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A pacifier is an object shaped and textured like the nipple of a bottle, intended to fit into an infant's mouth to comfort him or her when there is a need for extra sucking. Some babies have a constant need for sucking on their fingers, thumb, or pacifiers, while others do not show a need for extra sucking.

Extra sucking is usually a self-comforting behavior. Sucking on a pacifier can offer security and comfort to many babies. The need for extra sucking is a natural habit. Many babies sucked their thumb or fingers even before being born. While some caregivers rely on letting the infant suck on their thumb or fingers, others may offer a pacifier to a baby.

What is the information for this topic?

There are different opinions about using pacifiers. Parents often wonder if it is a good idea to use them. All babies have a need to suck, but the amount of sucking varies from baby to baby. Some want to suck all of the time, and others suck only during feeding.

With some infants, the urge to suck seems to be more than what is needed for nutrition. It appears babies suck to comfort themselves when they're upset. It also seems to be a way of exploring things. In some cases, sucking might be just a way for babies to pass the time.

Babies appear more willing to take a pacifier between the ages of 2 to 4 months old. This appears to be the peak age in the need for extra sucking. After this age the sucking drive usually decreases. Many parents oppose the use of pacifiers, as they see the pacifier as an "object used to pacify a baby" rather than an object used to satisfy the sucking need.

Other parents favor the use of a pacifier to meet the need for extra sucking, and as an alternative for thumb sucking. There are many suggestions to consider when using a pacifier. These include:

• Using the pacifier between meals, when a baby is not hungry, will minimize interference with normal feeding patterns.
• A pacifier may be soothing at naptime or bedtime to help an infant fall asleep. When an infant is young, he or she may need a caregiver to find the pacifier if it falls out of their mouth. As the infant becomes older, he or she may be able to find the pacifier and start sucking independently.
• When an infant cries, it is important to try to hold and cuddle the infant. Pacifiers should not take the place of bonding between a caregiver and an infant. A pacifier should not be placed in a baby's mouth every time he or she cries; rather, it should be used to satisfy the need for extra sucking above and beyond feeding from a bottle or breast. When a child is upset or stressed he or she may have a need for extra sucking as a security. A caregiver can also provide security by holding, rocking, singing to, or playing with a child.

When purchasing a pacifier, the following points may be helpful:

• Look for one-piece pacifiers that have a soft nipple. Some two piece pacifiers can come apart and be a choking hazard.
• Pacifiers usually come in two sizes, one for children under 6 months of age and another for children older than 6 months. Purchasing a pacifier that is age appropriate will offer more comfort based on the way the pacifier fits in the mouth.
• The shield of the pacifier should be at least 1 1/2 inches across, so it can not fit entirely into a child's mouth, again becoming a choking hazard. A pacifier with a shield made of firm plastic with air holes will reduce skin irritation around the mouth.
• Purchasing a pacifier that is dishwasher safe helps to keep the pacifier cleaner. It is a good idea to boil the pacifier or run it through the dishwasher before using it for the first time and frequently after use. This is especially important with a child 6 months of age or younger, who is more vulnerable to germs.
• Pacifiers come in different shapes. Some are almost a square orthodontic-shaped, and some are shaped like the nipple on a baby bottle. The orthodontic shaped pacifier is often recommended by dentists and healthcare professionals because it may prevent tongue thrusting. However, the standard pacifier that is shaped like the top of a baby bottle usually causes no problems. Trying different pacifiers and allowing a baby to choose the pacifier they like, by trial and error, is another option.
• It is helpful to buy extra pacifiers in case one is lost, dirty, or broken.

Some precautions to consider with pacifier use are:

• Never tie a pacifier around the baby's neck. The cord may strangle the baby's neck. There are holders for pacifiers that have a clip that can attach to the baby's clothes. This special cord is short enough to prevent it from wrapping around the baby's neck, but will also help keep the pacifier from falling on the ground.
• Pacifiers wear out and fall apart over time. It is a good idea to check the pacifier frequently for torn rubber or any change in color.
• Homemade pacifiers, made from a nipple taped to a bottle cap, can also come apart and present a choking hazard.
• Coating the pacifier with honey may cause a serious disease, known as infant botulism.
• Coating a pacifier with any sweet fluids may cause dental caries.
• The pacifier should be rinsed after each use or after it drops on the floor, to decrease exposure to germs.
• Certain chemicals that were once used in production of pacifiers are no longer recommended. Pacifiers made with diisononyl phthalate (DINP) or phthalate esters are not recommended for use. These chemicals are "plasticizers" that can be released during sterilization and contaminate the nipple of the pacifier.

Parents may hear controversy over pacifier use. In most cases, limited use of pacifiers will not cause medical or dental problems as long as a child stops using the pacifier before the permanent teeth erupt.

In some cases, if a pacifier is used frequently or a child sucks vigorously on a pacifier, damage to the top of the mouth or the alignment of the permanent teeth can occur.

If pacifier use continues after the permanent teeth begin to come in, damage to the roof of the mouth or alignment of the teeth can also occur. If a caregiver is concerned about the way the child's teeth are erupting, consulting with a pediatric dentist is appropriate.

It may be helpful to stop using a pacifier in stages. This may make the transition of discontinuing pacifier use smoother. When the child starts to crawl, it may help to decrease the availability of the pacifier. As language and speech begin to develop, especially after 12 months of age, it may help to limit the pacifier to times of stress or fatigue.

Sometimes keeping the pacifier in the crib for use at nap time or bedtime is also helpful. Picking a special occasion or way of giving up the pacifier may make the transition of getting rid of the pacifier smoother. Caregivers should pick a time to discontinue pacifier use when the child is not coping with new stresses, such as traveling, moving or adjusting to a new baby.

A child should not be forced to give up a pacifier through punishment or humiliation. If there is great difficulty getting a child to stop using a pacifier, parents may consult with the child's healthcare professional. When a child is stressed and no longer has the pacifier, a parent can offer cuddling, comforting and support. Playing games, holding or talking may also distract the child from stressful periods. When the child does give up the pacifier, caregivers should offer praise and support for doing a grown up thing.