Your baby is crying. She looks very unhappy: She has her mouth open, her eyes squeezed shut, her fists clenched. You've tried everything you can think of to calm her down—breastfeeding, walking her in the stroller, gently rocking her and singing to her. In your palm you hold what you hope will be the answer: a pacifier.
Experts agree that pacifiers are 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.
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.
While parents worry that binkies may harm baby's teeth, they typically have no effect 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.
A way to soothe: The amount of time an infant spends crying increases from birth until about 6 weeks, when a baby cries for an average of three hours a day. "That's a lot of crying stress," says Cynthia R. Howard, M.D., M.P.H., associate professor of pediatrics at the University of Rochester School of Medicine and Dentistry in New York. Sucking undoubtedly helps calm a baby, she adds, which is why pacifiers are so popular
Health benefits: The only proven medical benefits linked to pacifiers have been seen in preterm babies. Preemies who suck on binkies gain weight faster, according to a 1992 study published in the Swedish journal Acta Pediatrica. Other research has found that preemies who use pacifiers shortly after birth show earlier sucking patterns and experience fewer health complications. "Sucking promotes oral-muscle function and muscle development," says Nina L. Shapiro, M.D., assistant professor of pediatric otolaryngology at the University of California, Los Angeles, School of Medicine.
Reduced risk of SIDS: Pacifiers are associated with a reduced risk of sudden infant death syndrome (SIDS), according to four recent studies 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. But since a cause-and-effect relationship has not been proven, researchers aren't sure how, or even if, pacifiers prevent SIDS. In the meantime, the SIDS Alliance refrains from recommending their use.
Ear infections: Pacifiers were found to be responsible for 25 percent of ear infections in children under 3 attending day care, according to a study published in Pediatrics in 1995. Restricting pacifier use to just before a child fell asleep, though, returned the risk to almost normal, a follow-up study in 2000 (also in Pediatrics) found. Why the link? Pacifier sucking promotes fluid collection in the ears, which can lead to ear infections, Shapiro says.
Early weaning from the breast: Offering a pacifier to a full-term baby may keep her from what she really needs—food. Indeed, several studies have linked pacifier use with early cessation of breastfeeding. However, a study reported in the Journal of the American Medical Association found that pacifiers probably were not to blame for early weaning. The researchers concluded that their use is a sign of breastfeeding difficulties or reduced motivation to breastfeed.
While the pacifier-breastfeeding connection remains a question, if you do give a binkie, it's best to wait. "If you want to offer a pacifier, wait until four to six weeks, when your milk supply is established," Howard says.
Dental problems: Children who suck anything—thumb, finger or pacifier—past age 2 have a higher risk of developing protruding front teeth and/or a crossbite in baby teeth, according to a study published last year in the Journal of the American Dental Association. In some cases, these problems persist when permanent teeth come in.
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.
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.
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."
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.
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.
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."
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.