The Ins and Outs of Pacifier Use

The decision to use a pacifier is very personal. After one night of my newborn screaming in the hospital, I popped in a pacifier (Binky at my house) and never looked back. Both of my sons took a Binky without hesitation, but letting it go was not so easy - for both me and my children.

Sucking is a soothing reflex for all infants, whether they suck on breasts, nipples, fingers or pacifiers...they find a way. Pacifiers have been used for hundreds (but probably thousands) of years. They were originally made of bone or rock, but in the past one hundred years mostly rubber or silicone. Recently, studies have shown the pacifier use while sleeping decreases the risk of SIDS and while some professionals believe that pacifier use interrupts breastfeeding, recently studies have shown pacifiers can support breastfeeding. I also feel that pacifiers help keep infants from overfeeding, which can cause reflux, gassiness and discomfort.

If you want your infant to take a pacifier, but they seem reluctant. Here are few tricks:

1) Place the pacifier in your infant's mouth immediately after feeding. If breastfeeding, continue to hold the infant close to you as if you are feeding while offering the pacifier.
2) Gently rub the pacifier along the roof of your infant's mouth, until he or she starts sucking.
3) Try a couple of different brands.

Though some infants never take a pacifier, starting it is usually the easy part, breaking the habit can be much trickier. My advice is to go in with a plan to take it away (timing and method). You may not meet the goal, but at least you have one to work towards. Few infants or toddlers will walk up to you and hand it back. In my opinion, there are a couple of easy transition times that are good for taking it away.

• 1 year when you are making the bottle to sippy cup transition. Your child will cry for a few days, but will not try to manipulate or bargain for it. Also, you are already dealing with the loss of the bottle, so the pacifier may not be the bigger deal. 
• 18-24 months, if your infant still seems very attached to the pacifier and seems to need it to calm down, then wait until this time period. Much later and you will be pleading for your child to give it up. 

My method of choice for taking it away, is just that...cold turkey. Find them all and throw them away. There may be a couple of sleepless nights/naps, but most toddlers give up by 2-3 days and learn to sooth themselves in other ways. You may also want to offer a new transition object (stuffed animal, lovey, pillow pet) at this time. I have heard of several other methods that work, especially for older children, including:

• Cutting the tops of the nipple off and saying they are broken 
• Having the child throw them away and offer a "prize" in return
• The pacifier fairy (comes and takes them away during sleep, but leaves a "prize" in return)
• Using it only for sleep and gently weaning. However, you will still have to deal with the day that you don't give it at night. 

Pacifier use beyond the age of 2 or 3 can interfere with speech development and tooth positioning, so as hard as it may be, it is important to take it away at some point before this happens. My husband and I chose the age of 18 months with both boys and neither seemed to miss the Binky once it was out of site (and mind).

Heather Joyce, MD