Pacifiers: introducing and weaning

Many parents give their babies pacifiers (a.k.a. “binkies” or “soothers”) to satisfy their sucking needs and to calm them. However, there is no need to insist if your baby refuses the pacifier, and you do not need to reinsert the pacifier if your baby spits it out, whether she is awake or asleep.

Although some researchers have raised concerns about the impact of pacifiers on babies’ emotional development, even the American Academy of Pediatrics (AAP) gives pacifier use a thumbs-up under certain conditions.

When can I introduce my baby to a pacifier?

The AAP recommends waiting about 4 to 6 weeks after birth before offering a pacifier to ensure that breastfeeding is firmly established. The AAP urges parents to give their baby a pacifier at naptime or bedtime to reduce the risk of SIDS. However, there is no need to insist if your baby refuses the pacifier or to reinsert the pacifier if your baby spits it out.

What are the risks of using a pacifier?

Extended pacifier use can increase the risk for recurrent ear infections, speech impairment (for children 2 years of age or older), and permanent tooth and jaw misalignment (in children 4 years of age or older). Talk with your child’s health care provider or dentist about your child’s specific risks.

The constant presence of a pacifier in the baby’s mouth may negatively affect the development of communication skills, inhibiting the ability to mimic the facial expressions of those who talk to them, negatively impacting their earliest communication learning. This effect was not found with babies who used a pacifier only at nighttime and naptime, perhaps because these are not times when babies would be learning communication through observing and mimicking facial expressions.

When should I wean my baby off a pacifier?

The AAP recommends stopping “binkies” around age 1. Some health care providers suggest that parents wean their children from the pacifier once they are mobile to reduce the risk of fall-related injuries.

Despite these recommendations, many parents give their children pacifiers throughout the day, when they are awake, and beyond the age of 1.

Here are things to consider when weaning:

Think about when your child uses the pacifier. Is it an all-day companion? A sleep aid? Does it help her deal with stress? When does she seem to need it more, or less?
Set reasonable, low-stress limits. Children can understand and accept simple rules, such as “the pacifier stays at home.” Later, you can modify it to, “the pacifier is only for sleep.” Eventually, you’ll be able to eliminate the pacifier altogether. If your child is an infant, no explanation may be necessary. Just engage your baby with a variety of other comfort measures, including swaddling, babywearing (in a sling or other suitable carrier), rocking, singing, and dancing. Infant massage may also help.
Observe your child’s reaction. While you don’t want a years-long weaning process, there’s no reason to rush your child, or expect her to give up her pacifier cold turkey. While some children can easily find other ways to comfort themselves, many need time to accept the transition.
Engage your child in other distractions. Play with your child; physical activity that gets their whole body moving can help. You may want to offer a soft toy or blanket as a substitute object. (If your child accepts a substitute, you may want to have a duplicate, as a back-up!)
Don’t backslide. It’s hard for anyone to give up something they rely on, but if you give in and return your baby’s pacifier, you’ll start a negative cycle that will be hard to break. You can help your child through the difficult times with reassurance and distraction.
Arrange a visit from the “Binky Fairy.” Similar to the Tooth Fairy, the Binky Fairy visits to collect something (in this case, the child’s binkies) and leaves something (often a desired toy) in exchange.
Stage a ceremony. Some children enjoy a special ceremony in which they discard their pacifier and receive some special recognition or reward in return. Some are more receptive to hearing their pacifiers will be “recycled” rather than “thrown away.”

Whichever approach you use, be compassionate and consistent. Weaning from the pacifier is a big step for your growing child!