Considerations for Pacifier/Soother Use

A pacifier has been shown to be a simple, safe, and clinically effective tool in infant feeding interventions and general health.

Benefits of pacifier use:

• can be used to elicit and practice the non-nutritive suck (NNS), one of the earliest developed oral sensorimotor reflexes
  • development of the NNS is recognized as a stage in the development of feeding skills in infants (Browne & Sundseth Ross, 2011).
  • plays an important role in the development of ororhythmic behaviours, which are important in the reconfiguration of the suck central pattern generator to meet developmentally changing task dynamics (Barlow & Estep, 2006).
  • has been shown to have a significant effect on gastric motility, reduce transition time from gavage to full oral feeding (days), and decrease the length of hospital stay in preterm infants (Foster, Psaila, & Patterson, 2016).
  • evidence for positive effect on helping a preterm infant maintain and transition between behavioural states has been demonstrated, however, it is inconsistent across the literature (Foster, Psaila, & Patterson, 2016); (Harding, Cockerill, Cane, & Law, 2018).
• linked to reducing incidence of sudden infant death syndrome (Moon & Syndrome, 2016) provides a simple, non-invasive, and effective comfort measure for minor, routine procedures with neonates  (Barrington, Batton, Finley, Wallman, & Canadian Paediatric Society Fetus & Newborn Commit, 2017).

Risks of pacifier use:

• pacifier properties can alter non-nutritive suck (NNS), (e.g. pacifier compression, pull stiffness, and nipple shape type yield different NNS dynamics) (Zimmerman, Forlano, & Gouldstone, 2017).
• prolonged soother use has been shown to alter the development of oral anatomy (e.g. posterior cross-bite, narrow upper jaws, labial segmental alignment, anterior open bite) 
  • research shows that the risk of dental problems (e.g. changes in bite, alignment of teeth) increases with duration of soother use
  • studies show that pacifier use at one year is linked with development of an open bite and recommend that pacifier use be discontinued by age one (Chen, Xia, & Ge, 2015); (Ling, et al., 2018) (Zen, et al., 2019).
  • the risk for permanent malocclusion increases with pacifier use beyond age two and many studies recommend use should be discontinued by age four (Schmid, Kugler, Nalabothu, Bosch, & Verna, 2018),  (Bueno, Bittar, Vazquez, Meneghim, & Pereira, 2013); (da Rosa, et al., 2020); (Melink, Hocevar-Boltezar, & Ovsenik, 2010).
  • a minimum of 4 – 6 hours per day of soother use is required to cause a malocclusion (Medeiros, et al., 2018) soother use itself has not been linked with dental caries, however, sweetened pacifiers have shown a strong association (Jain, et al., 2015); (Nelson, 2012).
• pacifier use may increase the risk of repeated otitis media. The risk appears to increase with prolonged and more frequent use
• except for premature infants, or infants who are unwell who may benefit from comfort benefits, research suggests that pacifiers not be introduced until breastfeeding is established 
• offering a pacifier instead of a breast or bottle when an infant is rooting to feed may contribute to inadequate nutrition for growth and development 
• a pacifier when contaminated with or exposed to infectious agents can transfer the infectious agent to the infant or child. Consistent care and cleaning of pacifiers helps to limit contamination and exposure 
• in general, speech outcomes are not significantly associated with pacifier use, however, recent research suggests that the frequency of daytime pacifier use may increase the number of atypical speech errors a young child makes; these errors appear to resolve over time (Strutt, Khattab, & Willoughby, 2021)

For family friendly information, you can refer your patients to: https://caringforkids.cps.ca/handouts/pregnancy-and-babies/pacifiers