Pacifiers - Friend or Foe??

Rachel Heidling, OTR/L — August 10th, 2024

Pacifiers! Is there a certain kind that’s better than others? When do I wean? Is it better to not introduce at all to begin with? Let’s get into it…

Sucking

Babies begin sucking and swallowing movements as early as 13–16 weeks in uterus. The sucking reflex is established between weeks 32-36 in the womb, which is a survival reflex that allows babies to feed. The sucking reflex is triggered when something touches the roof of a baby's mouth (think nipple, bottle, finger). Babies born premature often have a weaker suck. When babies suck fingers, pacifiers, or other objects, this is called non-nutritive sucking. Sucking has a natural calming effect and this is why we often see more sucking before sleep. Sucking can help a distraught baby reach a state of regulation. Thus, I am a fan of pacifier use, in moderation, as this is a simple tool that draws on babies natural reflexes to calm. 

Breastfeeding & Pacifier Use

If you’re breastfeeding, you want to try to learn or be in the lookout for hunger cues like baby sticking out their tongue, licking lips, or, when very hungry, crying! Frequent pacifier use could make it easy to miss baby’s hunger cues, especially if they are cluster feeding or going through a growth spurt. Sometimes they’re hungry after just 1 hour (or less) and giving a pacifier would calm them, but it is not actually what they need. So, you can see how this could be a problem and why it is recommended not to introduce a pacifier until breastfeeding is going well and your baby is demonstrating proper weight gain.  

Not All Pacifier Are Created Equal

You want a pacifier that promotes the same oral motor skills needed to feed: wide open mouth and tongue elevation, cupping, and propulsion. A bulb on the end of a pacifier makes it easier to chomp/bite/chew rather than suck. I would recommend looking for a pacifier that is wider at the base than the tip and relatively straight, like a nipple. Here are some examples: Avent Soothie, Sweet Child Soothie, Nanobebe
These pacifiers will fall out if baby doesn’t have good oral motor coordination (a fairly common problem). Parents might say “my baby doesn’t like this type of pacifier”, however that’s a red flag for me (and it’s likely they’re having breastfeeding issues). A baby having a preference of something they like/dislike is unlikely, but rather, it could be an indication that baby doesn’t know how to suck well or has another underlying issue such as tethered oral tissue preventing them from sucking.

Shaping the Palate

You want your baby to have optimal oral resting posture when they are asleep and to be able to assume this posture when they are awake as well. Optimal oral resting posture means their mouth is closed and the tongue is resting on the roof of the mouth. If a pacifier is always in their mouth, the tongue learns to lay low in the mouth. And, this means the consistent pressure applied to the roof of the mouth is long and narrow (note: pacifier use is not the only reason someone may present with open mouth and/or low-lying tongue posture!). When the tongue rests on the roof of the mouth, the pressure applied to the palate is wide and broad. Pressure is what shapes the palate. Prolonged pacifier use applies pressure to the roof of the mouth, which leads to a high and narrow palate and an open bite. Meanwhile, pressure from the tongue naturally expands and flattens the palate. Poor palate expansion could lead to dental crowding. And then braces and/or teeth pulling can be an end result of dental crowding because the gum line/space is simply too narrow! So, when you do use a pacifier, you want to use it with the purpose of helping the baby calm or get to sleep and then, take it out.

Soothe and Remove

My favorite motto is “soothe and remove”. This is a helpful phrase to keep your pacifier use limited. When pacifier use is limited baby has more opportunity for practicing optimal oral resting posture, you’re unlikely to miss hunger cues, you provide opportunities for early communication/practice babbling, and baby can bring items to the mouth for exploration, tongue movement, and jaw strengthening. According to the American Academy of Pediatrics, it is recommended to wean pacifier between 6-12 months.

The Bottom Line

The newborn days can be hard. It’s okay to have various “tools” at your disposal to help calm a fussy baby. Babies are hardwired to suck and sucking is calming so why not use this built-in reflexive calming mechanism to our benefit? If you do decide to offer a pacifier, (1) wait until breastfeeding is well established, (2) try to use one that resembles a straight nipple shape, (3) use it as a tool for yourself, to help your little calm, and (4) limit overall time it is used once baby is calm.

Have a little who is unable to hold a straight pacifier in their mouth?? Book a Free 15 Minute Call with Rachel to discuss if she can help during a 1:1 Virtual Consultation!