Pacifier Use 101
Using a pacifier with babies is a controversial topic for some. There are those who feel it is detrimental for babies and those who feel using a pacifier is just part of being a baby. It’s yet another topic for parents to feel confused, stressed or guilty about. I hope this article gives you clarity and supports you in making a confident decision for your baby.
Common Concerns
First, let’s name the common concerns about giving a baby a pacifier.
Giving a pacifier to a baby is just that, it’s pacifying your baby and that’s bad for them. They should be able to express themselves or self-soothe.
The pacifier shapes the upper palate of the mouth, so if you want your baby’s palate to be the right shape (wide with a gentle arch) then use a flat pacifier or don’t use a pacifier at all.
The pacifier will affect the position of baby’s teeth, causing buck teeth or a need for braces in the future, for example.
Oral Motor Skills and Regulation
Ok so now that we know the concerns, let’s talk about development, specifically oral motor skills and regulation.
When do we usually give a baby a pacifier? When they are tired or upset, which is addressing regulation. The action of using the pacifier is by sucking, aka use of oral motor skills. Let’s talk regulation first.
First of all, babies cannot self-soothe. This is antiquated information that is simply incorrect. I talk more about this in my blog on co-regulation that you can read here. So, babies need support to regulate. That is, to move through the spectrum of states from social and safe/parasympathetic, to active/discontent/sympathetic, to sleep/parasympathetic. There are a variety of ways to support a baby with regulation. The most primitive and accessible (if oral motor skills are functional) regulation tool for babies is sucking.
When a baby is sucking, the tongue is the star of the show with the cheeks and jaw providing support. The tongue should stay forward in the mouth, while cupping the sides up into a taco shape and then doing a wave like motion from front to back. This is the ideal and most optimal way to suck.
Lastly, the upper palate of the mouth is shaped by the tongue! Optimal oral rest posture is when the tongue is suctioned to the roof of the mouth and the jaw and lips are gently closed. The tongue suctioned to the upper palate is actually the first posture that a baby ever achieves and this happens in utero. This is why the upper palate should be wide and flat, the tongue is wide and flat!
Addressing the Common Concerns
Now that we’ve covered the basics of regulation and oral motor skills, let’s look back at those concerns about pacifier use.
Concern #1 Giving a pacifier to a baby is just that, it’s pacifying your baby and that’s bad for them. They should be able to express themselves or self-soothe.
Response: Since babies cannot self-soothe, they need support from their caregivers one way or another. Rocking, boucing or sushing your baby isn’t considered pacifying. Giving your baby a way to use the main tool they have to regulate, sucking, shouldn’t be seen as pacifying either. Also, it is important to provide a pacifier thoughtfully rather than popping it in baby’s mouth as soon as crying starts. Tune into your baby’s cues and offer the pacifier when baby is sleepy or upset, and other basic needs have been met (for example, hunger or soiled diaper).
Concern #2 The pacifier shapes the upper palate of the mouth, so if you want your baby’s palate to be the right shape (wide with a gentle arch) then use a flat pacifier or don’t use a pacifier at all.
Response: Pacifiers DO NOT shape the upper palate, the tongue does. If a baby is getting proper oral rest posture with the tongue suctioned to the roof of the mouth, the palate will be shaped by the tongue. If a pacifier is being used inappropriately, then yes, it can exacerbate or influence shaping of the mouth.
Since the tongue makes a taco shape when sucking, the optimal shaped pacifier to use is a cylindrical one (i.e. a symmetrical tube like the Soothie or similar). This will fit in the concave space of the tongue properly, and therefore, have the least effect on palate. It will also reinforce optimal oral motor skills. Any other shape of pacifier is leaning into what compensations a baby already has when sucking. That means a baby might be struggling with sucking and is finding other ways to move their tongue, jaw or lips in order to suck and feed.
A flat pacifier tends to work for a baby that is using compression (i.e. an up and down motion of the tongue and jaw) rather than cupping of the tongue. That pacifier will be repeatedly pushed up into the upper palate. The bulbous type of pacifier tends to fit into a high arched palate and makes holding the pacifier in easier for baby so the tongue is doing less work.
Concern #3 The pacifier will affect the position of baby’s teeth, causing buck teeth or a need for braces in the future, for example.
Response: This is true if a pacifier is being used past infancy when teeth have come in, and especially, if a child is using the pacifier for extended periods of time. It’s ideal to quietly make the pacifier go away around 6 to 7 months when baby’s social nervous system is maturing and well after the suck reflex has integrated (this happens around 3 months of age). This is ideal because baby doesn’t have an emotional attachment or the awareness to experience upset by the pacifier not being available. An infant of this age is also ready to rely more on co-regulation rather than sucking the way they needed to as a newborn.
The Dos and Don’ts of Pacifier Use
Use these guides to utilize a pacifier optimally and in a developmentally appropriate way.
Things to Do:
use a pacifier that is cylindrically shaped (i.e. a symmetrical tube like the Soothie or similar)
offer the pacifier when support for calming or sleep is needed
remove the pacifier when baby is asleep and ensure baby’s mouth is closed
discontinue use of the pacifier when baby is about 6 to 7 months old and focus on co-regulation strategies such as talking or singing to baby, reassuring touch/hugging/holding, movement (rocking, swaying, bouncing), soothing objects (special stuffy or blanket), etc.
Things to Avoid:
using a pacifier that is not cylindrically shaped
using or forcing the pacifier without first tuning into your baby’s cues to ensure it’s not a solid diaper or hunger that is causing upset
allowing the pacifier to “live” in the mouth when baby is awake, active, calm, not actively sucking
allowing baby to sleep with the pacifier in the mouth
using a pacifier that is not cylindrically shaped
allowing use of the pacifier into toddler years
The Gist
It is not “right” or “wrong” to use a pacifier.
What matters is how and why the pacifier is being used, and most of all, if it’s effective for your baby. In the end, what your baby needs is nurturing support and tuned-in, mindful caregivers. You may find that what is needed varies from child to child. It’s ok to use a pacifier in a thoughtful and developmentally appropriate way. And it’s ok to not use a pacifier if it’s not helpful or there are other effective ways you can meet your baby’s needs. Ultimately, how you provide for your children is up to you!
Lastly, it’s important to note that some babies struggle with the pacifier or will only suck on a specific shaped pacifier because there are underlying challenges with sucking. In these cases, seek an evaluation and support from a licensed infant feeding therapist.
