Pacifier Use, Abuse and Disuse

New and expecting parents want to make the best decisions to protect and help their baby’s development. For something so small, pacifiers seem to be a big decision nowadays. If you Google the word “pacifier,” the list will be endless. Links from where to buy, which one is the best, why they are bad and why they are good. The opinion pendulum swings far. Some parents may decide to never use a pacifier. This may be out of concern for weaning, dental hygiene or to decrease exposure to germs that can be picked up. On the other hand, there are parents who offer pacifiers and choose not to wean for an extended period of time, well into toddler and preschool years. Perhaps those parents are prioritizing things such as sleep, potty training or the child’s comfort. The truth is that pacifier use and decision making lies somewhere in the middle and depends on that particular baby. 

From the start, babies are born with the innate ability to suck. It’s a reflex that may be a little immature to the newborn but develops quickly after birth. If a baby is offered the pacifier and they are not able to latch within the first 8 weeks of life, it’s not necessarily a cause for concern. However, if that same baby is also having trouble latching to the breast, bottle or struggles to feed, then there may be an underlying sucking skill concern. This type of situation should be addressed by a qualifying professional, such as a lactation consultant or pediatric speech therapist that specializes in infant feeding. 

Some mother’s may be cautioned to NOT use a pacifier and fear that the pacifier will confuse the baby,  causing disinterest in breast feeding. Fear not, there is no well established research that proves this theory.  In fact, the baby is not confused at all!  See for yourself: watch the different patterns when a baby sucks nutritively on a nipple compared to a dry pacifier.  The baby will suck for 2 cycles per second with infrequent pauses with a pacifier, whereas the nutritive suck is meaningful, with only 1 cycle of suck per second followed by a swallow and a breath.  So what is proven in research? That pacifier use is reflexive, supports calming and is especially good for oral development in premature infants.  So if a newborn responds well to the pacifier for any of these reasons, feel reassured that it is ok to use it!

Now let’s look at a baby that’s between 2-4 months of age. This is a critical time for an infant, there are so many changes that are happening to mouth and throat structures. One major change is that the reflexive suck is now integrated. If introduction to a pacifier or a bottle has been delayed, there may be unexpected challenges or refusals by this time. This is because the motion of sucking is now a learned and volitional motor plan.  Therefore, the likelihood of learning the non-nutritive suck pattern or even bottle feeding at this time may not be as good. The baby who does not generally prefer a pacifier may also begin to spit out the pacifier more often, trading it for more exploratory mouthing with their hands, toes or even some teether toys. This is completely normal and should be encouraged.

If the infant has been using a pacifier since birth, many parents wonder when it’s best to wean.  For a typically developing infant, consider the age of 6 months.  Teeth eruption may be around the corner and the infant is also starting to produce more consonants during babbling at this age. By removing the pacifier, it allows for good development of the tongue. The tongue will start to move in different directions.  It may protrude, retract, start to move side to side and even elevate with the support of the jaw. This promotes development of food manipulation for eventual chewing and the production of a variety of sounds. 

If the pacifier is over-used after this age, it can encourage the tongue to maintain a depressed/forward resting pattern instead of the preferred dynamic movements. This can negatively influence how the infant learns to make sounds, especially tongue tip sounds like “t, d, s” and so forth. It may also contribute to something called a “tongue thrust pattern.” However, this is more likely if the pacifier is used for an extended period of time, and not weaned between 12-24 months of age. 

There are exceptions to weaning infant’s from the pacifier early. One particular group would be those with colic or excessive fussiness. Babies that have poor coping skills may NEED the pacifier to organize, calm and even sleep. However, if the baby is not outgrowing the colic in a typical timeframe and this leads to extended use of the pacifier or other bad habits well into toddler/preschool years, it may be worthwhile to seek out help from a professional that specializes in infant state management, such as an occupational therapist. 

Diana Daniak, M.S. CCC-SLP/L

Diana is an ASHA certified speech/language pathologist with over 12 years experience working in a pediatric hospital based setting. She specializes in infant/pediatric feeding and swallowing disorders and currently services a hospital-based, multidisciplinary feeding clinic in the Chicagoland area.

https://www.stanfordchildrens.org/en/topic/default?id=newborn-reflexes-90-P02630

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