The question: My baby loves her pacifier and I'm worried that she may have a tough time giving it up when she's older. How do I know when the appropriate time is, and what are the best strategies to wean her off the pacifier?
The answer: For some infants (and parents!), soothers can be an absolute lifesaver. Many babies have trouble settling to sleep, and for these exhausted families the calming effects of the soother is nothing short of a miracle.
Pacifiers are not without controversy and I am frequently confronted in my clinic by extended family members who feel passionately either for or against soothers. I have no difficulty with soother use and – although I would avoid soothers in the first few days of life until breastfeeding is established – I think they are fair game.
Aside from home use, pacifiers are also routinely used in neonatal ICUs and pediatric wards to soothe infants undergoing painful procedures. Perhaps the most compelling argument in favour of soothers is that regular use of a pacifier is known to decrease the risk of Sudden Infant Death Syndrome (SIDS). Although the reason for this protective effect is not clear, the benefit is real and has been confirmed by multiple studies.
However, pacifiers do have their down side. For example, infants who use pacifiers tend to have more ear infections. Interestingly, soother use doesn't seem to be associated with other infections, a fact I find surprising given the number of times soothers are dropped on the floor, licked by the dog, and pawed by a snotty-nosed sibling. Prolonged use of soothers has been associated with significant dental problems including tooth and jaw misalignment.
As a result, I give the following advice to parents:
- 1. Don’t be afraid to offer a soother to your baby if she is fussy or has trouble settling on her own. Avoid using a soother in the first week of life or at least until breastfeeding has been established. Use only CSA approved soothers and ensure that any strings or ribbons attached do not pose a strangulation risk.
- 2. Do whatever you can to discourage thumb sucking! This is a much more difficult habit to break than using a soother. Substituting a soother in place of the thumb is always the better option.
- 3. After six months of age, soothers should be used primarily at bedtime and naptime then put away, out of sight, for the rest of the day. Exceptions can be made for special public outings and during travel.
- 4. Consider weaning the pacifier sooner rather than later if your child is prone to ear infections.
- 5. I have found the best age to wean the soother is around the second birthday. By now the colicky phase has passed, yet children are young enough that habits can easily be broken. Weaning now will also prevent dental problems. I suggest going “cold turkey.” This can be achieved by disposing of ALL soothers while your child is sleeping, perhaps leaving a small gift in return (if necessary, this can be attributed to the “soother fairy”). Be prepared for your child to initially demand the soother, especially in the first 24 hours. Ensuring that ALL the soothers have been permanently discarded will eliminate the temptation to give in to the whining. Parents are inevitably amazed at how quickly the soother is forgotten, usually by the second or third day.
Dr. Michael Dickinson is the head of pediatrics and chief of staff at the Miramichi Regional Hospital in New Brunswick. He's a staunch advocate for children's health in Atlantic Canada through his involvement with the Canadian Paediatric Society.
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