Risks and Benefits of Pacifiers

Resident: Cho
Author(s): Sexton S. and Natale, R.
Journal: American Academy of Family Physicians
Year. Volume (number). Page #’s: 2009. 79:681-685.
Major topic: Pacifiers
Type of Article: Handout

Main Purpose: To explain the risk and benefits of using pacifiers in infants

Benefits of pacifiers: Analgesia – pacifiers can be used for pain relief in newborns and infants younger than six months undergoing minor procedures in the emergency department. A small amount of sucrose solution (2mL) can be given within two minutes of the procedure, alone or in combination with a nipple or pacifier. Shorter hospital stays. Improved bottle feeding. Reduced risk of sudden infant death syndrome (SIDS).

Risks of pacifiers: Breastfeeding - conflicting evidence about whether early use of a pacifier disrupts breastfeeding or merely indicates other breastfeeding difficulties. Dental malocclusions – most significant malocclusions occurred in children who continued sucking habits beyond 48 months, however, notable changes in children who continued beyond 24 months. Infection – although some evidence exists for pacifier colonization with microorganism, the direct association between these organisms and infection has not been proven. Otitis Media – the pacifier could cause otitis media in the second six months of life by reflux of nasopharyngeal secretions into the middle ear form sucking, and Eustachian tube dysfunction from altered dental structure.

Recommendations: Postpone pacifier use until breastfeeding habits are well established. Pacifier use may be beneficial for the infant between the age of 1 month to 6 months of age preventing SIDS and providing analgesic effects. AAFP/AAP joint guidelines on otitis media, based on evidence from cohort studies, recommend that physicians advocated for little to no use of pacifiers in the second six months of life to prevent otitis media. ADA and AAPD recommend that pacifier use by discouraged after four years of age.