Pacifiers and Thumb Sucking

The Academy of Pediatrics recently recommended that parents give pacifiers to infants when they are going to sleep. After years of telling parents that pacifiers cause, misaligned teeth, speech impediments, and problems with breastfeeding, pediatricians are now recommending pacifiers to help prevent Sudden Infant Death Syndrome (SIDS).

How would a pacifier possibly prevent SIDS? Well, a good study did document a decreased risk of SIDS in babies who fell asleep sucking on a pacifier. We do not know what causes SIDS, but one possibility is that the tongue blocks the airway. Pacifiers seem to reduce the risk of this obstruction. Of course, babies still need to sleep on their back to prevent SIDS.

I tell my patients to wait until breastfeeding is established for a week or two and then they can give the baby a pacifier. Pacifiers are especially helpful for babies who are spending a lot of time on the breast, because this often means that the baby is using his mother’s nipple as a pacifier. On average, a baby only needs 7.5 minutes to empty a breast of milk, so if a mother is spending more than thirty minutes breastfeeding at a time, a pacifier can be introduced to take care of the sucking needs of the baby. Nipples can get sore and cracked with prolonged sucking.

Most parents are quick to discover and use pacifiers to buy a few minutes of peace—pacifiers often quiet down fussy babies. It is nice to know that there is some medical benefit to this object! On the other hand, if a parent does not want to use a pacifier, I do not think it is essential.

Weaning a baby from a pacifier is not easy, but can be done. Reducing the time he has access to the pacifier is a start. Many parents offer the pacifier only at bedtime or naptime. Eventually—ideally sometime before his first birthday—you can eliminate the pacifier entirely.

What if the baby discovers his thumb instead of using a pacifier? The bad thing about thumb sucking is that it’s hard to stop it once it’s started. It’s not like you can limit a baby’s access to his thumb, as you can with a pacifier. He may not give up the thumb until peer pressure forces him to, sometimes not until first grade. But babies need to suck, and the good part of thumb sucking is that the baby can easily find it after he is a few weeks old. There is no middle of the night scrounging to look for the pacifier that is wedged between the mattress and the crib.

Dr. Victoria McEvoy graduated from Harvard Medical School in 1975 and is currently an Assistant Professor of Pediatrics at HMS. She is the Medical Director and Chief of Pediatrics at Mass General West Medical Group. She has practiced pediatrics for almost thirty years. She has been married to Earl for thirty six years and raised four children. She currently enjoys writing, traveling, reading, almost all sports, and spending time with her two grandsons.

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