Pacifier information

Do I need a pacifier to calm my baby?

Pacifiers, also known as soothers or dummies, have been used to settle babies for hundreds of years; their use is optional. Mothers in our clinic report that the breast is generally better at settling babies as breastfeeding provides a warm, soft breast, and a little milk to help them sleep longer. It also helps minimize excess breast filling when the baby is sleeping. A pacifier does not offer these advantages and does present some risks. There are times when pacifiers are useful, but breastfed babies generally don’t need them.

A) Describing pacifiers

A modern pacifier is a device given to babies and young children to suck on. It generally has three sections: a teat, a mouth shield, and a handle. The teat can be made of rubber, plastic, or silicone.

Pacifier use varies between mothers, and health-care providers also differ in their pacifier recommendations. There are times when pacifiers are useful but there are risks associated with them. If pacifiers are used, they should be used properly.

B) Pacifier history

The baby is holding a cloth bag, likely filled with food and used as a pacifier. Madonna with the Siskin. Albrecht Dürer (1471 – 1528). Gemäldegalerie Berlin 2017

Parents have long tried to settle babies with a range of devices. In Italy, clay animals were found in babies’ graves dating back 3,000 years. The figures were filled with honey for babies to suck on. Honey is not recommended before one year of age because of the risk of botulism. 

Pacifier use was first recorded in 1473 by the German doctor Bartholomäus Metlinger (Levin 1971). Pacifiers have been made of coral, ivory, bone, cork, tin, glass, wood, and rubber (Castilho 2009). Many of these items were clearly dangerous. For example, pacifiers made of white rubber contained lead, which has many documented harmful effects on children (Raubenheimer 2014). 

Families have also used pieces of cloth wrapped around food or dipped in sweetened liquid, alcohol, and opiates (Castilho 2009) and this is shown in the above painting.  

C) Pacifiers are cultural

Pacifiers are not the biological norm. Other animals, including primates, do not use pacifiers. Rather their use is cultural.

Rates of use vary widely around the world. Studies have shown that 68% of a group of U.S. babies were given the pacifier before six weeks of age (Howard 1999) and Canadian pacifier use was 84% (Ponti 2016). Another study reported the rates of pacifier use in various cities, including (Nelson 2005):

  • Japan (2 cities): 12%
  • Chongqing, China: 16%
  • Stockholm, Sweden: 36%
  • Santiago, Chile: 36%
  • Buenos Aires, Argentina: 58%
  • Copenhagen, Denmark: 64%
  • Odessa, Ukraine: 71%

D) The breast is often more effective than a pacifier in calming the baby

Pacifiers are generally used to calm and quiet an unhappy baby. The breast does this and more.

For example, babies benefit from breastfeeding to sleep and this is a quick, effective, and safe way for parents to settle a tired baby. Some parents use a pacifier to help their baby get to sleep, but consider that breastfeeding offers babies a warm, soft breast to help them settle and gives them a little milk to help them sleep longer. Breastfeeding a baby to sleep also helps minimize excess breast filling when the baby is sleeping. A pacifier does not offer these advantages.

Not surprisingly, breastfed babies are less likely to be given a pacifier (Braga 2020; Gomes-Filho 2019).

E) The baby may not be able to use a pacifier

Some babies cannot latch onto or suck on pacifiers and it is unlikely they will learn. This is normal. They may show the same behaviour with bottles.

F) No conclusive evidence for using pacifiers to prevent SIDS

There is some evidence that pacifiers have a role in preventing sudden infant death syndrome, or SIDS, but the studies are not conclusive (Hauck 2005; Psaila 2017). Most expert groups do not explicitly recommend them for this purpose but rather leave their use up to parents (Ponti 2003).

References

Braga VS, Vítolo MR, Kramer PF, et al. Breastfeeding in the First Hours of Life Protects Against Pacifier Use: A Birth Cohort Study. Breastfeed Med. 2020;10.1089/bfm.2020.0054

Castilho SD, Rocha MA. Pacifier habit: history and multidisciplinary view. J Pediatr (Rio J). 2009 Nov-Dec;85(6):480-9
 
Gomes-Filho IS, Santana Pinheiro SM, Oliveira Vieira G, et al. Exclusive breast-feeding is associated with reduced pacifier sucking in children: Breast-feeding and pacifier-sucking habit. JADA 2019; 9:17

Hauck FR, Omojokun OO, Siadaty MS. Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics. 2005 Nov;116(5):e716-23

Howard CR, Howard FM, Lanphear B, et al. The Effects of Early Pacifier Use on Breastfeeding Duration. Pediatrics. 1999;103;e33
 
Levin S. Dummies. S Afr Med J. 1971 Feb 27;45(9):237-40
 
Nelson EA, Yu LM, Williams S; International Child Care Practices Study Group Members. International Child Care Practices Study: Breastfeeding and Pacifier Use. J Hum Lact. 2005;21: 289

Ponti M; Canadian Paediatric Society, Community Paediatrics Committee. Recommendations for the use of pacifiers. Reaffirmed 2016 Feb 26. Paediatrics & Child Health. 2003;8(8):515-519

Psaila K, Foster JP, Pulbrook N, et al. Infant pacifiers for reduction in risk of sudden infant death syndrome. Cochrane Database Syst Rev. 2017 Apr 5;4:CD011147

Raubenheimer E. The dummy dilemma – the fascinating history of the pacifier. 2014 Feb 9. In: Bubba West [Internet]. Melbourne: [publisher unknown]; [date unknown] [cited 2017 Sep 24]

Texas Health and Human Services (THHS). Infant Botulism and Risk of Honey Pacifiers.  Texas Health and Human Services; Austin, Texas; 2018 Nov 16 [cited 2020 May 12]