If there is an argument for pacifiers (also termed "soothers"), the prevention of thumbsucking is probably the best argument for early judicious use of an orthodontic pacifier (although I am unaware of any scientific study proving this). "Better a binky than a pinky." A pacifier can be discarded after the first few months (I recommend by no later than about 5-6 months), a finger can't. On the other hand, in 20 plus years of practice, I cannot remember sending even one child to the orthodontist for the ultimate thumbsucking cure (the little cage apparatus). So thumb sucking itself is probably an overrated problem as well.

Some people get nervous about using a pacifier too long - but remember, it is the parents who allow this. I also personally believe the talk about nipple confusion with breastfeeders is way overblown - some first time mothers are literally afraid to let their baby have a pacifier for fear of ruining nursing. That's rather extreme. A common sense approach - try it with your baby and stop if you think it causes problems - seems much more reasonable.

Pacifier use should be limited to initial falling asleep only. Otherwise, there is a now fairly well established association of increased ear infections with continuous pacifier use1. This use of pacifiers - just to aid falling asleep - may be OK for the first few months, but even this use should be avoided after 5-6 months because of the risk of reinforcing behavioral night waking and crying around 7-8 months.

Additional personal opinions on pacifiers (caveat lector):

  • Pacifiers were created more for the convenience of parents, rather than that of babies (who come equipped with perfectly good appendages on which to suck). The moment that the pacifier causes more work for the parents than it saves, it should go. To be specific, if you find yourself getting up four times a night to replace the pacifier, you need to get rid of it right away (and you have probably gotten into some bad habits with regard to sleep and bedtime issues, too - see my video ;-).
  • Getting rid of pacifiers is easy. Throw them in the trash. Your child cannot remember the thing for very long. If you dread this so much, just think of when you had to go to the dentist. It was probably not nearly as painful as you feared, and once done, it was done. "Well, that wasn't so bad after all..."
  • Pacifiers are routinely germ-laden. It is next to impossible to keep them clean, although admittedly this does not seem to be a major medical issue in real life.
    How many times has a parent picked a pacifier up off my floor, wiped it on a pants leg, placed it in baby's mouth, and calmly asked, "And doctor, how much longer should we boil the baby's water?"
1. Pediatrics 2000; 106:483-488.

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