Friday, September 12, 2014

Pacifiers - Friend of Foe

There are plenty of differing opinions out there when the subject is pacifiers. My thoughts are as follows. If used with a few common sense rules, a pacifier can be a useful tool, and what parent doesn't need all the tools they can get?

The main benefit is that it satisfies the baby's need to suck. Sure, a finger works, but a pacifier can offer a little peace and free up your hands so you can get something else done while the baby is content. If your baby is fussing and you are fairly certain they are not hungry, a pacifier may help them calm right down. Trust me, if they are looking for milk and you offer a pacifier instead of a meal, they will NOT simply happily suck. I also want to protect mom's tender nipples. It is not so good for a baby to linger on mom's nipple long after the feeding is done just because they are enjoying the sucking. A little extra sucking is fine, of course, but some kids will never sign off.

If I have my way though, I would counsel that you keep the pacifier out of the crib. Certainly it is fine if your baby drifts off to sleep occasionally when they have a pacifier in their mouth, but make it the exception, not the rule. Take it out before you put them in the bed. The cornerstone of my sleep advice is that you let your baby learn to fall asleep without too much assistance from you. Don't PUT them to sleep. Don't SNEAK them into their beds. If they learn that a pacifier is an essential part of their sleep routine, then they are dependant on you to replace it every time it falls out. I have plenty of families who are ruing the fact that they didn't heed that advice. Some of my patients now go to sleep with a dozen pacifiers scattered around the crib in the hopes that they will be able to find one and replace it themselves rather than waking up mom or dad every few hours.

Other disadvantages of a pacifier if you don't set limits is that you could end up with a Maggie Simpson on your hands. For the few of you who may not get that reference, Maggie is a cartoon character who is actively sucking on a pacifier 100% of the time. Pacifiers are also potential germ minefields. It is important to clean them well, especially after any illness. The dishwasher is fine for this.

Pacifiers can also be safety issues if they are worn down. If you have a brand that your baby is attached to, make sure you have several, and throw away any damaged ones immediately.

Typically the oral stage should be ending around 12 months. This is also an age when the mouth is about to go through some major growth changes. Ideally try to lose the pacifier habit well before that.

Dr David Rothman, who was my children's dentist says that he is often  able to guess the brand of the pacifier by the shape of the roof of the mouth. They do have an impact! Some forceful frequent sucking on a pacifier can generate more force than an orthodontic appliance. When I asked him his opinion about which is the least heinous type, he told me the better ones are probably the Playtex natural nurser and the evenflo. He says the worst offenders are the NUK and "orthodontic" type pacifiers.

Dr Claudia Masouredis, another popular local pediatric dentist says that she doesn't have any strong opinions on pacifiers. She admits to having had a daughter who used one and feels they provide comfort to some children, so she is not militant about forbidding their use. She adds that they can cause bite issues if used frequently. These malocclusions may self-correct when the habit stops.

Nurse Charity says that pacifiers can be  linked to early weaning. She prefers that folks use round ones for the least impact. She is fine with limited use.  As she says, "use them for a purpose, don't just shove them in!"

One of Dr Anne's twins enjoyed the pacifier while the other rejected them right off the bat. Every baby is different. She stopped offering the pacifier around 4 months.

My older daughter Lauren loved her pacifier. I don't even know what brand it was. It was pink and plastic and luckily she seems to have survived having that habit without any long term repercussions. She referred to it as her "powell" which was probably the garbled way she would have said "pacifier" if she didn't have it in her mouth. At the time, I didn't know enough to set any pacifier limits and it became clear that if we didn't intervene, this was a habit she was in no hurry to break. When she was older than two, we ultimately made the rule that she could only have it when she was at home and she had to deposit it in a little bowl when we were leaving the house. Eventually we staged an intervention and "gave them away" to a new baby that a friend had just had. She plaintively asked for her powell for about a week before she moved on.

Dr Kaplan sent her little guy's pacifier up to the pacifier fairy by tying it to the end of some helium balloons. "Bye bye pacifier"

Bottom line, if your baby likes it, use a pacifier for occasional sucking needs during the day and for the first year only (but try to get rid of it before 6 months unless it is essential to your peace of mind.) If you follow these guidelines, you shouldn't have to worry about breaking a difficult habit later.

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