Correct Pacifier Use, Important!

By Dr. Wilson:I have seen so many pacifiers being used incorrectly and dangerously in clinic recently that I felt the need to address this issue.

First, I am not at all against pacifier use. There are some good studies showing that pacifier use in infants decreases the risk of SIDS, and can help aid in breastfeeding by allowing mom less stress from a fussy infant. There is NO good evidence that pacifier use in infants causes any kind of "nipple confusion", or hinders good breastfeeding.

However, it is very important that parents know what kinds of pacifiers to use, and what ages to use them.

The Dangers:

soothie

The most common mistake I see is parents using the Soothie pacifier (the one with the round shaped nipple) in babies who are much too old for that style of pacifier. There are two big problems with using a Soothie pacifier beyond 6-months of age... The first problem is that the material that those pacifiers are made out of is not designed to stand up to teeth. We have seen babies choke from biting off the tip of the Soothie pacifier and breathing it in.It is a good idea, even before they have teeth, to get in the habit of checking the pacifier nipples for cracks on a regular basis (Avent actually recommends replacing the Soothie every 4-weeks).The second problem is that as babies get older the round shape of the Soothie pacifier will start to cause problems with the shape of the gums, roof of the mouth, and front teeth. Below is a picture showing what kind of teeth problems we commonly see.

Switch at 6 months of age:

After 6-months old, or as soon as teeth come in, it is important to switch to an orthodontic pacifier with the more flat shaped nipple such as these in the picture below.

Get rid of pacifiers by 18 months old:

The age that you really need to get rid of all pacifiers (and bottles) is 18-months old.I've heard all kinds of strategies from parents about how they have tried to get rid of pacifiers, but in general I would only recommend two different methods because I don't like any methods that encourage parents to tell their children lies (like the pacifier is "lost", or "the pacifier fairy took them"...)

• Method #1: I call it the "treat them like adults" method, and is my personal preference. This is typically the quickest way, but for some toddlers who are very stubborn it can be a difficult day or two. This method involves simply throwing ALL the pacifiers in the house away and they are gone forever.For this method a parent would want to talk to the child every day for about 1-week leading up to trash day, and clearly inform the child about what the plan is. Everyday you could say something like "in 3-days we're going to get rid of you pacifier because you're a big girl now!".When trash-day comes, it is good for the child to either watch you throw the pacifiers in the trash, or even better have them throw the pacifiers away him or herself to help reinforce that they are gone.With this method some toddlers will surprise you and not even notice that they are gone, but sometimes it could be a little bit rough with some fussiness for 1-3 days. I've never seen it take longer than the fourth day before they have completely forgotten about pacifiers. If this is the route you take I have one big warning: the worst thing you could do is to throw them away, and then give in one or two days later and bring them back. This would make getting rid of them in the future ten times worse! So if this is the method you choose you have to be committed.

• Method #2: This is more of a weaning method, and is a little longer process, but some parents prefer this more "gentle" approach.With this method you would start the first day by cutting a very little bit of the tip of the pacifier off, and then cut it shorter and shorter every 2-days until there wasn't anything left to suck on. If you try this method and your child is throwing tantrums, then it's time to go to method #1!

Whichever method you choose, it can help to substitute something else to help comfort them when they sleep such as a stuffed animal or a blanket.When you start the process stick with it and don't give in! The older the child gets the harder it can be to kick the habit.