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pacifier use

4/20/2020

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​As a speech pathologist, I've had people ask what I thought about pacifiers. I have always been somewhat hesitant about giving them the green light. I've seen kids that had them way way way past when they should be using them and I always fear if you say they are okay, that they will end up as a 4 year old with a pacifier. 

When I was making my registry, I put pacifiers on the registry to have as a 'just in case'. Luckily, I did. My second night home with baby, I was at my wits end. I had run through the list of things: hunger, wet diaper, cold, swaddle; nothing was working! In a hysterical fit I screamed
"Alright FINE! Just go get the pacifier!" It was still in the packaging. 

When I popped it in his mouth, I heard silence for the first time in what seemed like hours
(but it was realistically about 30 minutes). 

Ah. Pacifier, I do love you after all! 

After that, the pacifier was never too far from us. But I have since limited its use.

Here are my rules:
1. We use the pacifier only when nothing else works to calm baby
2. We remove pacifier when baby is calm (most of the time) 
3. Begin setting limits that pacifier is only for bedtime soothing (around 3 months)
4. Wean off pacifier by 5 months of age
5. Replace pacifier with age appropriate mouthing toys

Why are these my rules?

 You should never just trust someone because they say it should be a certain way. You have to do your research and you have to do what works for your family. 

That being said, ​these rules are really only my rules. You will notice if you research this topic, different people will say different things. Dr. Harvey Karp from the uber popular book Happiest Baby on the Block says at 4-5 months to wean. I have heard some SLPs say to wean at 6-10 months. 10 months is also the time that research tells us correlates to an increase in ear infections in babies that are not weaned by that time. I chose 5 months because that is when baby is starting to make more babbling sounds. When baby has a pacifier in their mouth, they are not making those sounds.

                          No pacifier = an opportunity to make a sound 

I also wanted the pacifier out by the time teeth start to emerge, which can be as early as 8 months. 

Also, since nothing really goes as smoothly as you would like, if you start around 5-6 months but don't make the mark, it's not the end of the world. I undershoot so there's wiggle room. I really don't want it used at all as we near 12 months because that's when baby should be starting to make their first words.  

the types of pacifiers

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If you search pacifiers on Amazon, you will see there's endless options, different shapes and sizes. How will you know which one baby will like? Are you just supposed to buy them all? 

You might be intrigued by the 'Orthodontic Pacifier' in hopes that your child won't need Orthodontic work in the future. That is unfortunately not the case. Orthodeontic is a term used because the jaw is not out of alignment when baby is using it. It does NOT help your baby's palate form. That is done by baby's tongue (assuming there are no tongue ties affecting tongue mobility) and mother's breast and there are NO pacifiers that can replicate that process exactly. 


I registered for the Avent Soothie because the shape is most conducive to the 'cupping' action the tongue needs to make to suck from the breast. I was also recommended the MAM pacifier by a friend who said it was the only pacifier her baby liked.
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The type of pacifier you purchase also depends on your baby's mouth and preference. I first tried the Soothie, which at first didn't work. I can now see why because my baby had trouble cupping the breast, so cupping the Soothie nipple was just as challenging. If you are breastfeeding, you want a nipple with that cylindrical shape like the Soothie. After baby had his tongue and lip ties released, we started working towards success with the Soothie. Each day we had more and more success and it has aligned with his progress in breastfeeding as well. 
The MAM worked like a charm from day one and seemed easier for baby to use.

I wouldn't assume that if baby spits out the Soothie that they have a tongue tie. If there are other symptoms then it's worth investigating, but that alone was not a determining factor in the tongue tie. 

The material that it is made of was important too. I choose silicone over latex to avoid any potential allergy risk. Ideally, I would have liked baby to take to the natural rubber option Natursutten, but it wasn't in the cards for us. 

 What's the big deal?: The cons

So why is it controversial anyway? It keeps baby happy and a happy baby means happy parents. No one agrees with you more! As evidenced by my story above, I was so relieved to have that pacifier!

Well, there are quite a few reasons you want to limit it's use, despite the love we have for it. 
  1. If used too early it can result in nipple confusion in some babies and it's not recommended until baby has mastered breastfeeding (about 2-3 weeks in is what Dr. Karp says, but I couldn't wait that long. Thankfully it worked out just fine.)
  2. Prolonged use (more than 10 months) can lead to an increase in ear infections, malocclusion, yeast infections, and cavities. 
  3. It's not the same as a mother's nipple and there is no pacifier that can replicate for the mouth what the breast does​.

what are the benefits?: the pros

Pacifiers can come under fire, but they shouldn't be completely dismissed! Like everything in life, the pacifier has it's place and some pros that come with it.
  1. Correlation between reduction in chance of SIDS and pacifier use
  2. Increased practice with suck-swallow-breath coordination
  3. Decrease in reflux
  4. Calming
  5. Reduces chance of ear infections

alternatives?

Babies are really programmed to suckle from the womb. If you don't want to use a pacifier at all, you can try guiding baby to bring their hands to the mouth to suck on their fingers. I personally don't love this because of germs and I feel like they can develop a habit that can extend well beyond the recommended 10-12 months we spoke of earlier. It's just a harder habit to break in my opinion.  

You can throw out a pacifier, but baby will always have their hands!


​Another option are mouthing toys/objects. Babies cannot independently use these right away though. It requires hand to mouth coordination and doesn't satisfy the needs for sucking. I will get into mouthing toys in another post. 
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