THE PACIFIER, IS IT STILL WORKING FOR YOUR BABY'S SLEEP?
PART 6 OF 7 AREAS COMMONLY OVERLOOKED OR NOT STRATEGICALLY PLANNED
Ahhh. The paci, dummy, nookie, soother, bo-bo, comforter, binky, piece, or whatever you choose to call your child's pacifier! For a lack of better words, it can be a double edged sword. On one hand, it can be extremely helpful with sleep and contribute to reducing the risk of SIDS. On the other, it can hinder consolidated sleep for both your infant and yourself and cause other issues with prolonged use. So, what to do about it?
FIRST, UNDERSTAND THE EXTENT OF THE PACIFIERS BENEFITS
Use of the pacifier is one of the nineteen suggested safe sleep guidelines by the AAP for infants under one year of age. Here is what is mentioned in the journal article, "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment":
"Although the mechanism is yet unclear, studies have reported a protective effect of pacifiers on the incidence of SIDS. The protective effect of the pacifier is observed even if the pacifier falls out of the infant’s mouth.
1 - The pacifier should be used when placing the infant for sleep. It does not need to be reinserted once the infant falls asleep. If the infant refuses the pacifier, he or she should not be forced to take it. In those cases, parents can try to offer the pacifier again when the infant is a little older.
2 - Because of the risk of strangulation, pacifiers should not be hung around the infant’s neck. Pacifiers that attach to infant clothing should not be used with sleeping infants.
3 - Objects, such as stuffed toys and other items that may present a suffocation or choking risk, should not be attached to pacifiers.
4 - For breastfed infants, pacifier introduction should be delayed until breastfeeding is firmly established. Infants who are not being directly breastfed can begin pacifier use as soon as desired.
5 - There is insufficient evidence that finger sucking is protective against SIDS."
The main message I want you to get from this?
DON'T LET THE PACIFIER BE AN EXCUSE FOR SLEEP ISSUES OR THE REASON FOR ADDED WORRY IN YOUR LIFE. YOU DO NOT NEED TO REINSERT THE PACIFIER WHEN IT FALLS OUT.
SECOND, REFLECT ON YOUR ANSWERS TO THE FOLLOWING QUESTIONS
Is your child at an age where the pacifier's benefits outweigh the risks or vice versa?
As mentioned in the first section, the pacifier is recommended for children under one year of age with an emphasis on children six months of age and younger to reduce the risk of SIDS. Along with this huge benefit, the pacifier can also provide soothing and better sleep.
However, if pacifier use is prolonged, a child is more likely to experience difficulty with speech articulation (Shotts et al.), development of abstract language (Barca et al.), hindered mouth and teeth development (Butler Mitchell, DDS), increased ear infections (Hanafin and Griffiths), and other issues. The suggested age by most pediatric dentists is removal of the pacifier by age two and even by some pediatricians six months of age to reduce the risk of ear infections.
Your child will reach a point where the risks of the pacifier outweigh the benefits. Keep an open mind so that you are able to recognize that what use to help no longer does. This leads to our next question!
Is the pacifier hindering sleep?
Unfortunately, the exact device we expect to help with sleep can actually be the reason for the struggle. I have had several clients in the past who have faced this truth. Some knew the pacifier was preventing quality sleep while others didn't want to admit it but eventually had to in order to reach their sleep goals.
This usually means one of two things. One, the baby heavily relies on the pacifier in order to fall asleep and is unable to do so without it. Given the nature of sleep, this means difficulty falling back asleep between sleep cycles resulting in short naps and assistance from Mom and Dad in the middle of the night when transitioning from one sleep cycle to the next. Two, the baby wakes up due to the pacifier falling out of their mouth. This results in short naps and even more night wakings.
THIRD, CREATE YOUR SLEEP PLAN WITH THE BINKY IN MIND
If you suspect that the pacifier is contributing to issues with sleep, it is important to include how you will handle the pacifier when creating your sleep plan. Here are a few options that I talk through with clients.
Option 1: Focus on all the other areas effecting sleep and keep the pacifier for now.
When guiding a baby to healthy sleep, it is important to look at all the components that contribute. For more on that, read my blog post Why Won't Baby Sleep. Sleep involves creating an appropriate schedule for your baby and an environment conducive for sleep in addition to the ability to fall asleep and connect sleep cycles independently. You might find that your baby is actually able to fall asleep on their own but was missing some other pieces of the puzzle.
If after working on all areas with the exception of the pacifier you notice that your baby still needs the pacifier to sleep well, you have a couple of ways to handle this. We will discuss those in the following options.
Option 2: Reinsert the pacifier at designated moments.
If you find that you are constantly replacing the pacifier, you can try keeping the pacifier while reducing your involvement. Stop replacing the pacifier every time that it falls out and choose whether or not you do want to replace it during certain times that make sense. For example, if you are doing timed checks, replace the pacifier at the time of each check but not in between.
Option 3: Use the pacifier but stop replacing it for your baby.
If you find that your assistance to replace the pacifier is the main culprit of sleep issues, it is time to heavily consider removing your involvement altogether. Work on helping your baby find the pacifier and replacing it themself. Do this throughout the day and give space to do so when it is a time for sleep.
QUICK PRO TIP: To help without directly being involved, place several pacifiers around your baby to easily find at night in case one or a few fall out of the crib. And invest in pacifiers that glow in the dark so that they are easily found!
Option 4: Completely remove the pacifier.
If you find that even without your assistance the pacifier is causing your infant to wake frequently and for long periods of time? It might be time to face the cold hard truth that the pacifier is doing more harm than good.
Unfortunately, there is no simple and safe way to do this other than cold turkey.
This might mean a few rough nights in order to lead your baby and your family to better sleep. With any kind of change, there is often a hurdle to get over in order to reap the benefits. However, keep in mind that infants and toddlers are much more adaptable than we often give them credit for!
QUICK PRO TIP: If you are going to get rid of the pacifiers, get them out of the house! Do not be tempted to bring them back into the picture once you have already started the process. You will be shooting your future self in the foot as it will make the next time even harder.
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Barca, Laura, et al. “Overusing the Pacifier during Infancy Sets a Footprint on Abstract Words Processing.” Journal of Child Language, vol. 47, no. 5, 29 Apr. 2020, pp. 1084–1099. Cambridge Core, www-cambridge-org.proxy.lib.odu.edu/core/services/aop-cambridge-core/content/view/D1E699F69FA29BC649E72956EEA66391/S0305000920000070a.pdf/overusing_the_pacifier_during_infancy_sets_a_footprint_on_abstract_words_processing.pdf, 10.1017/S0305000920000070. Accessed 28 Sept. 2020.
Barca, Laura, et al.. “Pacifier Overuse and Conceptual Relations of Abstract and Emotional Concepts.” Frontiers in Psychology, vol. 8, 1 Dec. 2017, p. 2014. PubMed Central, www-ncbi-nlm-nih-gov.proxy.lib.odu.edu/pmc/articles/PMC5717369/, 10.3389/fpsyg.2017.02014. Accessed 28 Sept. 2020.
Butler Mitchell, DDS, Jacqueline. “Tooth Talk - Will My Baby Develop Pacifier Teeth.” Tennessee Tribune - Health and Wellness, 21 Mar. 2019, p. 8B, web.b.ebscohost.com.proxy.lib.odu.edu/ehost/pdfviewer/pdfviewer?vid=2&sid=6ff13d25-6fb5-40b0-9acb-fb4dfa0f95bc%40pdc-v-sessmgr02. Accessed 28 Sept. 2020.
Ellis, Rachel Reiff. “Should You Give Your Baby a Pacifier?” WebMD, www.webmd.com/parenting/baby/features/using-pacifiers#1. Accessed 28 Sept. 2020.
Hanafin, S., and P. Griffiths. Does Pacifier Use Cause Ear Infections in Young Children?. Www.Ncbi.Nlm.Nih.Gov, Centre for Reviews and Dissemination (UK), 2002, www.ncbi.nlm.nih.gov/books/NBK69285/. Accessed 28 Sept. 2020.
Shotts, Laura L., et al. “The Impact of Prolonged Pacifier Use on Speech Articulation: A Preliminary Investigation.” Contemporary Issues in Communication Science and Disorders, vol. 35, no. Spring, Mar. 2008, pp. 72–75, www.asha.org/uploadedFiles/asha/publications/cicsd/2008STheImpactofProlongedPacifierUse.pdf#:~:text=prolonged%20pacifier%20sucking%20could%20lead%20to%20speech%20articulation, 10.1044/cicsd_35_s_72. Accessed 30 Sept. 2020.