The American Academy of Pediatric Dentistry (AAPD) provides the following recommendations regarding pacifier use by children:

Benefits:

  • Pacifiers can be beneficial for infants in the first few months of life.

  • They can help premature infants develop their sucking reflex.

  • Pacifiers offer comfort and can soothe babies.

  • They can provide an analgesic effect during minor medical procedures.

  • Pacifier use during sleep is associated with a reduced risk of Sudden Infant Death Syndrome (SIDS) in infants up to six months of age.

  • Pacifiers can help prevent a persistent finger-sucking habit, which can be harder to break. Starting pacifier use before four months of age may lower the risk of finger/thumb sucking compared to starting later.

Risks and Recommendations:

  • Prolonged use can lead to dental problems: The AAPD recommends discouraging pacifier use after the age of 3 years to prevent potential issues such as:

    • Misalignment of teeth (tipping of upper front teeth outward).

    • Changes in bite (anterior open bite, overbite, crossbite).

    • Changes in the shape of the roof of the mouth.

  • Weaning: It's best to begin the weaning process before 24 months of age. If a child is not showing signs of self-weaning by age two, parents can start limiting pacifier use to specific times like naps and bedtime.

  • Increased risk of ear infections: Pacifier use after 12 months of age may increase the risk of acute otitis media (ear infections). Reducing or eliminating pacifier use in the second six months of life may help lower this risk.

  • Speech development: While evidence linking pacifier use to speech delays is limited, prolonged daily use for several hours might have significance with atypical speech errors.

  • Safety:

    • Choose pacifiers with a firm shield that is at least 1.5 inches wide with vent holes.

    • Avoid pacifiers with straps, cords, or attachments.

    • Regularly inspect pacifiers for wear and tear.

    • Never dip pacifiers in sweet substances like honey.

  • Comparison to thumb sucking: The AAPD notes that it is generally easier to wean a child from a pacifier than from thumb sucking.

  • Orthodontic pacifiers: While marketed as more "dental-friendly," both orthodontic and traditional pacifiers can lead to bite issues with prolonged use. The duration of use is more significant than the type of pacifier.

General Guidance:

  • Parents should make informed decisions about pacifier use based on their infant's needs and their own preferences.

  • Establish a "dental home" for the child by 12 months of age for anticipatory guidance on preventive health practices, including discontinuing non-nutritive sucking habits by 36 months.

  • Healthcare providers should offer consistent messaging to parents about the benefits and risks of pacifier use.

  • Pacifier use should not be forced on a resistant infant.

  • Consider offering alternative comfort items as the child gets older.

  • Positive reinforcement is recommended over teasing or punishment when trying to wean a child from a pacifier.

If you have concerns about your child's pacifier use and its impact on their oral health, it's always best to consult with a pediatric dentist.