Are Soothers OK?

by Susan Miller, BScN

The use of soothers is a hotly debated topic in “baby land.” Many expectant parents swear they will never use a soother because of the disapproval they have heard from others, especially the baby’s grandparents. Breastfeeding experts and lactation consultants warn that the use of a soother (also known as a pacifier) could jeopardize breastfeeding. In spite of all this negative hype, soothers are still common, and in Canada today roughly 66 to 84 per cent of all infants under one year of age use a soother at least some of the time.

As a new parent you may have expected to never use a soother with your baby and then changed your mind. For many babies, a soother provides the non-nutritive sucking they need to be able to calm themselves. Most families I’ve talked to about soothers found they started using one when their baby was between two and three months old and continued to use it until their babies were six months and older. Don’t feel guilty if your baby likes and needs a pacifier. There is a place for the judicious use of pacifiers, even with fully breastfed infants.

The debate about pacifiers has been going on for years. The Canadian Paediatric Society (CPS) recently reviewed evidence and research on pacifier use. In most cases, the perceived hazards of pacifier use for young babies were found to be unsubstantiated. In February 2009, the CPS reaffirmed that pacifiers can be appropriate and safe. Here are some CPS findings and recommendations.

Pacifiers and Breastfeeding
If possible, avoid using a pacifier until breastfeeding is well established. The “Baby Friendly Hospital Initiative: Ten Steps to Successful Breastfeeding” guide states “give no artificial teats or pacifiers (dummies or soothers) to breastfeeding infants.” Many health care professionals and breastfeeding advocates believe that the early introduction of pacifiers is associated with “nipple confusion” or “nipple preference” and early weaning. A pacifier should not be offered to a healthy full-term newborn. The exception to this rule is an infant who is born early. Soothers actually help premature babies with calming and state regulation, and the organization of oromotor skill development (suck, swallow, breathe) which is required for feeding from the breast or bottle.

La Leche League International recommends that pacifiers never be used as a substitute for feeding or comforting, but it also states that “pacifiers can be of help to a breastfeeding mother when used judiciously, for short periods of time and in limited circumstances.” In a Montreal study, two groups of mother-baby pairs were followed from birth to three months postpartum. Both groups received counseling intervention that promoted breastfeeding and taught ways to calm a fussy baby. One group was counseled to avoid using pacifiers. The study found that there was no difference in the rates of weaning before three months of age in the two groups. Another similar study found no significant differences in breastfeeding frequency or duration in the first six months.

Pacifiers and Ear Infections
Babies and young children are prone to middle ear infections (otitis media) because the eustachian tubes are not fully developed until about the age of seven. Eustachian tubes in young children are shorter and less vertical than in adults and are more prone to being blocked and filled by secretions. Persistent sucking on a soother makes it easier for pathogens to be pulled up the eustachian tube to the middle ear where an infection can develop. Middle ear infections usually occur around the same time or shortly after a baby has a cold.

Some people believe that pacifiers carry the microorganisms that can cause a baby to develop an ear infection. One study tested 40 used soothers for microorganisms, and found that more than half were uncontaminated. Furthermore, the soothers that did carry organisms did not carry the major pathogens that cause otitis media. However several studies have indicated that soother use increases the risk of a baby developing otitis media if the soother is used for more than five hours a day. The CPS recognizes that soother use may contribute to the development of middle ear infections but this is only one of the many factors involved. The CPS recommends that pacifier use be restricted for infants who have chronic or recurrent otitis media.

Dental Concerns
Sucking on a pacifier is commonly believed to cause a child to have a malformation of the dental arch, and malocclusion problems. This can be true in children over the age of five, but babies who use a soother for the first year do not have a greater risk of dental problems. Both the Canadian and the American Dental Associations prefer the use of soothers over thumbs because it is easier to break a soother habit than a thumb sucking habit. In either case the habit should be broken before the permanent teeth erupt. Under no circumstances should a baby or a child be given a soother sweetened with sugar, corn syrup or honey as this will most certainly lead to early dental decay.

Pacifiers and SIDS
Some recent studies suggest that babies who use pacifiers are actually less likely to die of SIDS. The reason is not clear, but the statistical evidence is compelling. A study in the Netherlands revealed that only 12 per cent of the babies who had died of SIDS used pacifiers, while 48 per cent of the general baby population used pacifiers. Their conclusions state that pacifiers should be recommended, at least for bottle-fed infants. The CPS states that “No recommendation to use pacifiers to reduce the risk of SIDS can be made at this time. However the evidence is sufficient that paediatricians and other health care professionals should be cautious before routinely advising against their use.”

Find Out More
Always ensure that you are using a safety-approved pacifier and that it is clean. Soothers should be sterilized every couple of days by boiling them in water for five minutes. Check your baby’s soother often for cracks, tears or discoloration. Replace any soother that has worn out or if baby has had a thrush infection in the mouth. Always ensure that your baby’s soother is the right size for his age, and start to wean your baby off of the soother before he is around one year old.

The CPS website provides information on the recommended use of pacifiers and a handout: Pacifiers: A user’s guide for parents.

Susan Miller R.N. BScN is a Perinatal Educator and Certified Breastfeeding Counsellor. She is the proud grandmother of Meredith.