Definition

• A pacifier is an artificial nipple for a baby to suck on. It can be used when they are not hungry.
• This need for extra sucking is called non-nutritive sucking. Infants soothe themselves by sucking. Babies vary on how much of this they need. Some need very little.
• The pacifier is also called a soother, dummy or binky.

Health Information

Main Benefit: Prevent Thumb Sucking

• The amount of extra sucking babies need when they are not hungry varies. This extra sucking seems to be for self-soothing and self-comforting.
• Some babies suck on their thumb or fingers almost constantly. If you have a baby like this, try to interest him in a pacifier. To be accepted as a substitute for the thumb, introduce it before 2 months.
• Pacifier sucking is harmless compared to thumb sucking. Thumb sucking can cause a severe overbite if continued after permanent teeth come in. A pacifier exerts less pressure on the teeth and causes a minor overbite. However, dentists do recommend stopping a pacifier by age 2.
• The main benefit is you can control your child’s use of a pacifier. You can decide when to stop it. If over 12 months old, he will rarely start late thumb sucking if you take it away.
• In contrast, it is much more difficult to stop your child from sucking his thumb. This is because his thumb belongs to him.

Main Risk: Pacifier Dependency

• Pacifier dependency is when a child always wants the pacifier with him.
• It’s his constant companion. He feels like the pacifier belongs to him. He walks around with it in his mouth.
• He can’t fall asleep without it in his mouth. Following normal awakenings at night, he can’t fall back to sleep without the pacifier. If he can’t find it, he cries for his parent to help him. Normal infants can’t find, pickup and re-insert a pacifier until 10 to 12 months old.

Reasons to Phase Out the Pacifier By 12 Months of Life

• A pacifier can interfere with normal babbling and speech development. It’s hard for a child to talk with a pacifier in his mouth.
• A pacifier in the mouth can also interfere with learning normal facial expressions.
• A pacifier also encourages a child to continue exploring the world with his mouth. He should be doing it with his hands.
• Older children will strongly resist pacifier weaning. Bad habits become harder to break with each passing month. After age 2, taking away the pacifier may cause a battle.
• He probably won’t agree to give it up on his own until 4 years.

Pacifier Dependency: Prevention

If you allow your child to use a pacifier all the time, his interest in it will increase. To ensure your child doesn’t become overly attached to a pacifier, consider the tips below:

• During your child’s first 6 months, use the pacifier only when he wants to suck but isn’t hungry.
• The only exception is during the first month of life and you are breastfeeding. This is when breastmilk is coming in and milk supply is being established. Sucking and feeding from the breast are what make moms produce milk. So, we want all that sucking energy to go towards making more milk. If it’s been more than 90 minutes since the last nursing, your newborn is hungry. For formula fed babies, the pacifier is fine unless your baby is hungry.
• Be careful not to offer a pacifier every time he cries. Crying has a number of causes besides hunger and a need to suck. Try swaddling or rocking. (see Crying handout).
• When your baby seems unhappy, first use cuddling. This provides comfort instead of offering the pacifier. Try not to overuse the pacifier while you are comforting your baby.
• If your baby uses a pacifier, don’t forget to take it with you for air travel. Sucking a pacifier or swallowing fluids during descent can prevent ear pain.

Care Advice

Normal Pacifier Use: Gone by 6 to 12 months

1. Prevent Thumb Sucking with a Pacifier:
   • The peak age for thumbsucking or using a pacifier is 2 to 4 months.
   • In the following months, the urge to suck normally decreases.
   • Babies find other ways to soothe themselves.
   • Here are some tips for normal pacifier use in young babies.
2. Limit Pacifier Times to When Awake and Holding Your Baby:
   • Limit pacifier use to times you are holding your baby.
   • If you do so, he will usually lose interest in it by 6 to 9 months.
   • If your child seems to want a security object while he is awake, don’t give him a pacifier. Use a stuffed animal.
3. Don’t Use the Pacifier For Sleep:
   • Do not use the pacifier to help your child fall asleep. Exception: to calm a crying baby who has colic.
   • Never use a pacifier as a sleep transition object.
   • Help your child learn to put himself to sleep.
   • Keep the pacifier out of the crib.
4. Control When You Offer Your Baby a Pacifier:
   • Don’t allow a pacifier during car or stroller rides.
   • Do not allow your child to carry around a pacifier.
   • Don’t use a pacifier for teething. Do use a teether for sore gums. It teaches a chewing motion rather than sucking.
   • Do not let him think that the pacifier belongs to him.
5. Start Phasing Pacifier Out at 6 Months of Age:
   • After 6 months when your baby starts to crawl, use the pacifier less often.
   • Keep it out of sight when not in use.

Delayed Pacifier Use After 12 Months: How to Stop

1. Pick a Date to Give Up the Pacifier:
   • Help your child pick a date to give up the pacifier.
   • Sometimes giving it up on a birthday or holiday is easier for your child.
   • Ensure your child is not coping with other changes or fears at that time.
   • Then "do it".
2. Make the Transition as Pleasant as Possible:
   • Tell him the dentist or doctor said it was time to stop.
   • Say "it will make your teeth happy".
   • Never use punishment to force your child to give up the pacifier.
3. Giving up the Pacifier - Use Incentives:
   • If your child is strongly attached to a pacifier, you may need to offer incentives. Night time pacifiers are hardest to give up.
   • Encourage him to trade the pacifier for something he really wants. Perhaps a stuffed animal, book, video or special toy. Have him give the pacifier to the clerk at the toy store.
   • Some children will agree to just throw it out.
   • Others may want to leave it out for Santa Claus or the "pacifier fairy".
4. Comfort and Praise Your Child:
   • At times of missing the pacifier, comfort your child with cuddling.
   • Help your child talk about missing the pacifier.
   • But once it’s gone, never bring it back.
   • Praise your child for this sign of growing up.

Call Your Doctor If

• Your child cannot give up the pacifier
• You think your child needs to be seen
• You have other questions or concerns

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.