Clinical Reference Systems: Pediatric Advisor 10.0

INTRODUCTION

The amount of extra sucking babies do when they are not feeding varies. This extra sucking is a beneficial self-comforting behavior. Some babies suck on their thumb or fingers almost constantly. If you have a baby like this, you may want to try to interest him in a pacifier.

To be an accepted substitute for the thumb, the pacifier has to be introduced during the baby's first two months. The orthodontic type of pacifier is best because it prevents tongue-thrusting during sucking, but the regular type usually causes no problems. Use trial and error to find the shape your baby prefers.

ADVANTAGES OF A PACIFIER OVER THUMBSUCKING

The biggest advantage of a pacifier is that if you can get your child to use one, he won't suck his thumb. Thumbsucking can cause a severe overbite if it continues after your child's permanent teeth come in. A pacifier exerts less pressure on the teeth and causes much less overbite than the thumb. Also, you can control your child's use of a pacifier as he grows older. In contrast, it is much more difficult to stop your child from sucking his thumb because the thumb belongs to him.

WHEN TO OFFER THE PACIFIER

The peak age for sucking in infants is 2 to 4 months. In the following months, the urge to suck normally decreases. A good age to make the pacifier less available is when your child starts to crawl. A pacifier can interfere with normal babbling and speech development. This is especially important after 12 months of age, when speech should increase dramatically. It's hard for a child to talk with a pacifier in his mouth.

To make sure your child doesn't become overly attached to a pacifier (for example, walk around with it in his mouth all the time), consider the following recommendations:

• During your child's first 6 months, give him the pacifier whenever he wants to suck. Be careful not to offer it every time he cries. Crying has a number of causes besides hunger and a need to suck.
• When your older infant is unhappy, first use cuddling to provide comfort instead of offering the pacifier. Some infants like massage. Try not to overuse the pacifier while you are comforting your baby.
• After 6 months of age (or when your infant starts crawling), keep the pacifier in your child's crib. This allows him to use it at naptime and bedtime. After your infant falls asleep, take the pacifier out of his mouth (if it hasn't fallen out already).
• If you allow your child to use a pacifier all the time, his interest in it will increase rather than decrease. If your child seems to want a security object while he is awake, offer something besides the pacifier, such as a stuffed animal.

REMINDER:

If your baby uses a pacifier, don't forget to take it with you when you travel. Keeping a spare pacifier in the car can save you some trouble. In air travel, sucking a pacifier or swallowing fluids during descent can prevent ear pain.

PACIFIER SAFETY

Observe the following precautions for using a pacifier:

• Use a one-piece commercial pacifier. Don't try to make one yourself by taping a nipple to a plastic bottle cap. A homemade pacifier can be pulled apart, get caught in your baby's throat, and cause choking.
• Don't put the pacifier on a string around your baby's neck. The string could strangle your baby. The new "catch-it-clips" that attach the pacifier to your child's clothing on a short ribbon are practical and safe.
• Don't use a pacifier with a liquid center. (Some have been found to be contaminated with germs.)
• Don't coat the pacifier with sweets, which may cause dental cavities if your child's teeth are coming in. Honey may cause a serious disease called botulism in children less than 1 year old.
• Rinse off the pacifier each time your baby finishes using it or if it drops to the floor.
• Buy a new pacifier if the old one becomes damaged.

STOPPING THE PACIFIER

If use of the pacifier has been restricted to naptime and bedtime, your child will usually agree to give it up completely by the age of 3 or 4 years. Pick a time to give it up when your child is not coping with new stresses or fears. Sometimes giving up the pacifier on a birthday, holiday, or other special occasion is easier for your child.

Make the transition as pleasant as possible. You may need to offer incentives. If your child is strongly attached to a pacifier, help him give it up at naptime first. Use a star chart to mark his progress. When that goal is accomplished, offer to replace the nighttime pacifier with a new stuffed animal or encourage him to trade it for something else he wants. Never use punishment or humiliation to force your child to give up the pacifier.

Give your child the choice of throwing the pacifier away or leaving it out to be picked up (for example, by Santa Claus or the "pacifier fairy"). Putting the pacifier away somewhere in the house is usually not a good idea, because your child will be more likely to ask for it during times of stress. At such times, comfort your child with cuddling instead. Help your child talk about missing the pacifier. Praise your child for this sign of growing up.