Pacifiers in babies and children: Encourage or discourage?

There’s a lot of debate about pacifiers and since it’s Children’s Dental Health Month I thought I’d tackle the issue. Many parents are apprehensive to start one with a baby, yet many babies need to suck. Sucking is a natural reflex. Sucking on thumbs, fingers, pacifiers or other objects may make babies feel secure and happy and help them learn about their world. They can even be sucking on a hand or arm when still in the womb. Many babies find their thumb or a finger to suck on and self-soothe if not offered a pacifier.

Baby friendly?

pacifiers, thumb suckingI personally was unhappy to hear of the “baby friendly” initiative at our local hospitals that discourages any pacifier use during hospitalization.  I think it makes parents fear the pacifier even more than they had before and they have benefits as well as cautions.

I’ve seen more mothers get frustrated with breastfeeding when they can’t use a pacifier. I have rarely seen a problem with breastfeeding when babies are allowed to use a pacifier.

Studies do not support the thought that pacifiers affect breastfeeding rates.

This Cochrane Review also failed to show problems.

Things to love about pacifiers:

Babies have a natural desire to suck.

Even in the womb we can see babies sucking. A pacifier allows them to fill this need, which allows parents to have a much needed break.

Pacifiers can help with pain relief.

There’s a natural pain relieving property to sucking. Think about how addicted older kids are to sucking on a thumb or pacifier. It is soothing. Adding sugar to the pacifier for painful procedures helps pain even more.

Don’t give your baby sugar at home. It’s not good for them and can lead to cavities once they have teeth.

Pacifiers help prevent Sudden Infant Death Syndrome (SIDS).

We don’t know why they help, but studies show that pacifier use decreases the risk, along with sleeping alone on a firm, flat surface, on the back, without soft bedding.

Parents can control use.

Pacifiers can be weaned gradually and kids tend to outgrow them earlier than thumb-sucking.

Infants over about 4 months of age can develop other self-soothing abilities, so you can use them just for sleep in older infants and toddlers.

Keep them in the crib to decrease the risk of germ spreading from displaced/replaced pacifiers.


I like pacifiers better than thumbs

If a baby wants to suck, he will find his hand if something else isn’t offered. Babies eventually find thumbs or fingers if they want to suck on something.

Thumbs are always with a baby and child, so they can suck on them whenever they want, not just in the crib when a parent gives it.

Thumbs can get red, dry, and cracked with sucking behaviors – especially in dry weather. This can be painful to the child. The drive to suck is so strong they continue to do it despite pain. It can also lead to infections of the thumb.

Most kids will stop a pacifier habit by 3 years of age. If a pacifier is limited to sleep time only, kids are already not in the habit of sucking on something all day long. They only have to learn to fall asleep without sucking.

Thumbsuckers continue their habit more often and much longer. Often it’s not until they’re teased at school that they decide they want to quit. Until they make the decision to quit it’s hard to make it happen.

Thumbs are never clean. At least you can wash the pacifier and keep it in the crib. Kids play with their hands and you can’t keep the thumb out easily after they’ve touched everything.

a few cautions to pacifier use:


Don’t use them instead of feedings

Don’t use a pacifier to try to limit the number of breast feedings in a day, especially early on. Newborns need to eat quite a bit. Trying to “hold them off” with a pacifier will only limit your milk supply and could cause them to not gain sufficient weight.

Work with your pediatrician or a lactation consultant to be sure your baby is feeding enough if you’re feeling a need to breastfeed less.

Latch problems

I find that most babies can go back and forth from breast to pacifiers easily.

Most isn’t all.

If your baby seems to have trouble latching on the breast after using an artificial nipple (either a pacifier or a bottle) then stop the artificial nipples and focus on breastfeeding. (If you need to supplement, you can use a syringe, a supplementing system, a spoon, or other methods.) Continue avoiding artificial nipples until breastfeeding is going well.

Work with a lactation consultant if you have continued problems.

Pacifiers can spread infections.

Ear infections and other illnesses can spread easily from pacifier use.

Wash them regularly.

Keep them in the crib for babies over 6 months of age to avoid exposing it to germs from other kids.

Choking risks.

Pacifiers can crack and come apart as they age. Be sure to check it regularly to make sure it’s not damaged. You don’t want it to become a choking risk.

What about teeth?

After permanent teeth come in, sucking can cause problems with the proper alignment of the teeth. It can also cause changes in the shape of the mouth.

Both finger or thumb-sucking and pacifiers can affect the teeth in the same ways, but pacifier use is often an easier habit to break.

General recommendations about stopping the sucking habit

Be careful how you approach stopping a thumb-sucking habit or pacifier use. If you are too harsh or negative it will probably make the habit worse.

Use positive rewards.

Have your child come up with goal ideas and things to earn. Rewards don’t have to be expensive. It can be a trip to a special park or the ability to pick dinner or what book to read. You can also get stickers, trinket toys, an

Sticker charts are a great way to keep track of times that there was no sucking!

For thumb-sucking

Think about making it more difficult for your child to suck his thumb. Keep the hands busy with crafts, toys, etc.

For the older child, talk about germs and how important it is to keep the thumb out of the mouth unless she just washed her hands.

Consider sewing socks or mittens onto long sleeve pajama tops. This will keep the thumb out of reach. (Unless your Houdini takes the PJs off.)

Using a “bad” tasting polish or tabasco doesn’t really keep kids from not sucking their thumbs unless it’s only a reminder to stop. If they really want to suck, they don’t care about the taste. But if they do want to stop and need reminders throughout the day to keep it out of their mouth, the bad tasting nail polishes can help.

For pacifiers
Plan a countdown to not using the pacifier any longer.

Make getting rid of the pacifier a big deal, like any other special event. Find a fun name for the day, like “Big Kid Day” or “Give to baby day”.

Put the chosen date on the calendar and do a count down every day by crossing off dates. Or make a paper chain and tear off one chain daily until the big day.

Find a replacement for the pacifier, such as a new stuffed animal or blanket. The stuffed animal can even be from Build-A-Bear. Put the pacifier inside so the child knows it’s there when he hugs his bear. Whatever you choose, be sure it can be snuggled or used to replace the pacifier for comfort.

Fill a box with all the pacifiers on the big day and leave it out for the “binky fairy” to take to new babies. The fairy can leave the new comfort item. Or you can just have your child put all the binkies in the box and seal it shut with tape when he’s ready to earn the new comfort item.

The big thing is you need to get rid of all the pacifiers. If your child finds one hiding somewhere, he will sneak it and return to the habit quickly.

Books that might be helpful

Note: These are Amazon Affiliate links and I do get paid a small amount for the referral.

In this book for toddlers,Little Brown Bear finds some tricks to help him stop sucking his thumb. It can help put the idea into your child’s head.

This is not specific to thumb-sucking, but the Berenstain Bears always teach kids in a fun way. Sister bear has trouble biting her nails in this story.

Thumb Love is appropriate for the older child who wants to stop sucking his or her thumb. If your school aged child has been the object of teasing due to thumb-sucking, he or she will relate.

Share Quest for Health

Keep that sparkle in their smile! Dental health tips.

February is National Children’s Dental Health Month, so a great time to talk oral health. Cavities are the #1 chronic health condition in children. Don’t underestimate the benefits of proper oral hygiene.

Why is a pediatrician writing about a dental issue?

February Dental Health MonthBecause cavities are a huge concern.

As stated above, they are the #1 chronic health condition in kids.

February is National Children’s Dental Health Month

This year’s slogan is…

(drumroll please)

Brush your teeth with fluoride toothpaste and clean between your teeth for a healthy smile!

fluoride and floss
Using fluoride and flossing are the best ways to prevent cavities!

The good news is that we can help prevent cavities with a few good oral health practices.

Don’t share germs

Cavities are caused by bacteria in our mouth, so don’t share saliva with your kids.

Evidence has proven that the transmission of saliva from a parent to child can be harmful to their teeth!  Parents with active tooth decay can pass the Streptococcus mutans bacteria through their saliva and give their children cavities!

Don’t “clean” your baby’s pacifier by putting it in your mouth.

Never offer your kids food that you’ve had in your mouth.

Don’t share silverware or drinks.

And finally, keep your own mouth healthy. Visit your dentist regularly. Brush your teeth at least twice a day with fluoride paste. Floss daily. Use a fluoride mouthwash for an added bonus. Not only does this model good dental hygiene to your kids, but if you don’t have tons of bacteria causing cavities you’re less likely to share them.

Stop sugars

Sugar feeds the bacteria that cause cavities. That’s why it’s so important to brush teeth before sleeping. Overnight the bacteria can grow more readily because the saliva production slows. (Saliva naturally helps keep our teeth clean.)

Most foods and drinks have sugar, even healthy foods. That’s okay. What’s important is that we get the food residues out of our mouths several times a day by brushing and flossing.

Foods that cling to your teeth for a long time such as milk, ice cream, honey, sugar, soda, dried fruit, sticky candy, cake, cookies, hard candy and mints, dry cereal, and chips are more likely to cause cavities than foods that are easily washed away by saliva.

Of course sticky candies are a known culprit, but juice is a big actor in cavity creation. Kids don’t need juice. Fruit is great, but juice is basically all the sugar from the fruit concentrated into a glass.

Sports drinks are another source of excessive sugar despite the healthy-sounding name. Kids don’t need the sugars in these drinks in most cases. Water is just fine for rehydration for typical young athletes.

Never put anything other than breast milk or formula in a bottle. Kids who drink juice in their bottle are at a much higher risk of getting cavities. There’s even a name. You guessed it: Baby Bottle Tooth Decay.

Kids who eat or drink anything before bed without brushing afterwards are at much higher risk – so don’t let your infants and toddlers fall asleep while drinking their bottle! Enforce brushing before bed!

watch acidic foods and drinks

Acidic foods are also very bad for teeth. Frequent exposures to acidic foods can erode enamel, making teeth more susceptible to decay over time.

Most carbonated soft drinks, including diet soda, are acidic. Regular sodas have the double whammy of sugar and acid. Keep kids from developing the habit of drinking sodas. They should be for a special treat no more than weekly and should be followed by at least rinsing the mouth with water.

A squeeze of lemon or lime can turn a simple glass of water into a fun beverage, but the acid can damage teeth if not limited. Citric fruits and juices can also irritate mouth sores.

Water, especially fluoridated water, is the best drink.

Limit snacking

As mentioned above, saliva helps to clean our teeth during the day. When kids graze on food all day or have a cup of juice, soda, or milk to sip all day, the teeth are constantly exposed to sugars.

Have set meal and snack times throughout the day. Between those times we should only have water. This is not only good for teeth, but also for weight management and the practice of patience and self control.


Most parents know that this is easier said than done. Kids hate brushing their teeth! But it’s such an important thing that it must be done despite crying and fighting.

Even before baby teeth appear you can start good oral hygiene. Gently wipe the gums and inside of the mouth every day, especially after feedings and before bed. You can use a clean wet cloth or a finger toothbrush.

When kids get their first tooth it’s time to start brushing! Brush baby teeth twice a day with a soft, age-appropriate sized toothbrush. Use a grain of rice sized amount of fluoridated toothpaste. This has been recommended since 2014, but many parents are surprised they are “allowed” to use fluoride in babies. Just because they sell infant toothpaste without fluoride doesn’t mean that’s the recommended product. Use a kid-friendly flavor though. Mint toothpastes tend to make young mouths feel like they’re burning!

When kids are adept at spitting out the toothpaste, they can use a pea-sized amount. Even adults don’t need more than that.

There are many things you can try to help your kids brush:
  • Entice with a song. Mouth Healthy from the American Dental Association has a great playlist.
  • Let them choose if you brush first or if they brush first. Either way you need to use the toothbrush on their teeth. They don’t actually brush well until at least 6 years of age, often later.
  • Try different toothbrushes. Some kids like electric brushes, others don’t. Most prefer soft bristles.


Kids need to start flossing once their molars start touching each other.

Dental floss is used to remove food particles and plaque. It’s very important to floss between teeth daily, preferably before bed.

There are many types of floss. Talk to your dentist about which is right for your family members.

Many kids can’t floss on their own, and even getting a parent’s fingers in to floss their mouth can be difficult. Pediatric Dentist Dr. Emily Day turned me on to Gum Chucks. They’re a great way to floss small mouths. I’ve even used them myself when I cut my finger and couldn’t wrap floss around my finger. (These are not paid endorsements – I just like the product and the dentist!)

To floss properly,  wrap the ends of the floss tightly around your fingers. Guide the floss between all teeth to the gum line, pulling out any food particles or plaque. Unwrap clean floss from around your fingers as you go so that you have used the floss from beginning to end when you finish. Don’t forget to floss behind the back teeth.

When you first begin flossing, your gums may bleed a little. This is due to inflammation in the gums that comes from poor oral hygiene. The fix is to improve oral hygiene!


Fluoride helps to strengthen enamel. It is important to brush teeth with a fluoridated toothpaste, as mentioned above, and to drink water with fluoride.

Fluoride in drinking water has been shown to prevent tooth decay by at least 25% in both children and adults.

Most bottled waters and filtered waters do not provide the recommended fluoride. Some cities do not offer fluoride in their water. Talk to your doctor or dentist to find out if your child gets enough fluoride through water.

Topical fluoride should be applied every 3-6 months to your child’s teeth by your child’s pediatrician or dentist. Varnish sticks to tooth surfaces, which minimizes the risk of swallowing it. Fluoride varnish is recommended for all age groups once they have teeth.


Believe it or not, chewing sugar free gum after meals has been shown to help prevent cavities.

Young kids should not chew gum due to choking risks, but if older kids won’t go to the school bathroom after lunch, chewing sugar free gum (if allowed by school rules) might help.


Your child’s dentist will likely offer sealants when your kids start getting their permanent molars. This can help seal the crevices in the molars to prevent food trapping. Sealants have been shown to reduce the risk of cavity formation by nearly 80% in molars.

Additional Resources

The American Academy of Pediatric Dentistry has a Mouth Monsters site that is full of ideas to help kids get good oral hygiene.

I love this oral health screening guide. It has photos of different tooth problems, a chart of when to expect teeth to erupt, and fluoride facts.

Share Quest for Health