Pacifiers for Kids- Risks and Benefits

Non-nutritive sucking (NNS) is an innate reflex for newborns. Even inside the womb, fetuses are often seen sucking a hand or finger. Pacifiers, also known as soothers, binkies, dummies are artificial teats given to babies and toddlers to help fulfil the desire to suck.

Pacifiers are used since ages. Earlier Pacifiers were made of clay, silver, ivory, pearl or coral, and sugar teats. Initially, pacifiers were made of rubber but abandoned due to latex allergy, have been replaced by plastic now.

How to Choose Correct Pacifier?

• Pacifiers consist of a latex or silicone nipple with a firm plastic shield and handle, available in different forms and sizes.
• Look for Single unit Pacifier which is safe and best to avoid choking.
• Choose physiological or functional exercises or Orthodontic Pacifier.  Physiological pacifiers have a better fit to child’s face due to concave curvature of its shield as compared to conventional pacifier having a shield with convex curvature. Also, the nipple of the conventional pacifier is thicker than the ones of the physiological pacifiers.
• The material should be durable, tasteless, odourless and should not be leaching harmful substances. It should be BPA free.
• Flanges of Pacifiers should have minimum horizontal and vertical dimensions of 43 mm to prevent the pacifier from lodging in the soft palate and should have a ring behind the flange for removal in case of aspiration
• The shield should be wider than the child’s mouth (just over 3 cm in diameter)
• Make sure Shields should have ventilation holes. These holes allow a child to continue breathing even if the child sucks the pacifier shield into his or her mouth.
• The inner surface of pacifier should be-belt soft and textured, not a course to prevent irritation and rashes that result from trapped saliva.

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How to Clean Pacifiers?

• Sterilize the pacifier by putting it in boiling water for 5 minutes before the first use. Make sure it’s completely cooled down before giving it to your baby. Keep it clean by washing it with hot, soapy water after each use. Don’t “clean” the pacifier by sucking on it yourself because it can spread germs from you to your child.
• Always check for cracks or tears before giving a pacifier to your baby. Don’t give your baby a pacifier right after giving medicine (like a pain reliever, antibiotics or vitamins), because some of these medicines can cause the material in the pacifier to break down. If there are cracks or tears, throw it out.
• Replace the pacifier every two months. But do not stick to timeline religiously, change pacifier if it shows any signs of tear and wears before 2 months.

Medical conditions that justify the use of Pacifier

• Premature and low birth weight < 1,500 g and/or < 32 weeks gestation
• At risk for hypoglycaemia
• A baby who needs oral stimulation to maintain and develop sucking reflex
• Severe maternal illness preventing breastfeeding (e.g. Herpes Simplex)
• If the mother is medically nit fit for breastfeeding. (e.g. psychotherapeutic drugs)
• Neonatal intensive care unit (NICU) infant needing calming, pain relief and stress management
• During tube feedings

Benefits of Pacifier Use for Kids

Soothing Baby

Pacifiers have a positive effect on the emotional and psychological development of the child by soothing, comforting, calming and helping baby to fall asleep.

Analgesia

Pacifiers are identified by the American Academy of Pediatrics (AAP) as one of the key methods for pain and anxiety reduction for children less than six months of age. Pacifiers are used for minor procedures to calm and soothe the infant. Pacifiers have been found to relieve stress and teething pain, promote sleep and decrease the tendency of digit sucking.

The AAP has recommended or studied pacifier use for procedures such as “catheterization, circumcision, heel sticks, immunizations, insertion of an intravenous line, lumbar puncture, screening for retinopathy of prematurity, and venipuncture.

Preterm infants

Babies are born “inherent biological derive for sucking”. Sucking reflex is essential to obtain nutrition called as Nutritive sucking as in breastfeeding and bottle feeding. However, preterm babies, born less than 32 weeks of gestation, sucking reflex may not be developed, making oral feeding inadequate. These babies are usually fed with tubes. Premature babies who are given Pacifiers have been found good at gaining weight and have shorter hospital stays the earlier transition to bottle from tube feeding, and improved bottle feeding. These infants have lesser chances of necrotizing enterocolitis, a gastrointestinal infection common in infants.

 Sudden Infant Death Syndrome

SIDS defined as “the sudden death of an infant less than one year of age that cannot be explained after a thorough investigation is conducted, including a complete autopsy, examination of the death scene, and review of the clinical history”. Chances of SIDS is high among age group of 1- 4 months old babies. The AAP guidelines recommend pacifier use for infants as a method of Sudden Infant Death Syndrome (SIDS) prevention.

Pacifier use may decrease the likelihood of rolling into the prone position, increase arousal, maintain airway patency during sleep. It is recommended that pacifier use should be restricted until six months to prevent SIDS.

Risks of Pacifiers use

Pacifiers and breastfeeding.

Step nine of the United Nations Children’s Fund/World Health Organization “Baby-Friendly Hospital Initiative: Ten Steps to Successful Breastfeeding” states “give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants”. Pacifier use in breastfed children is associated with early weaning or breastfeeding difficulties.

Pacifier use may contribute to ‘nipple confusion’ or nipple preference, especially if introduced before breastfeeding has been fully established.  AAP advises to hold off on pacifier use for full-term infants until the mother and children have established strong breastfeeding habits.

Dental health

Dental caries, malocclusion and gingival recession are commonly cited problems associated with pacifiers. Pacifiers per se do not create any dental issues, problems exist only with prolonged (after age five) or inappropriate use (sweetened pacifier). Pacifier use alters occlusal development, depending on the intensity, frequency, and duration of the habit. Pacifier use can lead to lip incompetence, lip entrapment, a decrease in muscular tonicity of tongue and lips and a narrow hard palate.

Infection

Pacifiers can be considered as a fomite. Pacifiers constantly come into contact of saliva, providing an excellent niche for supporting the growth of microorganisms, but their ability to cause clinically significant infections is questionable. Pacifiers should be thoroughly cleaned to limit contamination.

Otitis media

Pacifier sucking may impair the functioning of the eustachian tube by changing its patency, and the pressure balance between the nasopharynx and the middle that, thereby, restricting pacifier use to the moments of falling asleep would reduce the occurrence of acute otitis media.

Pacifier use may be causing “reflux of nasopharyngeal secretions into the middle ear from sucking and Eustachian tube dysfunction.

Allergies (mostly latex allergies)

Interfering with speech development

Potential for compulsive use (pacifier addiction

Overall Recommendations for Pacifier Use

1. AAP and AAFP both recognize the benefits of use especially in the first six months of life in reducing SIDS.

2. After children reaching 6 months of age, the risks start to outweigh the benefits and after two-years-old, the risks increase benefits

3. As per Baby-Friendly Hospital Initiative of the World Health Organization and United Nations Children’s Fund, avoid pacifier use full-term infants

4. If the child is successfully breastfed: avoid pacifier use in the 1st month of life

5. Give pacifiers to babies only after they are well fed. Do not make pacifiers, a substitute  to replace or delay meals with full-term infants

6. The U.S. Consumer Product Safety Commission (U.S. CPSC, 2001) defined pacifiers as “an article with a nipple intended for a young child to suck on, but that is not designed to help a baby obtain fluid”

7. Don’t force your baby to take the pacifier if he doesn’t want it. Avoid ad lib use of pacifiers  throughout the day

8. Put the pacifier in your baby’s mouth when you put him down to sleep, but don’t put it back in his mouth after he falls asleep

9. Keep the pacifier clean, and buy a new one if the nipple is damaged

10.. Never tie pacifier with a string to the crib or around a child’s neck or hand to avoid strangulation.

11. Never  share pacifiers among siblings and never lick to clean them

12. Bigger children should not play or walk around with a pacifier

13. Don’t coat the pacifier with honey, alcohol, corn syrup or any other substance because of the risk of promoting caries except when the pacifier and sucrose solution are used simultaneously for the purpose of pain management

When your Child should stop using a Pacifier?

1. Pacifier use should no longer be actively discouraged and may be especially beneficial in the first six months of life. However, the risks begin to outweigh the benefits around 6 to 10 months of age and appear to increase after two years of age

2. The American Academy of Pediatrics and the American Academy of Family Physicians recommend weaning children from pacifiers in the second six months of life to prevent otitis media

3. Start to wean pacifier  at the age of 3 years and that the habit should be discontinued by or before the age of four years to minimize the dental effects

4. From a speech therapy perspective, clinicians recommend cessation at 14 months of age to prevent interference with speech

5. American Dental Association (ADA) and American Academy of Pediatric Dentistry (AAPD) suggest that pacifier use be discouraged after children turn four-years-old

6.  Recommendations are very conflicting I would suggest weaning from as early as 6 months and if the situation requires, not later than four years of age. As the derive for sucking has been found to be highest at 3 months of age, gradually decreases by the age of 9 months

6 Key Alternatives to Pacifier use in Younger Infants include

1. Swaddling
2. Rocking
3. Soft music
4. Singing
5. Infant massage
6. Older infants or toddlers activities, toys, or other objects of affection

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