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March 24, 2020
Pacifiers are not the worst thing in the world!
For quite a long time, humans have been using pacifiers to help soothe a child to sleep. There is a robust amount of kerfuffle about the risks and benefits of its use. What do we really know?
1) Pacifiers may reduce the risk of sudden infant death syndrome in a subset of pacifier users while sleeping. (Hauck et. al. 2005) The data here appears pretty solid for premature infants and children at risk.
2) Pacifiers may increase the risk of recurrent otitis media. (Salah et. al. 2013)(Niemela et. al. 2000)(Rovers et. al. 2008) Milk protein intolerance is the number one risk factor for recurrent otitis media in our clinic. If your child is suffering from recurrent otitis media, remove dairy from their diet, stop using a pacifier and try and avoid daycare. That should significantly shift the needle.
3) Pacifiers do not cause early breastfeeding termination.(O'Connor et. al. 2009) This one is definitely true. In my experience, nipple confusion is not a real entity. We have thousands of mothers that breast and bottle feed while using pacifiers without difficulty.
4) When a parent picks up a dropped pacifier and cleans it by sucking on it briefly their is a transfer of oral microbes to the child that appears to be beneficial at immune priming and reducing allergy risk. (Hesselmar et. al. 2013) This is likely a mild truism based on the microbiome transfer from mom to baby. There is clear evidence that the more microbes a child is exposed to early in life the better the immune tolerance. How much the pacifier sucking transfer of microbes affects this is likely to be a small adjunct. The more clear data is with farm and domestic animal exposure.
On the flip side, the pacifier can develop a biofilm on it that can harbor nasty pathogens like Staph aureus or Candida. (Comina et. al. 2006) Cleaning the pacifier weekly with soap and water would go a long way toward reducing pathogen colonization.
5) Malocclusion of teeth from pacifiers. This has always been a major reason why kids should not use pacifiers. (Lima et. al. 2016) This is a source of concern for pacifier use.
How do you boil all of this data down?
I think that the totality of the data is pointing to least amount of use is best. I would recommend that if you use a pacifier at all it should only be centered around sleep events. When a child is awake and alert the pacifier should be nowhere in sight. If it falls out while they sleep, leave it out. If they awaken crying, give them some time to self soothe unless you know that the cry is related to a problem.
To pacify or to not, that is the question,
Hauck Pediatrics Article
Salah J Pediatric Oto Article
O'Connor JAMA Article
Hesselmar Pediatrics Article
Niemela Pediatrics Article
Rovers Family Practice Article
Comina Nursing and Health Sci Article
Lima International J of Ped Dentistry Article