The Pacifier Dilemma Uncovered

They say you can pick out a Speech-Language Pathologist (SLP) from the crowd by her reaction when you mention the word ‘Pacifier.” We shudder! Being an SLP mom I know this feeling. My son grew up without having ever used a pacifier and I am really questioning the very limited use of a binky with my 4 month old.

So what is correct? Pacifier –v- no pacifier, and if yes, then for how long? I will answer this for you.

Pacifiers are part of a category called nonnutritive sucking (NNS). This refers to the action of newborns whereby they instinctively suck their fingers in utero and in the first few months of life. This provides them with a sense of comfort. It can help when they’re in pain, soothe them when they are irritated, and help them feel secure.

So what are all the various professional perspectives regarding pacifier use?

The Dental View:

According to the American Dental Association, pacifier and finger sucking in infants and toddlers is a normal behavior. However, if the behavior persists beyond 3 years of age, there is a higher risk of: anterior open bite, posterior crossbite, mean overjet, and smaller inter-canine distance of the upper arch.

In layman’s terms, prolonged use has the potential of affecting dental development.

The Speech-Language View:

The American Speech and Hearing Association acknowledge also that pacifier and finger sucking in infants and toddlers is a normal behavior. Use of NNS tends to be most needed at 2-4 months of age and most children will stop using pacifiers by 3 years of age.

However, continuous use of a pacifier causes the obstruction of the oral cavity, this therefore affects babbling, imitation of sounds, and word usage and it can also obstruct the production of sounds.

A study found a 3X increase in speech disorders for children who persisted with pacifier use or extensive finger sucking post the age of 3 years.

Studies have also proven that continuous pacifier use increases the risk of acute otitis media episodes by 33%. Another study also proves that the risk of ear infections is up to 3 times higher with extended and continuous use of a pacifier.

Acute Otitis Media is a type of ear infection. Many times this is accompanied with fluid build up in the middle ear – Otitis Media with Effusion. The fluid obstructs the auditory pathway and can create a temporary conductive hearing loss. Ear obstruction causes difficulty with language perception, and therefore can affect receptive and expressive language development.

The Safety View:

A study by De-Kun Li in a 2006 study demonstrated that use of a pacifier in infants reduced SIDS (Sudden Infant Death Syndrome) by 90% despite factors that could increase the risk of SIDS such as infants sleeping on their stomachs. One of the conclusions was: “A baby who sleeps on his stomach without a pacifier has a 2.5 times greater risk of SIDS”.

A study by Shahid Sheikh, MD, a pediatric pulmonologist at the Columbus Children's Hospital in Ohio found that pacifier use decreased the incidence of acid reflux in infants. From the infants that presented with reflux, there were 3 times more who didn’t use a pacifier. However this study still requires further verification.

The Health Visitor/Sleep Consultant view:

Having attended several sleep training workshops, the general sentiment from midwives and health visitors is that pacifiers are a great prop to use to assist babies in self-soothing themselves back to sleep. It is advised that the pacifier only be used as associated with sleep (it doesn’t leave the crib) and over time, it is utilized less, and eventually eliminated as other means of self-soothing tactics take effect e.g., white noise or sitting beside your baby’s crib etc., So that by 5-6 months, the baby is not extensively using the pacifier.

The Piaget Perspective:

This is another aspect to consider when utilizing a pacifier. Jean Piaget is the father of Object Permanence. This is the understanding that items continue to exist even when they cannot be sensed. According to Piaget, object permanence begins between 4-8 months of age, while full object permanence occurs between 8-12 months of age. By 12 months of age, babies will be able to look for an object that is completely hidden. The implications for pacifier use are that as the concept of object permanence begins to solidify, it becomes increasingly difficult to hide the pacifier out of sight of your infant as a tactic to get him to stop using it. It is therefore important to consider these time frames when deciding to wean your child off the pacifier.

Conclusions and My Advice:

As much as I’ve tried to have a hard and fast rule of “no pacifiers” for my children, this rule worked for my son, it hasn’t really worked for my daughter.

And from what I have presented above, pacifiers can have significant benefits in the first few months of life. Since my daughter is turning 5 months and the understanding of object permanence is beginning to occur, I continue to use the pacifier at nap and bed-time, and only as a last resort in my hierarchy of self-soothing tactics:

My Hierarchy – Thanks to Julie Mallon of Babies and Beyond, Dubai:

White Noise – 20 second

Sit by her bed – 20 seconds

Speak to the baby – 20 seconds

Pat the baby - 20 seconds

Hold the baby – 20 seconds or longer

Put the baby back down.

White noise

Sit by her bed

Speak to the baby

Pat the baby

Hold the baby

Pacifier if it’s required.

Funnily enough, on the occasions when I do co-sleep with her (in a safe co-sleeping environment and only when I’m desperate for sleep), she doesn’t require the pacifier at all, proving that she uses it as a source of comfort, but also that it is not necessary as long as I can provide her with other sources for that comfort she seeks.

Since my daughter is showing signs of maturity in movement and I know she is able to move the blanket away from her face to protect herself, my plan is that by 6 months of age, when the risk of SIDS decreases significantly, I will introduce a small stuffed toy or muslin lovey that she can chew on, in place of the pacifier.

However, it is critical to note that whilst 90% of SIDS cases occur prior to 6 months of age, there have been rare incidences of unexpected deaths until 1 year of age. The American Academy of Pediatrics recommends no loose bedding, soft toys etc., until the child is 1 year old.

This must be taken into consideration when deciding to move from a pacifier to a lovey.


Use a pacifier only as associated with bedtime (it doesn’t leave the crib) until 6-8 months of age. At this time, start to reduce the dependency by using my example above. If your child has mature motor skills by 6-8 months of age and is able to move items out of her face, you can start to replace the pacifier with something that has less long-term implications e.g., a small lovey.

However, please be mindful of The American Academy of Pediatrics recommendations of waiting to introduce soft/loose bedding till 12 months of age. If you decide to use the lovey earlier, consistently monitor your baby and wait till she falls asleep before you remove it gently.

If the pacifier is still required, press down with two fingers on the side of the baby’s cheek to help to gently remove the pacifier once the baby is sleeping so the baby does not maintain the pacifier in mouth.

By 1 year of age, when object permanence has completely set in, pacifier should already be significantly reduced, otherwise the struggle may become more difficult. Other coping mechanisms can be taught to the child in order to reduce the dependency. The long-term effects of consistent pacifier use beyond 3 years should be avoided.

Eliminating the Pacifier post 1 year:

My recommendations focus more on the very early months of a baby’s life. If your child is older and continues to use a pacifier, the recommendations on the following site provide some great ideas on how to eliminate pacifier use:


BabyCenter editorial staff (2004). The Ins and Outs of Pacifiers.

Barbosa, C., Vasquez, S., Parada, M., Velez Gonzalez, J.C., Jackson, C., Yanez, N.D., Gelaye, B., & Fitzpatrick, A. (2009). The relationship of bottle feeding and other sucking behaviors with speech disorder in Patagonian preschoolers. BMC Pediatrics 9:66

Biello, David, 2005.

De-Kun Li et al. Use of a dummy (pacifier) during sleep and risk of sudden infant death syndrome (SIDS)

Hanafin S1, Griffiths P. Does pacifier use cause ear infections in young children?

Kivi, Rose & Yu, Winnie.

Niemela, M. Uhari,M & Mottonen, M (1995). A pacifier increases the risk of recurrent otitis media in children in day care centers. Pediatrics, 96(5), 884-888

Niemela et al 2000 otitis media

Marshalla, P. (2001). How to Stop Thumbsucking: Practical Solutions for Home and Therapy. Kirkland: Marshalla Speech and Language.

Mayo Clinic staff (2003). Pacifiers: The Good and Bad News.

McLaughlin, E., RN, BSN (2004). Infants and Pacifiers.

Morelli, J. (2000). Pacifiers May Help Babies with Acid Reflux.

Snopek, R.W. (2004). To Plug or Not To Plug: The Pacifier Debate.

Van Norman, R.A (2001) Why we can’t afford to ignore prolonged digit sucking. Contemporary Pediatrics. 18(6), 61-65

Vroom, Jennifer.