Pacifier Use: When To Start & When to Stop
Pacifiers are wonderful tools to help soothe babies and young toddlers. Some children never take to them, but for those that do, pacifiers become their prized little possessions! At some point though, the question arises, when to stop pacifier use?
Sucking is a natural reflex for babies, and the ADA (American Dental Association) explains that pacifiers help provide a sense of security and comfort. My son loves his pacifier and has often used it as a source of comfort in unfamiliar situations. He also uses it to help him relax and go to sleep at nap and bedtimes.
While pacifiers serve a wonderful purpose, a number of professional pediatric associations recommend discouraging pacifier use sometime between the ages of 1 and 3.
These recommendations are related to concerns about teeth alignment and mouth formation issues, as well as increased risk of ear infections with prolonged pacifier use. In addition, it is important for children to develop other ways to soothe themselves and regulate their emotions as they get older, rather than continuing to rely on a pacifier.
When to Start Pacifier Use
Starting Pacifier Use at 1 Month Old
According to a handout I received at the hospital when my son was born, the American Academy of Pediatrics SIDS task force recommends holding off on pacifier use until a baby is 1 month old. There are a couple of reasons for this recommendation.
Establishing a Breastfeeding Routine Before Introducing a Pacifier
During our hospital stay, nurses encouraged me to establish a breastfeeding routine before offering my son a pacifier. This is to avoid “nipple confusion” between a pacifier and a mother’s nipple. If babies develop a preference for pacifier nipples, they may be less inclined to latch in order to breastfeed. Or they may become frustrated or not know how to latch to a nipple that isn’t long and stiff like a pacifier nipple. Babies may also use a pacifier to soothe hunger pangs, rather than breastfeeding or taking a bottle if they prefer the feel of a pacifier.
It was hard not to give my son a pacifier right away, because he had a very strong sucking reflex! After he was born, the nurses at the hospital suggested giving him one of our pinkie or ring fingers to suck on for a few moments when he needed comfort, rather than a pacifier those first few weeks.
Decreasing the Risk of SIDS
Starting at 1 month old, or after a breastfeeding routine has been established, the American Academy of Pediatrics recommends offering pacifiers during nap and bedtimes to decrease the risk of SIDS (they say you don’t need to worry about putting the pacifier back in your baby’s mouth if it has fallen out after they have gone to sleep. They add that you also shouldn’t attach a pacifier to clothing or anything else when you offer it before bed).
It is unclear how exactly pacifiers reduce the risk of SIDS, but an article from the Journal of the American Academy of Pediatrics discusses how it may have to do with the forward positioning of the tongue while sucking as well as how pacifier use affects sleep position.
What is SIDS?
SIDS (sudden infant death syndrome) is when a baby dies for an unknown reason, usually when sleeping. The National Institute of Health states that 90% of SIDS cases occur before 6 months, but that SIDS is the leading cause of death among babies between 1 month up until 1 year old. WebMD explains SIDS is most common in babies between the ages of 1 and 4 months.
In addition to age, there are other factors that seem to make SIDS more likely (eg ethnicity, premature birth, sleep environment), but ultimately the cause of SIDS is unknown.
When to Stop Pacifier Use?
Professional Association Recommendations
- The American Academy of Family Physicians and AAP recommend pacifier use for up to 1 year old. The risk of SIDS decreases at 1 year old, but the risk of otitis media (ear infection) increases with continued pacifier use.
- The American Dental Association says that children usually naturally self wean from pacifier use between ages 2 and 4. They recommend parents step in if a child is still using one at age 4.
- The American Academy of Pediatric Dentistry also states that children will usually stop sucking on fingers and pacifiers on their own, but that pediatric dentists may recommend mouth pieces if the behavior persists past age 3.
- When a child has developed other emotional regulation tools to replace needs met by a pacifier.
Considering a Child’s Emotional Development
Considering pacifier timelines from another perspective, psychologist Mona Delahooke discusses considering children’s readiness in terms of their emotional development. If a child has used pacifiers and the sucking reflex to regulate his or her emotions, then it is important to slowly make the transition out of pacifier use while also providing a replacement soothing object or activity.
Pacifier Use Weaning Approaches
The Cold Turkey Approach
While I initially tried the cold turkey method to banish my toddler’s pacifier use at 15 months old, I decided to reassess. While he showed no signs of great distress for the first 2 days we took his pacifier away at sleep times, this all changed on day 3. He started screaming and crying before nap and bed times and this was very unusual for him. And it wasn’t just his usual protest crying, but something more intense and distressing. So, we gave him a pacifier again, and this helped calm him down almost immediately. This indicated to me that he wasn’t quite ready emotionally and that we needed a different approach.
The Slow & Gradual Approach
So I have decided that in my son’s particular case, a slow and gentle transition out of pacifier use may be best. He is still young and learning how to deal with change and regulate his emotions.
Our plan is to not give him a pacifier during the daytime at all, but to continue offering one at nap and bed times. And after a couple of weeks or so transition to offering one only at bed time. And eventually stop offering them altogether.
Orson shows little interest in lovies or stuffed animals as substitute soothing objects, but I plan to start introducing one into his crib at night in hopes that he will turn to that for comfort when he does ultimately give up his pacifier.
Goodbye Party for Pacifiers
For older toddlers, I love the idea of having a goodbye party for pacifiers or making up a special box to keep them in and then send them off (you and your toddler can get creative in deciding where the pacifiers are going and can take them to the mailbox together).
Making a Pacifier Use Weaning Plan and Sticking to It
I think one of the most important but difficult things to do when it comes to trying to break old habits and institute new routines is to meet a child where he or she is at and be consistent with a plan. If things are one way some days and another on other days, this can be confusing for kids. To them, it may seem like there is no rhyme or reason to things, and that element of unpredictability can create a feeling of insecurity.
Some days we are very tired as parents and it is easier to just do whatever is going to soothe our children in the quickest manner. This is why in my case, I think a slower and gentler approach will work better so that we can stick to the plan with less chance of deviating.
Ultimately I think that parents know their own children best and what approach is going to work for everyone. And sometimes it just takes some trial and error and figuring things out along the way!