According to findings published by the National Center for Biotechnology Information, U.S. National Library of Medicine, 84% of infants use a pacifier at least some of the time. However, despite their widespread use, there is much controversy surrounding the device and regarding everything from its necessity to how and when should a child stop using a pacifier.
Pacifiers: Are They Necessary?
Pacifier, binky, dummy, soother — there are many names for it. However, ask the majority of parents why they introduced the device to their children and you’ll likely receive the same answer: because it’s soothing.
Experts agree. “Most babies have a strong sucking reflex, which has a soothing, calming effect,” Dr. Natasha K. Sriraman MD/MPH, practicing physician and Associate Professor of Pediatrics in Norfolk, VA, tells Parentology. “[Pacifiers] can soothe a fussy baby and serve as a distraction … They can also help babies fall asleep and calm them during air travel, as the sucking helps with the air pressure that develops in the middle ear.”
Sriraman also explains that pacifiers help reduce the incidence rates of Sudden Infant Death Syndrome, which is the unexplained death of an otherwise healthy infant or toddler. Other experts, including lactation consultants, sleep therapists and even the CDC, back Sriraman’s assertion that pacifiers play a role in the prevention of SIDS.
That said, while they both cater to an infant’s natural suckling tendencies and serve a life-saving purpose, pacifiers, if used improperly and for prolonged periods, can have detrimental side effects.
“[Pacifiers] can interfere with establishing breastfeeding,” Sriraman explains. “As a pediatrician and lactation consultant, [I] usually recommend delaying the introduction of a pacifier until breastfeeding is well established, after about three to four weeks. Once breastfeeding is established, delayed introduction of the pacifier does not interfere with long-term breastfeeding.
“Babies can [also] become dependent on the pacifier,” she continues, “and prolonged use can lead to dental health issues.” Such issues can include improper growth of the mouth, changes in the shape of the roof of the mouth and misaligned teeth. That said, if parents do elect to let a child use a pacifier, they should know how and when to take it away.
When Should a Child Stop Using a Pacifier?
“Everyone has a different opinion on when to ween children off of pacifiers,” Adina Mahalli (MSW), family care specialist and mental health expert who writes on behalf of Maple Holistics, tells Parentology. “However, there’s no reason why a child should be using it beyond the age of three. Most kids can even be weaned as early as one year old.”
Eva Klein, JD, Certified Infant and Child Sleep Consultant with My Sleeping Baby, recommends against taking the binky away until children are three to three and a half years of age. Sriraman, on the other hand, believes children should be off pacifiers by age two. Both Klein’s and Sriraman’s opinions go against those of American Academy of Family Physicians, which suggest that the risks of prolonged pacifier use outweigh the benefits after six months.
According to the AAFP, pacifier use for preterm infants comes with ample benefits, including decreased hospital stay, improved bottle-feeding performance, earlier transition from bottle-feeding to enteral feeding and reduced pain and anxiety. In babies up to six months, pacifier use continues to have a calming effect and helps to reduce the risk of SIDS. However, pacifier use up to six months may lead to premature breast weaning.
For children beyond six months, pacifier use has no real benefits. In fact, children between the ages of six months and two years who continue to use pacifiers have higher incidence rates of otitis media, which is inflammation or infection in the middle ear. Pacifier use beyond two years is associated with dental malocclusion, such as crossbite, open bite or overjet.
How Can Parents Help with the Weaning Process?
Regardless of when parents choose to wean, many struggle with how to do it. And, like with the age for removal, professionals often disagree with how to do it.
Mahalli believes parents should develop a comforting ritual or activity to help children cope with the change, while Klein takes the opposite approach. “I recommend removing the pacifier cold turkey,” she tells Parentology. “Have the child give it to the dentist in exchange for a toy on his next dental visit.”
Richard Dowell, PhD, a pediatric neuropsychologist at Evangelical Community Hospital in Lewisburg, Pennsylvania, offers another approach. He suggests removing the pacifier at home in “zero-distress” situations. Once that’s become normalized, eliminate the pacifier outside – and don’t worry about giving the child explanation for what you’re removing it. “We sometimes over-talk to our kids,” Dowell told Parents.com. “All you need to say is: The pacifier doesn’t leave the house.”
Sriraman suggests a happy medium. “When it’s time to wean, get rid of ALL pacifiers except one. Every two to three days, snip off a small amount of the pacifier. Check for any hanging pieces of silicone. Continue to repeat this for three to four days until there is nothing left. At that point, I tell parents to say: ‘Look you’re a big girl/boy now, you don’t need the pacifier anymore.’ And then [the parent] can help [his or her] child throw it in the trash.”
Every child is different, including when it comes to soothing. At the end of the day, the best thing parents can do regarding pacifier use is to exercise their best judgment.
When Should a Child Stop Using a Pacifier – Sources
Natasha K. Sriraman MD/MPH, practicing physician and Associate Professor of Pediatrics in Norfolk, VA. website and Instagram @Natasha Sriraman
Adina Mahalli (MSW), family care specialist and mental health expert writing on behalf of Maple Holistics
Eva Klein, JD, Certified Infant and Child Sleep Consultant, www.mysleepingbaby.com
NCBI, Recommendation for use of pacifiers
American Academy of Family Physicians — Risks and Benefits of Pacifiers
Parents.com – Ending the Pacifier Habit