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The Informed Parent

Are Pacifiers Finally Vindicated?

by Louis P. Theriot, M.D., F.A.A.P.
Published on Jun. 26, 2006

I had just finished the nine month well-check of baby Jake. He was found to be a healthy, thriving infant whose growth, development and examination were all perfectly normal. Both sets of grandparents had accompanied mom and were beaming with pride. It was a fun visit since Jake was doing so well, and there were no particular problems. As I started to leave, one grandmother leaned over and whispered into the ear of Jake's mom. There was a sudden tenseness in the air. Mom shook her head and began to bite her lip.

Tentatively I asked if there were any problems. A long, awkward pause produced only embarrassed quiet. Then, suddenly everyone began talking at the same time. Grandmother from back East reached into the diaper bag, producing a pacifier which she held in the air at eye level. "This darn thing is causing all sorts of problems," she openly confessed. It seemed that there was no consensus at home among the various family members about what to do with the pacifier. One camp felt it was perfectly normal and acceptable. The opposing camp felt it was a bad thing that would cause Jake to have buck teeth and ear infections. Worse of all, it just didn't look right.

While this was erupting in the examining room with all four grandparents talking at once, I noticed mom sitting there calmly holding the baby. She smiled at me as if to say, it's no big deal. We go through this at least once a day. I'm really okay with it because they mean well. I returned her smile to convey that I knew exactly where she was coming from. The grandparents gathered their composure, apparently realizing what had just happened. The talking stopped and they settled down like third graders who had just been scolded by the teacher. Grandfather from back East cleared his throat, folded his hands in his lap and sat up perfectly straight. Once again, there was a deafening silence as NO ONE now talked.

Turning to Jake's mom I asked her what SHE thought about the pacifier. She reported that Jake enjoyed it. He slept well with the pacifier and she was inclined to continue using it. I then told her that it was the right decision for Jake!

I told the family that I wanted to share something with them. I left the room to make copies of a timely article I had just read in the latest journal Pediatrics. It looked at the relationship of pacifier use in infants and Sudden Infant Death Syndrome (SIDS). The first suggestion that there may be a protective effect of pacifier use against the incidence of SIDS was as far back as 1979. This was somewhat downplayed until it was strongly supported in a large study published in 1993. This sparked significant interest in the subject and a flurry of papers were published from all around the world: New Zealand, Ireland, Germany, Scandinavia, England and the United States. These papers looked at routine use of pacifiers versus pacifier use only when the baby is put down for nighttime sleep. These two groups were compared to babies who did not receive pacifiers at all. Interestingly enough, the incidence of SIDS in the two groups that did use the pacifiers was decreased dramatically. Taking the results of all the studies, the incidence of SIDS was decreased by 61 percent in the pacifier group. A more recent study, published this year of 2006, was conducted at Kaiser Permanente in California. It looked at a wide socio-demographic cross section of families, both breast-fed and bottle-fed babies. They reported a 92 percent reduction in risk for SIDS when the pacifier was used for last sleep or when the baby is put down for the night.

The studies came from various countries throughout the world and the results were remarkably the same. Some doubters might suggest that the results were the benefit of the Back-to-Sleep program introduced years ago with great success. It reduced the rate of SIDS by having babies sleep on their backs and not in the prone position. All of the recent results mentioned designed their studies to take this into account and insure that this did not bias the outcome.

Others have raised possible side effects from pacifier use. These include an increase in the number of ear infections. This is a difficult thing to prove because it raises the chicken-egg question. Children that have ear infections are fussy and irritable, and are more likely to be given a pacifier for comfort...or did the pacifier actually cause the infection? Others raised concerns that pacifier use may interfere with successful breast feeding. Here again, there are numerous articles that can recommend using a pacifier after successful breast feeding has been established.

The bottom line is pacifiers are NOT bad. The literature shows overwhelmingly that their use is protective against SIDS. Pacifier use should be on an individual basis. Quite frankly, it should be a decision that is made between the mom and the child. The official stance by the American Academy of Pediatrics, published in October of 2005 in updated guidelines for the reduction of SIDS, was a recommendation that parents consider offering a pacifier at bedtime for infants up to twelve months of age.

Jake's mom and family members were asked if they had any questions. Each were given a copy of the article we discussed. They seemed satisfied and content with the discussion...except for the grandmother from back East. When I handed her the article, she shook her head and mumbled, "I still don't like these darned things!" We all laughed and I trust the controversy has been put to rest.

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