Pacis, binkies, nuk-nuks. No matter what they are called, pacifiers have long been a source of debate among pediatricians, dentists, parents, and childcare providers. The many questions that surround pacifier use may confuse caregivers and parents or cause concern about long term dental or developmental damage.

The truth is pacifiers serve an important purpose, both in satisfying an infant’s need to suck and possibly even in protecting against Sudden Infant Death Syndrome (SIDS). But to many health professionals and early education specialists, the question of whether to advocate for or inhibit pacifier use still remains an issue.

Infants and young children use sucking as a means of soothing themselves when they are tired, hungry, hurt, or scared. The desire to suck, typically present from birth, is an important factor in helping newborns breastfeed.

Although pacifiers are intended primarily to ease the desire to suck, many caregivers take the name pacifier literally--they use it to pacify a restless or cranky child. This kind of use may increase a child’s dependence on a pacifier for comfort and stress relief, which can cause difficulty when it is time to wean.

The pacifier’s role in helping protect against SIDS has been a hot topic lately. According to the American Academy of Pediatrics (AAP), the latest research is “compelling,” and the organization has recommended that parents “consider” offering a pacifier at nap time and bedtime. The research about the possible protection against SIDS seems stronger than findings that pacifier use prohibits breastfeeding or causes dental complications.

In spite of the many positive findings, pacifier use has a downside. In order for parents and caregivers to make an informed decision about whether to use a pacifier, it is important to address concerns about pacifier use.

Concern: Using a pacifier will cause problems with breastfeeding.

Fact: This is probably the most debated issue associated with pacifier use. Current recommendations by the AAP advise that newborns not be given pacifiers until breastfeeding is well established.

According to the AAP, pacifier use in some infants may indicate a breastfeeding problem that needs to be addressed. Often babies are “plugged” with pacifiers, when in fact they need to be breastfed more often. Because getting an infant to breastfeed can take time and is often challenging, many breastfeeding specialists council against using a pacifier with nursing infants at all, limiting use to bottle-fed babies.

Concern: Pacifiers cause buckteeth or other dental abnormalities.

Fact: According to the American Academy of Pediatric Dentistry (AAPD) Policy on Oral Habits, thumb sucking or the sucking on pacifiers is normal in infants and young children.

Further, the AAPD considers such habits unlikely to cause long term damage in children unless they continue until the age of five. From the age of five on, however, significant damage can occur.

Concern: Pacifiers can cause ear infections.

Fact: Research shows a slight increase in the risk of ear infection (known as acute otitis media) for children who use pacifiers.

Concern: Using a pacifier will hinder language development in young children or cause a lisp.

Fact: It is possible that some children who use pacifiers may take less initiative to speak than other children, or may have trouble learning to form words correctly, but there is not enough research to confirm this. Limiting the use of a pacifier to bedtime and naps may help encourage a child to practice verbalizing his or her needs rather than relying on a pacifier or thumb for comfort.

Whether to allow pacifiers in childcare can be as tricky a question as the pacifier debate itself. For one thing, research shows that gastrointestinal problems and yeast infections are more common in children who use pacifiers.

Caregiver beliefs and practices vary widely, and childcare regulations differ from state to state. Some may feel that if a baby is used to a pacifier, or if a parent recommends letting their baby use one, it is fine to do so (especially given the latest SIDS risk reduction guidelines).

Others may discourage pacifier use because of the challenges related to ensuring each pacifier is clean, sanitized, and given to the right baby, a problem that can occur when infants and toddlers are combined and toddlers try to take the pacifiers from their younger companions.

Caregivers who choose to allow pacifier use can best address these challenges by supervising pacifier use visually and cleaning and sanitizing pacifiers after each use. In addition, the AAP offers several recommendations for pacifier use, some of which may be beneficial to providers who allow pacifier use by children in their care.

• Offer a pacifier at nap time to help reduce the risk of SIDS.
• Do not reinsert the pacifier once an infant falls asleep.
• Clean pacifiers often and replace frequently. This will help to prevent tearing of the plastic nipple.

Although any object that makes a child feel more secure is difficult for the child to let go of, stopping the use of pacifiers is typically easier than breaking a child of thumb sucking because you can remove the pacifier when ready to wean.

But a child who has become accustomed to relying on a pacifier during times of stress or change may have a difficult time letting go. Techniques for self soothing, such as verbalizing stress or frustration, should be introduced.

As children grow older, peer pressure becomes more of a factor and may actually be all the incentive a child needs to let go of his or her treasured pacifier. Parents may consider talking with their children about why it is important to stop using pacifiers, while also giving them lots of one-on-one attention during this transition. As the caregiver, you can help this process by asking parents what techniques they use to comfort their children and adopting those strategies in your childcare setting.

Diona L. Reeves
Freelance writer and former employee of the American Academy of Pediatrics’ Healthy Child Care America program

American Academy of Pediatrics, 141 Northwest Point Blvd., Elk Grove Village, IL 60007-1098; 847-434-4000; www.aap.org

Healthy Child Care America program, www.healthychildcare.org; 888-227-5409

American Academy of Pediatric Dentistry, 211 E. Chicago Ave., Ste. 700, Chicago, IL 60611-2663; 312-337-2169; www.aapd.org

Baby Center, www.babycenter.com/expert/toddler/toddlerdevelopment/11542.html