To Bink or Not To Bink: On Pacifier Use in Babies

Just recently, a deliriously happy and understandably tired mother of a newborn looked at me earnestly, perhaps even guiltily, and asked the following question: “Is it ok if I use a pacifier for my baby when she fusses?” What a great, simple, and wholly controversial question!  Does it matter if you start using a binky right from birth, or should you wait a week or so? Are there benefits or risks to using a pacifier?

Everyone agrees, breastfeeding is bestfeeding whenever possible.  The pro-breastfeeding, caregiving world has grown far more outspoken in supporting moms to this end.  Even the WHO has listed in its Top 10 Tips to Promote Breastfeeding, that pacifier use is possibly counterproductive to mom’s starting and continuing to breastfeed. Then again, the American Academy of Pediatrics says they’re ok.  Who to believe?

Newborns must master the fine art of eating. This is harder than it sounds. Babies must respond to their appetite, commence rooting and lipsmacking, or otherwise shriek  like a banshee to let the world know it’s chowtime.  Then, for the breastfeeding infant, the dance of two partners begins: the mom must find the best hold for the baby, and set herself up so the baby may latch and commence nursing. Meanwhile, the infant must open up his little yap and get a good seal around the nipple.  If all goes well, dinner is served.

Enter the pacifier. Also known as the soother, sucker, dummy, artificial teat, and in the USA, as the binky, this little invention has been around for hundreds of years. Historically, versions have involved devices made of bone, coral, sacks of sugar, and in the last hundred years, devices have evolved into their more familiar silicone, plastic or rubber forms. Why do babies go for them?

For newborns and even older infants, sucking on a real or artificial nipple is a neurologically potent experience.  A hungry infant sucks harder when he intends to feed. This demand drives the feedback loop for milk production for the breastfeeding mother. QED.  However, after feeding, as newborns and infants inexorably chill and drift off, they will still suckle, but with less force and intensity. Ask any parent of a just born babe, this so-called non-nutritive sucking is the stuff.  The rhythmic mouth movements helps babies relax, or ‘organize.’ Stick a finger in a fussy infant’s mouth, he’ll likely suckle upon it and mellow out.  Nice

In certain situations, pacifiers can sabotage proper breastfeeding.  First, and perhaps more validly in my book: anxious parents who overbink their infant may mask or miss the cues the child is giving to say she is ready to feed.  Second, many lactation advocates feel some babies might balk at the breast after being soothed on an artificial teat, resulting in nipple confusion.  In my humble experience, nipple confusion is rare. And, I find the the level of concern around it to be a bit overblown, to put it mildly. Yet, for some instances (preemies, say, or moms with inverted nipples), it may be an issue.  And, as I tell many binky ambivalent parents, we’ll all do well to consider each baby individually on this matter.

A recent meta-analysis (a study of studies done) by authors at the Cochrane Collaborative looked at the question of whether pacifier use interfered with the initiation or continuation of breastfeeding. In the over 1300 breastfeeding moms studied (some using just breastfeeding, some supplementing with formula), the use of a binky did not affect the number of infants who breastfed up until four months of age (the period examined in the study).  Good.  To those still not be convinced, a Learned Colleague, steeped with wisdom in Breastfeeding Medicine (as it is called), suggested families wait a week, getting the nursing thing down, and then give it a try. Fair enough.

Are there other upsides to binky use? Medically, perhaps. A study published a few years ago suggested that binky use significantly lowered the incidence of sudden infant death syndrome. These findings warranted the American Academy of Pediatrics to walk back some of its criticism of binky use, and to cite that they may be beneficial in this context. Still, I think the overarching benefit of sensible binky use is providing tired parents with a means to comfort a baby having a hard time.

Are there other downsides? For one, binky using infants who develop thrush may take a little longer to beat the oral infection if the soother isn’t properly boiled and cleaned after use. The pacifier can also serve as a vector of infection between sibs or daycare classmates. All you have to do is watch 10 month olds on the floor pass a boogery unit between them from mouth to another. It’s cute, but it’ll give you the willies. URI here we come!  Longer term, infants who use pacifiers past a year are more at risk of developing ear infections than their unbinked peers.  And, like thumbsuckers, those toddlers who use binkies past two years are at greater risk of dental issues with their front teeth, such as malocclusion.

For parents of older infants and young toddlers, the challenges shift to quitting the pacifier. To a 13 month old, the binky can be very much a transitional object of comfort, a sort of oral Linus’ blanket. From a medical and developmental point of view, it makes sense to me to work toward quitting the binky by 12-15 months. This will prevent the dreaded ‘talking around the binky,’ something I find both unpleasant and unhelpful for a toddler learning to use her words, and/or, the dental and ear complications noted above. If any parents or daycare providers out there would like to offer tips on how to quit the binky, I encourage you to share below.

Be it noted, too though, that pacifiers are not a go for every child. Not all babies take to a pacifier, and that is all right. When used well and properly, though, the binky can be a great tool for parents to calm and soothe a baby.  For those so inclined: bink up, me hearties!

Top photo by MADixRAWR

Middle photo by 25261622

Cartoon below by me

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