What You Should Know About Pacifiers
As I write this, my 2-1/2-year-old, Sophie, is in our family room, loudly demanding her "binkies." I've spent the last few weeks talking to experts -- pediatricians, pediatric dentists, child psychologists -- about when and how to put an end to her pacifier habit, and have heard everything from "ignore it and it will stop eventually," to "no pacifier past 24 months, period."
Perhaps no discretionary decision causes parents more angst than the question of whether to introduce a pacifier -- and later, when and how to take it away. There is no shortage of opinions on the subject. When our first baby, Jake (now 4), entered the world a colicky tyrant, my mother insisted there was but one solution: "Give him a pacifier." (We tried; he refused.)
My friend Carolyne Hynes, of Weston, Connecticut, mother of 3-year-old Olivia, is of precisely the opposite mindset: "Pacifiers exist to soothe the parents, not the child."
Meanwhile, what mother, having sheepishly allowed her over-2 toddler a pacifier at the grocery checkout (to avert the tantrum sure to erupt when said toddler is denied a Blow Pop or M&Ms), hasn't endured the disapproving glances of well-meaning strangers?
The good news for parents puzzling over pacifiers: Experts agree they're entirely appropriate for soothing baby. Still, pediatric dentists recommend limiting pacifier time once a child is 2 and eliminating it by age 4 to avoid dental problems. Beyond that, there are no hard-and-fast rules about when and how to say "bye-bye binky." Here's what you need to know to make the right choice for you and your child.
When purchasing a pacifier, be sure to follow these guidelines from the American Academy of Pediatrics:
- Look for a one-piece model with a soft nipple (some two-piece pacifiers can break apart).
- The shield should be made of firm plastic with air holes, and should measure at least 1 inch across so baby can't swallow it.
- Purchase dishwasher-safe pacifiers and clean them this way frequently until baby is 6 months; after this, wash pacifiers regularly with hot soap and water.
- Pacifiers come in two sizes: 0-6 months and 6 months and above; for baby's comfort, make sure pacifiers are the correct size.
- To prevent the risk of strangulation, never tie a pacifier around your baby's hand, neck, or crib railing. Use a pacifier clip instead.
- Never use a bottle nipple and ring in place of a pacifier; the nipple can separate from the ring and pose a choking hazard.
- Inspect pacifiers regularly for damage and replace them if the rubber has changed color or torn.
The Basics of Pacifier Use
Babies are born with an innate need to suck, says Richard Dowell, PhD, a pediatric neuropsychologist at Evangelical Community Hospital in Lewisburg, Pennsylvania. Newborns rely on this "suck reflex" not only for sustenance but also for soothing. "Young infants have no other mechanism to control their distress," explains Dowell. "They can't get a drink; they can't ask for a blanket; they can't use their hands to control things. Sucking provides a way for them to calm themselves."
Thus, babies will suck -- if not on a pacifier, then on a thumb, finger, bottle, or breast, says Karen Breach, MD, a pediatrician in Charlotte, North Carolina. "If a baby needs to nurse more than every two hours, he's using Mom as a pacifier," she says, noting that, in such cases, a pacifier can help satisfy baby's non-nutritive sucking needs while giving Mom a needed break.
Just be sure breastfeeding is well established before introducing the pacifier, cautions Kellen Glinder, MD, a pediatrician at the Palo Alto Medical Foundation, in Palo Alto, California. "For babies who do have trouble learning to breastfeed, the pacifier can teach bad habits." Once baby is an expert at nursing and Mom's milk supply is established (typically in a few days), it's fine to bring on the binky.
Pacifier Pros and Cons
While parents worry that binkies may harm baby's teeth, they typically have no affect on a child under 2. "From a dental-health perspective, it's best to limit the pacifier when a child is 2 and stop it entirely by the time a child is 4," says John Stritikus, DDS, a pediatric dentist in Dickson, Tennessee. Past age 4, pacifiers can cause an overbite, open bite, or crossbite -- problems that affect chewing, speech, and appearance, and often require orthodontics to correct, notes Dr. Stritikus. Unfortunately, so-called orthodontic pacifiers don't make a difference. What matters is the frequency and intensity of the sucking habit.
PROS: On the plus side, pacifiers may decrease the chance of cavities by keeping baby from using the bottle or breast for non-nutritive sucking, says Stritikus. "Babies who sleep with the bottle can develop "baby-bottle cavities" in all 16 or 20 of their teeth," he warns.
CONS: Recent studies have linked pacifiers with a three times higher risk for ear infections, so if these are a recurring problem for your child, it may be worth eliminating the pacifier to see if it makes a difference, says Breach.
PROS: On the other hand, pacifiers may help reduce the risk for sudden infant death syndrome (SIDS). One study found that babies put to sleep with a pacifier were 20 times less likely to die of SIDS than were babies who slept without pacifiers. Researchers speculate that pacifiers may keep babies from rolling onto their faces or may keep their tongues forward and away from their airways. "I wouldn't introduce the pacifier just to prevent SIDS," says Breach. But it's another reason to feel okay about doing so.
Weaning Your Child Off of Pacifiers
When to Stop
Here is where opinions diverge. Marolyn Morford, PhD, a developmental psychologist in State College, Pennsylvania, recommends discontinuing the pacifier by a year. "At that age, a child's developmental needs do not include sucking," she says. Dr. Breach allows more latitude: "It's okay to make pacifiers the last thing to go. Once a baby is weaned and potty trained, then focus on stopping the pacifier."
It's a tolerant attitude echoed by Dr. Dowell: "Ultimately, children develop higher level strategies to manage their distress -- usually beginning at around age 2," he says. "They phase out their pacifiers as they develop skills to replace them." Most kids willingly surrender their binkies by age 3 or 4.
How to Stop: The Three-Day Plan
Your child can be binky-free in just three days, says Mark L. Brenner, author of Pacifiers, Blankets, Bottles & Thumbs: What Every Parent Should Know About Stopping and Starting (Fireside). Here's how to do it.
Day 1: In the morning and at bedtime, tell your child that you can see she wants to do lots of things that make her older. Tell her that's a good idea, and that in three days it will be time for her to say goodbye to her pacifiers. Tell her you know she can do it and that you'll work together on it. Keep the talk to 30 seconds and don't sound as if you're asking permission. If your child responds, reflect back her feelings -- "I know you don't want to" -- then move on. Don't worry that your child will become anxious if given advance warning. "That's a myth," says Brenner. "Like adults, children like to prepare themselves physically, psychologically, and emotionally for change."
Day 2: Repeat the same 30-second talk twice daily, only replace "in three days" with "tomorrow." Don't try to sell her on the idea. Keep your tone and manner matter-of-fact.
Day 3: Remind your child that it's day three and time to gather up his pacifiers. Act as if you're going on a scavenger hunt and ask your child if he'd like to help. Even if he refuses and protests, proceed to collect his pacifiers, place them in a plastic bag, and put them on the front step for "pick-up by the recycling truck." Explain that the pacifiers will be made into new tires or toys. "Children recognize that recycling is purposeful and intelligent, and will be far less upset than if you throw their treasured pacifiers in the trash," says Brenner. Which is not to say your toddler won't have a meltdown. Be empathetic, but firm, Brenner says, adding that most children get over losing their pacifiers within 48 hours.
The Gradual Approach
Start by removing the pacifier in "zero-distress" situations, like when your child is home, happy, and playing. Once she's used to not having her pacifier at home, eliminate its outdoor use. You don't need to offer an explanation. "We sometimes over-talk to our kids," Dr. Dowell says. "All you need to say is: The pacifier doesn't leave the house."
From here, it's usually a painless leap to: "The pacifier stays in the crib." Convincing your child to make the final break, however, may be more challenging. Some parents use the "Binky Fairy" or Santa to help smooth the transition. "Near the holidays, you might tell your child that Santa collects all the pacifiers for new babies and brings toys for all the big girls and boys," suggests Ivy Faske, MD, a pediatrician in Palm Beach Gardens, Florida. Or you could tell your child that the dentist or doctor collects pacifiers for new babies, and that if she donates hers, she'll get a special toy.
Don't be surprised, however, if the child who traded her pacifiers for a Dora doll suddenly wails for her binky. "You have to be willing to put up with a few really bad nights," says Faske. "But most kids soon find other sources of comfort."
Weathering the Storm
Whatever method you choose, brace yourself for one to five nights of crying, and whatever you do, don't give in. "If you give a child back the pacifier after he's cried, screamed, and kicked for 45 minutes, you'll only solidify that such carrying on will get him the pacifier -- and everything else he wants," says Glinder. If you're tempted to cave, remember: Children (and parents) have endured this rite of passage for millennia. "We all get rid of our pacifiers eventually," he says.
Marguerite Lamb is a writer and mother of two in Glastonbury, Connecticut.
Originally published in American Baby magazine, August 2005.