Q: Now that I am a grandparent, perhaps you could discuss in a column some day some of the aspects of using pacifiers with young children. My wife thinks it may delay speech in those children who are given a pacifier extensively. I don’t know. Any thoughts?
A: It may surprise you and other readers, as it surprised me, that there is an extensive body of scientific literature about pacifiers and their effects on their users – the 3,000,000 American babies (of 4 million born each year) who take a pacifier at least some of the time. Controversy exists within that literature; it’s clear that there are perceived benefits and harms from pacifier use, though the evidence is clearly not all in. It reminds me of the vehement controversy I’ve written about on circumcision, and partly because a few weeks ago I was allowed to soothe a baby during his circumcision with a pacifier dipped in sugar water, but I wasn’t permitted to send the pacifier back to his mother’s room with him.
“Pacifiers will not be given to normal full-term breastfeeding infants,” the Academy of Breastfeeding Medicine states on its website, http://www.bfmed.org/Media/Files/Protocols/Protocol_7.pdf. “Newborns undergoing painful procedures (circumcision, for example) may be given a pacifier as a method of pain management during the procedure. The infant will not return to the mother with the pacifier.” My hospital complies.
The concern is that pacifier use will result in “nipple confusion,” making it more difficult for infants to take the breast, which virtually everyone agrees is the best way to feed an infant. Evidence for this concern appears to be very thin, according to a Virginia family physician, Dr. Fern Hauck, and her colleagues who have looked at all of the English-language studies for relationships between pacifier use and breast-feeding.
The same group of researchers has examined studies probing the association between pacifiers and sudden infant death syndrome (SIDS). As I’ve written recently, the incidence of SIDS fell remarkably from when my children were born to when my grandchildren (now 11 to 14 years old) came into the world, almost certainly because babies are now placed on their backs to sleep, or con la boca arriba, as my Spanish-speaking parents say. That’s literally “with the mouth up,” and it’s probably exactly that, placing the nose and mouth in the air where they won’t be obstructed by the mattress or bedding, that makes the difference. But pacifier use also seems to have an important effect; Dr. Hauck found a 30%-50% decrease in SIDS if a baby used a pacifier. Since there is still more than one SIDS death for every 2,000 American infants (2,300 per year), that element of prevention is important.
You note your wife’s concern about speech. A nurse-scholar from New Hampshire, Antonia Nelson, R.N., Ph.D., has summarized the scanty literature looking for an association between speech delay and pacifier use, and came up with mixed results – one showing a questionable association, another seeing a significant connection, but only if pacifier use extended beyond 3 years of age, and one showing no relationship between the two. It does appear that babies who take a pacifier are somewhat more likely to get ear infections, but there is surprisingly little information about whether ear infections lead to speech problems.
Some dentists believe that pacifiers (and thumbs!) lead to misshapen mouths full of teeth. The most likely compromise between those who believe this hypothesis and those who do not is that prolonged use of a pacifier or prolonged thumb-sucking both can cause an overbite if done for many hours a day and for more than three years. Dr. Nelson notes that pacifiers may be easier to take away than thumbs, although it is probably very difficult to do the research on that!
Perhaps having something to suck on when disturbed is good for a child’s healthy emotional development. Perhaps sucking on a pacifier interferes with nursing. The evidence for both assertions is nil. The American Academy of Pediatrics recommends no pacifier for breast-feeding infants during the first month (the risk of SIDS is low then), and then states it may be helpful between then and one year of age.
Most Americans call the subject of discussion here “pacifiers,” while Canadians often call them “soothers.” The idea is the same, giving some peace and happy sucking to an infant bothered by life around her. The British call these objects “dummies.” I can’t find the derivation of this term, even in my giant Oxford English Dictionary. From the evidence I’ve cited, that can’t be because those who use them are stupid dummies (preventing 700-1,200 SIDS deaths per year is certainly not that). Maybe it’s because, like a crash test dummy, the “dummy” or “pacifier” is a stand in for something else not available at the moment, soothing the infant. That seems OK to me.