The 5 Pacifier Pitfalls

The pacifier, binkie, dummy, paci, soothie, nuk, mute button, plug whatever you call it, its benefits are all the same.

Benefits of Pacifier

The pacifier meets a physiological need to suck and allows a baby to find self-comfort. It may reduce the risk of SIDS as it appears to allow a baby's airway to remain more open and prevent the baby from falling into a deeper sleep.¹Not to mention the other fringe benefits of a pacifier like quieting rowdy newborns, helping them sleep longer, and making outings and car rides more enjoyable for all. The pacifier certainly has a place in an infant's world!

Risks of Pacifiers

Aside from the benefits above, pacifier overuse is associated with certain risks. Pediatricians and family physicians recommend weaning or stopping pacifier use after the first six months.² Shocking, I know, considering how many toddlers we see with pacifiers in their mouths!

So what do we, as therapists and trusted resources on development, need to know to inform our families about the pros and cons of prolonged sucking? What do we need to share with the families so that they may safely navigate our pacifier-pushing world? Here are five points to keep in mind as you observe pacifier use and abuse.

1. Prolonged sucking puts children at risk for misaligned teeth

Using a pacifier past the recommended age puts children at a higher risk for misaligned teeth. As those tiny white pearls erupt, the pressure of the pacifier nipple can cause teeth to shift. Also, the pressure can cause changes in their hard palate, the roof of their mouth directly behind the front teeth. It can push the palate forward, again changing the position of the teeth. In J. Poyak's research, he concludes, "The greater the longevity and duration of pacifier use, the greater the potential for harmful results."³

2. Prolonged sucking may cause speech delays

Although inconsistent, research suggests a relationship between prolonged sucking and speech delays. Barbosa et al. concluded in their 2009 research of 128 Patagonian preschoolers that extended use of sucking outside of breastfeeding may have detrimental effects on speech development in young children.⁴ When speech sound development is negatively impacted, so is the child's intelligibility of speech making them more difficult to understand.

3. Sucking on a pacifier increases the risk of an ear infection

Sucking on a pacifier increases a child's risk of developing an ear infection otitis media. The AAP (American Academy of Pediatrics) and AAFP (American Academy of Family Physicians) advocate for limited to no use of the pacifier in the second six months of the child's life to decrease this risk.³

4. A pacifier puts a child at a higher risk for mouth injuries

A pacifier that is always in the mouth of a child, even when the child is walking around, increases the risk of mouth injuries. A 2012 study by Dr. Sarah Keim of Nationwide Children's Hospital in Columbus found that a young child is rushed to a hospital every four hours in the U.S. due to an injury from a bottle, sippy cup, or pacifier.⁵ When little ones are just learning to walk, doing two things at once requires a bit more coordination than they are capable of!

5. Stronger emotional attachment increases difficulty with detachment

Besides the physical risks, beyond the age of one, a stronger emotional attachment to the pacifier makes it increasingly difficult for the child to detach. The pacifier goes from meeting a physiological need during infancy to providing emotional comfort to the toddler when scared, upset, or sleepy.

No matter what you call it, whether you are for or against it, knowing how to advise families on pacifier use is essential to good practice. We educate parents who feel empowered to make the best decisions for their children. Although we may not agree with their decisions, we respect them. One thing we can all agree on is that a pacifier that is used wisely can benefit both the baby and the parents, and that is pure magic!