As a new parent, there are a lot of things to worry about. Seemingly small decisions can end up causing a lot of grief. One common challenge parents face is deciding ‘should I give my baby a pacifier?’
The current medical research indicates that it is generally safe to give babies pacifiers. The most common issue is negative effects on dental development. There are several other risks and benefits. Consult with your family doctor and adopt good pacifier habits. Experts recommend not to use a pacifier until breast-feeding is established and to curtail pacifier use around the age of 2 years and discontinue it by age 4. It is important to pick a safe and appropriate pacifier made with quality materials. It is also crucial to have good pacifier hygiene habits. The research is not conclusive either for or against pacifier use, so it is up to parents to decide what is best for their infant.
There are a number of potential concerns related to pacifier use. This article will breakdown the common concerns, as well as what medical studies have to say about them. It will also provide tips for proper pacifier use. This article is not a substitute for professional medical advice, it is a summary of information from medical journal articles.
Common Pacifier Use Concerns
The most common considerations related to pacifiers are: effect on teeth (dentition), preventing sudden infant death syndrome, effect on breast-feeding, risk of infection, physical safety, chemical safety, and latex allergy.
Pacifier Effects on Teeth (Dentition)
Pacifier use is considered nonnutritive sucking (NNS). NNS is the term for when a baby sucks on something such as their thumb or a pacifier, for purposes other than feeding. NNS can have a negative impact on how the jaw and teeth develop and their resulting alignment. This can result in problems like openbite or excessive overjet.
Research suggests that pacifiers may be less harmful than digit habits (finger or thumb-sucking). This is because infants typically stop using pacifiers on their own when they are between 2 and 4 years old. As a result, some authorities recommend pacifier use for NNS to prevent digit habits like thumb-sucking.
The risk of these potential effects can be reduced by limiting pacifier use, such as only having it at sleep time. Stopping around age 2 can allow developing problems to correct and most authorities recommend stopping by the age of 4 to significantly reduce the risk of dentition problems.
Pacifiers and Sudden Infant Death Syndrome
Some studies have found that pacifier use may have effects that help to protect against Sudden Infant Death Syndrome (SIDS). SIDS is the sudden death of an infant under a year old that medical examination cannot explain and it most commonly occurs when the infant is between 2 and 4 months old.
One study found that pacifier use at sleep time was associated with a 50% reduction in the risk of SIDS. Several other studies had similar results. The studies did not confirm why pacifier use during sleep reduced the risk of SIDS but there are a few theories.
Some of the theories involve pacifiers helping to prevent restrictions to breathing. This may be by holding the baby’s tongue in a forward position reducing the potential for it to block the airway. It may also increase airway muscle tone, reducing the risk of airway collapse. It may also make it easier for the baby to switch from breathing through their nose to breathing through their mouth if their nose gets blocked.
Other theories are related to sleeping position. A pacifier may prevent a baby from turning over to a prone position during sleep and if they do, a pacifier may keep their nose off of the bed, preventing suffocation. A baby using a pacifier may be more likely to keep its nose free of bedding to maintain its air supply.
There are several other ideas such as pacifiers increasing saliva production, which may have an unknown protective effect or could help by stimulating swallowing. Another theory is that pacifier use affects parent behaviour, causing them to check on the baby more often during sleep.
Pacifier Effect on Breast-feeding
Several studies have found that using a pacifier can create some challenges for breast-feeding. One concern is nipple confusion. Nipple confusion refers to when a baby gets used to a bottle or pacifier and has trouble getting back on the breast. Because of this, experts recommend waiting until after breast-feeding has been established before introducing a pacifier. This usually takes around three weeks.
Another concern, is early weaning. Weaning refers to when a baby breast-feeds less and moves on to other nutrition sources such as a bottle or solid foods. Early weaning is when a baby begins breast-feeding less, earlier than the parents intended. While some studies associated pacifier use with early weaning, others found that early weaning and increased pacifier use were both linked to challenges breast-feeding.
Pacifiers and Infection
The surface of pacifiers can carry bacteria and fungus. According to the Canadian Pediatric Society, there isn’t clear evidence that links pacifier use with increased rates of infection. Some factors that may increase the risk of infections are pacifier sharing and cleaning the pacifier by licking it. To reduce the risk of infection, clean the pacifier before use.
Physical Safety of Pacifiers
Because infants put pacifiers in their mouths and suck on them, chocking is a potential hazard. This risk and the severity of a choking incident can be reduced by having a properly designed pacifier. Do not use a ‘make-shift’ pacifier. Experts recommend choosing a pacifier with holes in the flange. The flange is the wide outer ring that presses against the infant’s face when they are using the pacifier. Having holes in the flange lets air get through in the event that the pacifier gets lodged in the infant’s airways. They also recommend that the flange have a minimum 43mm vertical and horizontal dimensions and that it has a ring at the back of the flange. The minimum size reduces the risk of it getting in their mouth and the ring makes it easier to pull out.
The use of pacifier chords is another concern because of the risk of strangulation. Experts warn against attaching chords to pacifiers. If you want to keep your baby’s pacifier close, use an appropriately designed pacifier clip. Typically, clips are under 7 inches long, or for loops have a circumference of less than 14 inches, so that it cannot wrap around the neck. Never attach a pacifier with something around an infant’s neck.
Chemical Safety of Pacifiers
A potential concern with pacifiers is the risk of harmful chemicals in the material. In Canada, regulations prevent the use of materials that may contain harmful chemicals in pacifiers. Pacifiers in Canada are typically made from latex, silicone or rubber. Regulations limit the allowable presence of potentially harmful substances such as N-nitrosamine.
Latex Allergy and Pacifiers
Studies looking at risk factors for latex allergies found that there was not a connection between pacifier use and the risk of developing a latex allergy. Some infants are allergic to latex and should not be given latex pacifiers.
The decision of whether to give an infant a pacifier is widely debated. It is up to parents to choose what is right for them and their child. Getting advice from a qualified medical professional can help with making an informed decision.
Research indicates that pacifier use can be associated with increased risk for certain types of infection, early weaning and dental problems, but the scope of this impact, as well as the nature of the connections are still unclear. Pacifier use has also been found to potentially help protect against SIDS.
There is a lack of strong evidence either for or against pacifier use. If you choose to give your child a pacifier, experts recommend doing so selectively and safely.
Tips for Giving Your Baby a Pacifier
While pacifiers are generally safe, if in doubt consult with your family doctor, especially if there are potential concerns such as challenges breast-feeding or allergies. In Canada, the design of pacifiers is regulated. This includes factors such as flange size, flange holes and materials.
If you choose to give your child a pacifier, here are some tips from medical experts:
- Get information about safe pacifier use, such as from your family doctor.
- Wait until breast-feeding is established before introducing a pacifier. Afterwards, limit the use of a pacifier for soothing a breast-fed infant.
- Have a plan for how and when you will use a pacifier. Avoid ad lib use throughout the day.
- Clean pacifiers regularly.
- Avoid pacifier sharing between children.
- Do not lick pacifiers to clean them.
- Consider having multiple pacifiers to be able to rotate through clean ones.
- Consider reducing pacifier use around 2 years of age and discontinuing it by or before the age of 4 to reduce the risk of dental issues.
- Avoid putting sweet substances on pacifiers. The sugar can contribute to tooth decay.
Adair, S. M., 2003. Pacifier Use in Children: A Review of Recent Literature. Pediatric Dentistry, 25(5), pp. 449-458.
Canadian Pediatric Society, 2003. Recommendations for the use of pacifiers - Position Statement CP 2003-02. Paediatric Child Health, 8(8), pp. 515-519.
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