Tag Archives: Pacifier

Don’t be passive about pacifiers (pedcast)

Welcome to another edition of DocSmo.com.  Welcome new listeners and welcome back old ones.  I hope you are having a great day, I am. In today’s pedcast we are going to get into some serious Doc Smo  opinion about a topic that parents often agonize over, pacifiers.  We are going to take on the topics of whether parents should start their children on pacifiers as well explore how and when they should finally say good bye to these devices: you know, the  pacifier’s end game.  How and when should parents consider doing away with the yum yum, the binky, the ya ya.  Let’s do it shall we!


When it comes to pacifiers, everything is controversial.  Emotions are high when it comes to these little pieces of plastic.  Some people, especially breastfeeding advocates don’t think they are ever appropriate for infants or children since some of the infant’s sucking cues can be masked by the paci. The AAP on the other hand, think that there is good evidence that for infants under 6 months, falling asleep with a paci reduces the risk of sudden infant death.  Otolaryngologists are convinced that ear infections are far more common in children who use them. Speech therapists think that language acquisition is slowed by them and orthodontists think they sometimes cause a child’s teeth not to fit properly because the pacifier can change a child’s natural bite. Wow, my head is spinning after reading all these opinions.  I will give you one pediatrician’s opinion, mine, in just a few moments.

There is no right or wrong answer for parents when it comes to starting a pacifier habit. Some babies absolutely refuse them no matter how hard parents try to get them to suck on them. Others babies will use them until they get enough hand control to suck their own thumb.  And others love them and get very attached to them. Go figure. Babies are as different and unique as their parents!  There are arguments both pro and con and ultimately this comes down to a parent’s choice.


I suspect that many of  the listeners to this podcast have children who love their binky and you, the parent, are looking for some information about how to get rid of it.  Maybe you have a 1, 2, 3, or 4 year old? Controversies continue on the best age to stop them just like whether to ever get started. What is the right age to make them go away?  Again, “experts” vary greatly in their opinions about this one as well.  Some say they need to go by 12 months along with the bottles. Others, advocate getting rid of them by age 4 years…you heard me, by 4 years of age.  Most advocate an age somewhere in between 1 and 4 years. Again, my opinion is coming shortly. Stay tuned!


How do you make it go away? Again, there is no consensus about this either. Methods vary greatly.  Here are some I have seen.

– simply making them disappear. Its gone Johnny, get over it!  I call this the direct approach.

-sniping the nipple off and showing the child that the binky is broken and cannot be fixed.  Let them get mad at the binky not the parents. Clever!

-Getting the child to agree to give the binky to a new baby or kitty they know.  Amazingly, this often works with 2.5 year olds and older.

– Then there is the gradual making the binky fade away, limiting it to certain times and places: the method that most parents choose to use.

-I saw one mother once get so fed up with her son’s pacifier that while driving down the road with her crying child who couldn’t get his pacifier to him, she simply rolled back the sunroof, tossing it toward the sky, and declared that the binky was going to “paci heaven”.  That method worked for her.

-One expert that I read said it is crucial to give your child warning that the paci is about to disappear. He is of the notion that you treat children like adults, they will act like them…a definite maybe on that!


So what do I see in my practice? How do I help parents deal with this issue?  First let me say that everything I am about to tell you is based on my experience and is my opinion…lets get that out on the table first. I personally, am not a big fan of pacifiers. I think they can interfere with successful breastfeeding, create too much work for parent, and I think they delay the age when children can learn to sooth themselves.  I also think that children who use pacifiers have far more orthodontic problems their thumb sucking friends.  I can usually tell by age 2, without asking, which children are still using pacifiers.  I think they deform a child’s mouth more than their own thumb.  I also don’t think it matters which type of pacifier a child uses, they all have a tendency to change the shape of a child’s upper teeth, making them not fit properly against the lower teeth.  This malocclusion as dentists call it can cause both speech difficulties, especially a lisp, and an unwanted cosmetic change in a child’s face. Both of these problems can be very expensive to remedy with orthodontic expanders.

I think that pacifiers should be gone by age 2 years. If parents do this, I rarely see a child substitute their thumb for the paci at this age. More importantly, I see any deformity that has developed from the paci disappear fairly quickly.  A child’s natural facial features return to normal without expensive dental appliances. And finally by age two, most children have good enough language to allow them to calm themselves down in other ways other than sucking on a paci.


-As you can see from this discussion, pacifiers can be both a blessing and a curse. On the one hand, they can save lives in  infants and provide mom with a non nutritive sucking outlet for her infants  but they can also greatly increase the number of ear infections in some children, pose a choking hazard, and cause speech delay as well as facial deformity in some children.

– Your call parents.  You can see why pediatricians have trouble giving advice on this issue.  There is no clear answer. What I do strongly believe is,  that if your child is a paci user in the second year, make it disappear by age two. I think you will be glad you did.  Remember, children get more rigid and stubborn not less as they age.  What is hard at 2 years of age may be impossible at 3. Remember that Doc Smo pearl,“Parenting decisions that are easy in the short run may not look so easy in the rearview mirror” or “Parents who chose the path of least resistance are often rewarded with a rocky path”


-Thanks for joining me.

-If this is your first pedcast, take a look at the extensive DocSmo library of pedcasts and articles.

-If you are so moved, send in your comments and join the conversation.

-If you like talking about children, go ahead and subsribe to the feed on my website by hitting the rss feed button or linking to us by facebook or twitter.  We would love to have you.

– This is Dr Paul Smolen, broadcasting from the low country of south Carolina, hoping your little angel doesn’t get too sassy about getting rid of their paci.

-Until next time.


Smo Notes:

Pacifiers: Are they good for your baby? – MayoClinic.com

BMC Pediatrics | Full text | Predictors of and reasons for pacifier use in first-time mothers: an observational study

Bye-Bye Binky: Ending the Pacifier Habit

Safe Sleep Environment for Infants 2011 (Pedcast)

This podcast is part of the Essential Series for parents with newborns and infants.  Knowing the dos and don’ts when it comes to safe sleep environment for infants is something that parents must master.   Sleep associated deaths may, to a large degree, may be preventable.  Listen to what experts feel is the safest environment for babies to sleep.


-I created this podast in order to bring parents useful information they can use to help their children from the crib to the country club, from the bassinette to the board room.
-This episode is part of my essential knowledge edition of DocSmo
-Today we are going to talk about the new recommendations, appropriate for most babies, from the Academy of Pediatrics regarding Safe Sleep Practices for infants.
-A task force, working for the AAP, consisting of academic pediatricians. Reviewing available data and making recommendations based on available evidence and some opinion, albeit informed opinion.
-So get ready and sharpen up your pencils if you are a new parents bringing a newborn home from the hospital. I have some detailed recommendations for you hot off the AAP press. Important since deaths during sleep are the most common cause of death in infants during the first year of life!!! Pay close attention and learn what the experts at the AAP think constitutes the safest sleep environment for infants.
-Let me remind my listeners that, I am not your child’s doctor and for specific advice regarding your child, consult the wonderful person you call your child’s doctor.

First some definitions so we are all on the same page;

Our discussion today revolves around deaths that occur in infants during sleep time in the first year of life after they have transitioned from the birth process. These fall into a few categories;
-APNEA is the medical term for lack of breathing that is centrally mediated, that is, your brain forgetting to breath…common in premature infants before they have mature centers in their brain’s to control breathing, especially during sleep. Remember, no need for breathing in the womb so many immature premies just forget to breath…especially if they are asleep.
-SIDS Sudden infant Death Syndrome- Any sleep associated infant death that cannot be explained after a thorough medical investigation that includes an autopsy, toxin screens, metabolic tests…no trauma, no sickness, no suffocation etc. Presumably, the terminal event in a SIDS death is an apneic spell.

-SUID Sudden Unexpected Infant Death- Any sleep associated sudden death of an infant whether explained or unexplained which includes SIDS deaths as well as suffocation, asphyxia, entrapment, infection, ingestions, metabolic diseases, cardiac deaths, and trauma whether accidental or non accidental.

-New distinctions about sleep related deaths depend not only on traditional medical information like autopsy and lab tests but also on scene investigation. In recent years, a new tool that can explain many of these sleep associated deaths.

The goal of the new emphasis on safe sleep environments is to eliminate all sleep associated deaths in infants, whether they be SIDS type or SUID type. Here is the consensus of the AAP experts of the do’s and don’ts when it comes to a safe place for your infant to when they are unattended–Hot off the press.

-Except in rare cases, Back to sleep for EVERY sleep in the first year. Not side, not elevated, not in or on a device such as a wedge.
– Your babies “sleep surface” should be firm and conform to Consumer Product Safety standards for ALL sleeping, day and night.
-Your babies mattress should have no gaps around the edges (suffocation risk) and should only be covered by a fitted sheet…no loose bedding, no toys, no bumpers
-Dress your baby in light, comfortable clothing such as a one-piece sleeper in a room that is between 68-72 with no more than one layer more than that which would make an adult comfortable. No clothing that can get near the babies face.
-Breastfeed your infant
-Consider using a pacifier after breastfeeding is established.
-Put your infant’s crib or sleep surface in the room with the parents for the first 4-6 months?
-Its OK to put your baby down on their tummies for supervised Tummy Time everyday as soon as you get home to prevent flat spot on head however, this time must be supervised and follow the same rules I just outlined except the child is on their tummy rather than back.

Don’ts of sleep;
-NEVER Use pillows, soft bedding, sheep skins, quilts, pajamas with hoods, or blankets that can get near a babies face. If a blanket absolutely has to be used, tuck it firmly under the mattress so it cannot get loose.
-Crib should be free of loose toys or mobiles that can be reached. And nothing should be tied to the baby like jewelry or pacifier tether.
-No co sleeping. Feeding at night…must go back into crib. Infants should not sleep with siblings, parents, strangers, or anyone.
-Do not rely on monitors… cardio respiratory or any other type.
– Do not use a crib that has any broken or mended parts
-NEVER let a baby sleep on an adult who is drowsy or asleep
-NEVER let a infant sleep in a device that covers their face.
– Do not leave your baby to sleep in a car seat or carrier
– NEVER smoke before or after your baby is born
-Never use drugs or alcohol while caring for your baby

Easier said than done. I recently got a note from a Mom with a now 3 month old late preterm infant and you could hear the angst in her note. Let me read a portion of it for you. ” …it can be very frustrating as a parent (trying to preserve one’s own sanity) when doctors make these rulings that are not so easy to execute in the trenches!- Like –Never doze with your baby!! No toys in the bed!! Car seat MUST face back (This mom is particularly distressed when I’m alone with a young baby in the car!) Or—Sleeping in unapproved device may result in DEATH! Never leave baby unattended!!(How do I go to the bathroom, she asks??) She goes onto to say, It’s enough to make anyone lose their marbles. I know doctors just want the best for us, but take pity on us poor sleep deprived parents!”
– Here is hoping that you don’t lose your marbles. We need all the healthy, energetic healthy parents we can get to raise this next generation.

– If you want to read the full Academy of Pediatrics recommendations about safe sleeping environments, check out the references in the Smo Notes.
-Thanks for joining us today.
-Take the plunge and subscribe for your free pediatric education by getting the RSS feed from DocSmo.com or signing up on iTunes, Facebook or twitter.
-Remember this is a blog so your comments are welcome and may possibly be posted for others to ponder and comment on.
-This is your podcast host, Dr Paul Smolen, broadcasting from studio 1E in Charlotte, NC… hoping it is not a great leap for you to provide a safe place for your infant to sleep!

-Until next time

Smo Notes:

1.  Charlotte Observer- safeSleepPoster.pdf (application/pdf Object)-http://www.charlotteobserver.com/images/graphics/post/safeSleepPoster.pdf

2.  http://pediatrics.aappublications.org/content/early/2011/10/12/peds.2011-2284.full.pdf+html

3. http://aappolicy.aappublications.org/cgi/content/full/pediatrics;116/5/1245#SEC15

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