to note that, if you are nursing, research recommends waiting to give a baby a pacifier until they have a strong breastfeeding latch. This prevents “nipple confusion” and helps to ensure that baby will continue to latch onto the mother without issue and develop healthy breastfeeding habits. Also, because the risk of SIDS drops significantly after one year, I strongly recommend taking away your baby’s pacifier after his first birthday.

So as you can see, there is evidence that supports both sides of the pacifier debate. Now let’s take an even closer look at some of the factors to consider before giving your child a pacifier.

When Is It a Good Idea to Use a Pacifier?

Ultimately, you’ll want to use a pacifier from time to time, and there is no shame in that. There are occasions where it’s totally fine to use a pacifier, including:

  1. After a strong breastfeeding latch has been established and before the age of one, as pacifiers significantly reduce the risk of SIDS.
  2. If you are breastfeeding and overproduce milk, you can slip the pacifier in to give your baby a breather from the excess milk (you’ll know this is happening if your baby throws up right after feeding or appears to be drinking too fast).
  3. If you bottle feed, pacifiers can strengthen non-nutritive sucking habits (that is, sucking that is not related to feeding/nourishment) and allow your baby to feed more easily from a bottle.
  4. If your baby is undergoing a painful procedure, such as circumcision.
  5. If your baby is in the NICU. Babies in the NICU need pacifiers because they can’t have other forms of soothing, such as skin to skin contact.
  6. When parents have exhausted all other methods to soothe baby, but he seems to be inconsolable. Pacifiers should never be the first line of defense, but it is certainly okay to use them when necessary.

If you do decide to introduce a pacifier, here are some things to keep in mind:

  • Only offer between feedings (never to hold off on a feeding).
  • Don’t force it if your baby doesn’t want it.
  • Don’t use pacifiers to space feedings.
  • Keep it clean and don’t use your mouth to clean it.
  • Make sure it’s made from safe materials.

And, again, try not to unnecessarily use pacifiers. For example, if it falls out while your baby is asleep, there is no need to put it back in.

Negative Impact of Pacifiers

New parents often ask me, “Do pacifiers make teeth crooked?” The short answer is, YES! This is the number one concern I have for pacifier use—they can significantly and detrimentally impact the development of the mouth, teeth, jaw, and face, and all of these impacts are made worse the longer a pacifier is used.

Specifically, pacifiers cause:

  • Anterior open bite—The most common of pacifier-related malocclusions, or imperfections in teeth positioning. This is when the front and bottom teeth are pushed outward (to make space for the nipple or thumb).
  • High narrow palate—This is when the roof of the mouth is higher than normal and the airway is narrow, resulting in a smaller airway.
  • Posterior crossbite—When the front teeth are an overbite, extending over the bottom teeth, but the molars are an underbite, meaning the bottom molars protrude further into the cheek than the top molars.
  • Narrow intercuspal width of the maxillary arch—This is when the width between your top molars is narrower than it should be.

This is important to discuss because mouth and airway deformations can carry serious health consequences later in life. The biggest concern with the above changes in mouth development is that they cause a smaller airway, which leads to sleep-disordered breathing. Sleep-disordered breathing refers to numerous conditions that are all characterized by improper breathing during the deepest stages of sleep. This prevents the body from completing critical restorative processes throughout different cells and organs, which can ultimately cause debilitating symptoms and contribute to diseases, including:

  • Exhaustion
  • Brain fog
  • Insomnia
  • ADHD in children
  • Difficulty concentrating
  • Anxiety
  • Depression
  • Mood related disorders
  • Cardiovascular disease
  • Alzheimer’s disease
  • Obesity
  • Type 2 diabetes

As you can see, the impacts of a pacifier on airway development is not to be taken lightly. The reason we are still learning how serious pacifier use can be is because it took time for the first pacifier users to grow up. Since the first pacifier was developed in 1901 until it’s widespread use in the 1940s, it took decades for us to fully realize the effects. We are now realizing that sleep-disordered breathing conditions like sleep apnea can be prevented during childhood, especially when pacifier use is limited or discontinued completely.

Beyond the negative impacts on oral development, other problems with pacifiers include:

  • Breastfeeding interference—Pacifiers can make breastfeeding more difficult through nipple confusion and poor latching. You can minimize the chances of this happening by waiting until your baby is a proficient nurser before introducing a pacifier.
  • Increased risk of ear infections—Babies who use pacifiers have a three times higher risk of developing ear infections. However, research has found that this correlation appears to be dose-dependent. Essentially, the more you use a pacifier, the higher the risk. (Yet another reason to use that pacifier sparingly if you do choose to use one.)

The Emotional Impact of Pacifiers

It’s impossible to discuss the pros and cons of pacifier use without considering the emotional impact of pacifiers. From a positive perspective, we know that pacifiers can help to soothe an inconsolable baby and help baby fall asleep faster, and they are an easier habit to break than thumbsucking.

Pacifiers are often one of the most effective tools a parent has for soothing a crying baby. Early on, this isn’t a problem. However, as babies become older it can become a bigger issue. On the negative side of the emotional equation, we know that babies can become dependent on pacifiers and trying to wean them later can be traumatic.

I also want to note that pacifiers can signal to your child that the particular emotion he is experiencing when you give them a pacifier isn’t a good one. Additionally, if a child is scared, uncertain, worried, or upset, the reflex to always soothe these uncomfortable emotions rather than addressing them can prevent him from learning how to properly deal with situations as he ages.

As your child gets older, I encourage you to help him with him emotions instead of relying on a pacifier. This not only prevents unnecessary pacifier use, but it also empowers the child to deal with emotions productively and without shame.

pacifiers

What’s the Best Pacifier on the Market?

If you are going to give your child a pacifier or have one on-hand for emergencies, I recommend choosing one that can limit the potential consequences of pacifier use.

As a dentist, my favorite pacifier is the Natursutten BPA-free Natural Rubber Orthodontic pacifier. I like this one because it’s flatter and designed more like a real nipple. However, there are many other factors to consider when buying a pacifier, and your baby may have a strong preference for one over another.

Factors to consider:

  • Pacifiers can be silicon, latex, or plastic. Make sure any plastic is BPA free. Latex is softer and more like a mother’s nipple but needs to be replaced every six to eight weeks. Also, if there’s a history a latex allergy in your family, I’d avoid these. Also, latex also has a higher risk of becoming infected with Candida.
  • One-piece pacifiersare the best—and most hygienic—option. A one-piece pacifier is more hygienic because the single-piece construction means there are no joints or cracks where dirt and bacteria can accumulate. Standard pacifiers usually have a crevice where the nipple and shield come together, which is difficult to keep clean. If the pacifiers have an open access to the nipple that will gather a lot of dirt and bacteria.
  • String or lanyards shouldn’t be attached to the pacifier. They can be a choking hazard.
  • The pacifier you choose should fit your baby’s mouth well.You may have to choose a few different styles and brands to find the perfect fit.

With that in mind, other pacifiers I recommend include:

Reversing Pacifier Side Effects

If you’ve already used a pacifier, and perhaps chosen the wrong pacifier for your child, your heart may be starting to race because you weren’t aware of some of the drawbacks mentioned in this article. But there is no need to panic. There’s a lot you can do to correct the damage of pacifiers, and as with so many interventions, the earlier you get started the better.

Myofunctional therapy is a good option if you or a doctor has noticed any abnormalities in your child’s oral or facial development that could be related to pacifier use. Myofunctional therapy is like physical therapy of the mouth and face. Painless, simple exercises are used to activate the right muscles and improve function and shape. You can use myofunctional therapy to improve the tongue position and swallowing patterns, which can prevent complications down the road.

The topic of myofunctional therapy is complex and differs from child to child. My recommendation is to find a good myofunctional therapist and get an initial assessment. You can get a recommendation from your dentist. I also suggest seeing a dentist who is airway-focused, meaning they are trained to look for changes in the palette, mouth, jaw, and airway.

5 Tips for Breaking the Pacifier Habit

Two questions I’m often asked are, “When should my child stop using a pacifier?” and, “How can I get my baby to stop using a pacifier?”

Honestly, the earlier you stop pacifier use, the better. Obviously, you want to get past that dangerous SIDS territory, but once you’re in the clear (around baby’s first birthday), you should limit any sucking behavior that isn’t breast- or bottle-feeding for nutritive purposes. This is your best bet for preventing improper facial development and emotional dependence. This can be easier said than done, though, so here are five tips for breaking the pacifier habit.

  1. Do it early—I’m going to keep saying this because I know it makes it easier on the parent and child. Plus, it significantly prevents oral facial development issues. The earlier you can stop pacifier use, the better. I recommend right at the one-year mark.
  2. Go cold turkey if you can—I believe that going cold turkey on pacifier use with a younger baby is better because it’s a faster transition. However, this approach can quickly backfire if you don’t stick to your plan.
  3. Try gradual removal—Some parents prefer gradually removing the pacifier by only offering it at certain times and slowly cutting back. This may work if you have a clear timeline and can ensure that all adults responsible for the child’s care is on the same page.
  4. Trade it in for a treat—If your child is old enough to understand, swap the pacifier for a toy or a blanket. Swapping a pacifier for another soothing object can be an excellent way to positively reinforce this change.
  5. Associate quitting with “being a big kid”—Depending on how old your child is when you stop pacifier use, you can associate it with other positive changes related to getting older. If he has an older sibling he looks up to, you can point out how he or she doesn’t use a pacifier.

If you’re trying to break your child’s pacifier habit, I DON’T recommend making it taste bad with hot sauce or some other unappealing substance. I also don’t recommend going cold turkey only to give in later.

First, making it taste bad just isn’t nice or necessary if you do it early enough. Second, if you decide to go cold turkey, commit. Giving in a few days later only makes it harder on you and your baby. If you think going cold turkey is going to be hard on you or you might give in, then try the gradual approach first. Just make sure all family members involved are on the same page for this or it can drag out the process and make it tougher on everyone.

pacifiers

A Word of Caution: Avoiding Thumbsucking After Taking the Pacifiier

When you take the pacifier away early and your baby still has a desire for non-nutritive sucking, you increase the risk that he will turn to thumbsucking. The major issue with this is that thumbsucking can be an even harder habit to break than a pacifier because you can’t ever fully take a thumb away.

If you notice thumbsucking starting to replace pacifier use, you might want to return to the pacifier and try to remove it again in a month or two. As your baby gets older his sucking habits should naturally subside, at which point it may be easier to reason with him or have him trade his pacifier for another soothing object.

At the end of the day, there isn’t one way to approach pacifier because every baby is unique. Trust your intuition while keeping in mind the guidelines above. I hope you feel empowered and informed to make the best decisions regarding pacifier use and your baby.

Do you have experiences with pacifiers and weaning? We’d love to hear what worked and didn’t work for you in the comments. Your experience might help another mom and baby find the solution that is just right for them. We look forward to hearing from you!

Dr. Mark Burhenne

resources

https://www.thoracic.org/patients/patient-resources/breathing-in-america/resources/chapter-23-sleep-disordered-breathing.pdf

https://www.ncbi.nlm.nih.gov/pubmed/17256438

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1325127/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462418/

http://pediatrics.aappublications.org/content/116/5/e716

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010837/

https://www.ncbi.nlm.nih.gov/pubmed/17256438

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/sleep-disordered-breathing/

https://www.nytimes.com/2014/06/22/magazine/who-made-that-pacifier.html

http://www.brianpalmerdds.com/pdf/Master_2_27_06.pdf

https://www.ncbi.nlm.nih.gov/pubmed/11979200

https://www.ncbi.nlm.nih.gov/pubmed/16389794

https://www.aafp.org/afp/2009/0415/p681.html

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