The great pacifier debate

Why won’t she stop crying?
As I hovered over my four-week-old daughter’s bassinet, her wails filling the house, I was out of my mind with frustration. I’d tried everything to soothe her, but nothing worked. In my hand, I held a pacifier. Desperate, I popped it in. Her little mouth latched on. She fell asleep almost immediately. I, on the other hand, was in tears. I felt like a failure for not being able to calm her myself. Guilt flooded over me.

My worries are very different from those of a few generations ago. Back then, pacifiers were relied on heavily and came only with a slight warning of giving children an oral fixation. Today, parents often hesitate to give one to their children: What if it creates nipple confusion? How do I take it away? When should I give it to her? Will it hurt her teeth? To soothe parents’ pacifier panic, we took these questions to a host of experts.

What does a pacifier do?
Comfort, comfort, comfort. Sucking on a pacifier satisfies the sucking reflex infants are born with, says Denis Leduc, former president of the Canadian Paediatric Society. “Some babies won’t accept a pacifier and won’t be comforted by it, but others really need it.”

What are the benefits of soothers?
Pacifiers are an easy and non-medicinal comfort technique to ease pain, whether it be from a booster shot or surgery. And in 2005, the American Academy of Pediatrics advised that giving infants pacifiers may lower the risk of SIDS (sudden infant death syndrome). However, it should be noted that experts around the world continue to debate whether pacifiers play a role in preventing these deaths.

But, of course, what usually drives parents to reach for a pacifier is the simple hope that it will help their babe sleep better. To a parent with a fussing baby, that’s a huge benefit.

Can pacifiers cause nipple confusion?
Pacifiers require a different sucking action than breastfeeding. If a baby sucks on the breast the same way she sucks on a soother, little milk will come out and the nipples may become sore. This is why paediatricians recommend pacifiers only be given once breastfeeding has been well established.

Can pacifiers harm teeth?
Ross Anderson, head of paediatric dentistry at Dalhousie University in Halifax, explains that extended soother use can lead to an anterior open bite (where the top front teeth don’t meet the bottom front teeth) or a cross-bite (when the upper row of teeth hangs down inside the lower teeth, rather than outside). “But if it’s a passive use of a soother (meaning the child uses it for naps and nighttimes only), there may not be any dental effects at all,” says Anderson. “And don’t lose sleep over a sucking habit. Anterior open bites, for example, correct themselves generally by the age of five, just before the permanent teeth erupt. In fact, 95 precent of chilren who use pacifiers stop by age five.

Is there a connection between pacifier use and ear infections?
There can be. Anderson cites a study that says that extensive use — more than five hours a day — can lead to chronic ear infections, which, he adds, can lead to speech delays.

Which is better — a pacifier or a thumb?
Anderson says it really doesn’t matter because the same dental effects happen with either. Yet he and our other experts agree that, generally, a thumb-sucking habit is harder to break than a pacifier habit because the parent can take away the soother. “So pacifiers are generally felt to be the better choice,” says David Smith, medical director of the General Paediatric Clinic at Vancouver’s BC Children’s Hospital.

When and how should I introduce a pacifier?
Wait until breast- or bottle-feeding has been established, which could take days or weeks. “And then, generally, pacifiers are given when the bottle or both breasts are drained, assuming the infant still wants to suck,” says Smith.

Using pacifiers only at sleep times avoids many of the problems linked to soother use. Also, don’t hold the pacifier down in the baby’s mouth to help her nod off. “If the baby pops it out, which they always do, don’t pop it back in if they aren’t crying for it,” says Denis Leduc, former president of the Canadian Peaediatric Society (CPS). “The problem is some babies are so used to it that when they wake up, they want to know where it is and will cry for it.” Instead, try to soothe her in different ways — a few loving strokes on her head or murmuring “shhhh” to let her know you’re still there.

How do I take care of soothers?
Clean pacifiers daily with hot water and soap or run them through the dishwasher. If the soother falls on the ground, don’t stick it back in your baby’s mouth. And don’t even think about popping it into your own mouth to “clean it off” before putting it back into theirs — that just throws more germs into the mix. Instead, pack a backup pacifier.

Is there a difference between styles?
Don’t believe the hype regarding pacifiers labelled orthodontically-friendly. “Studies have shown that whatever type of pacifier it is, they’ll all cause anterior open bites if they’re in the mouth long enough, and they’ll all cause posterior cross-bites if it’s an intense and frequent use of the soother,” says Anderson.

As for the silicone vs. latex decision, it’s really just personal preference. But if there’s a family history of latex allergy, it’s best to be cautious, says Leduc.

Look for a soother with the nipple firmly attached to the base — and check it regularly to make sure it hasn't loosened, to prevent a choking hazard. Also, the soother should have a ventilating hole punched into either side of the plastic base, which allows air and saliva to escape, minimizing rashes around the mouth.

When and how should I get rid of the soother?
While the CPS generally recommends that pacifier use should stop after a year, paediatricians vary in the age they recommend in their own practices. So why the inconsistency? “We all feel the sooner the removal the better. But the science is such that we won’t start to see major problems before the age of three,” says Leduc.

Quitting pacifiers can be a challenge, for both parent and child. Start by encouraging your child to turn to another source for comfort — perhaps a blanket or a doll. Don’t spring the removal on them: Talk it up first and give them fair warning that soon they will part with their beloved bubba.

Some tricks include “losing” the pacifier or having your child trade in her pacifier for much-wanted toy. Or have her “give” her pacifier to a new baby in her life, such as a friend’s infant or new baby cousin. You can also try reading books on the subject, the same way you use books with potty training (try Scott Nelson’s Bye-Bye, Pacifier or Ricki Booker’s No More Pacifier).

Are there any emotional repercussions about saying bye-bye to soothers?
It can be traumatic, says Janet Morrison, Toronto psychological associate and Today’s Parent columnist. “In the short term, it’s a big loss for a kid,” she says. As Morrison sees it, many parents don’t realize that giving up a pacifier can be a really tough thing.

With that in mind (and to minimize meltdowns), time the change well (not around a move or arrival or a new baby, for example) and mull over your wording before ditching the soother. “You have to have your child onside,” she says. “Saying ‘You’re too big for this’ and taking it away fills the child with shame and rage and leaves them distraught, so you’ll get temper tantrums, nightmares and whining — or all three!” Instead, try positive reinforcement. A well-placed “Look at how well you did without your soother this afternoon — you deserve a sticker!” goes a long way.

As for me, as I look down on my now two-year-old daughter at night, soother (still) firmly planted in her mouth, I try to remember Morrison’s reassurance that one day Annika will surrender her sucky. “Just remember, they don’t take these things to college!”

Soother Smorgasbord

Roam the baby aisles and you’ll find a slew of innovative pacifiers:

Keep it Kleen Pacifier by RazBaby ($5.99) comes with a shield on either side of the nipple which closes when the pacifier falls, preventing the nipple from touching the floor.

Raz Berry Teether ($6.99) is part teether, part soother. The bumpy texture on the nipple (which looks like a raspberry) comes in handy during teething bouts.

Avent Night Time Bear Pacifier ($5.99) has glow-in-the-dark handles, making nighttime soother scavenging a little easier.

Avent Pacifier ($6.99) has clear snap-on cap. No more linty suckies!