Pacifiers

As I write this, I’m sitting in a hotel lobby in Seville, Spain, waiting out a rain shower – one of many. Sunny Spain has chosen to replenish its sorely depleted aquifers during our 2-week holiday. Along with the tree-lined avenues and Moorish architectural motifs, one of the more striking images I will take home is that of Spanish toddlers, who are probably old enough to scribble their names, sucking on pacifiers ... at all hours of the day.

So while I’m waiting for a break in the weather, I’ve decided to share some of my observations on pacifiers. My family and I were all thumb suckers. In fact, I still have a shallow depression across the middle of my right thumbnail as evidence. If we had been asked prior to parenthood if we planned to offer our babies pacifiers, I’m sure Marilyn and I would have answered, "Definitely not! They don’t seem natural and we don’t like the looks of toddlers wandering around with plugs in their mouths." However, it doesn’t take long for pragmatic and sleep-deprived parents to alter their long-held and unrealistic principles.

For whatever reason, none of our three children could figure out how to keep the darned things in their mouths for longer than a few seconds. There may be some association with the fact that none of the Wilkoffs are particularly talented whistlers, either.

Despite my prior prejudices and our family’s experience with pacifiers, I have come to realize that, if used properly, they can be an effective parenting tool. Proper use, though, requires some anticipatory guidance by pediatricians and a little bit of discipline on the part of parents. Although I don’t think we should encourage parents to give their babies pacifiers, I do believe that how and when to use them should be a topic that is touched on at prenatal visits and 3-day weight checks.

First, with rare exception, a pacifier should not be offered to a neonate until her mother’s milk is established and regular weight gain has been demonstrated for several days. This may take a week or more. Hopefully, by then, parents will begin to have some inkling of when the baby is hungry and when she is just cranky (in other words, sleepy). In the interim, many mothers will be nursing much more often than they may have anticipated. They will need support and reassurance that getting their milk established is a temporary phase.

When the risk of nipple confusion and insufficient breast stimulation has passed and the baby is gaining weight, it’s safe to offer a pacifier to a fussy baby, with one important rule – only in the baby’s crib and only with her sleeping on her back. This makes the clear statement that a pacifier is first and foremost a sleep aid. It also emphasizes that a crib is the best and safest place for a child to sleep.

Of equal importance is the message this advice sends to parents: "If the baby is fussy and isn’t hungry and wants her pacifier, she is sleepy and needs to be put to bed." This is one lesson that will continue to pay dividends for years – provided the parents stick to the rule.

Used in this manner, pacifiers may decrease the risk of crib death and might even be associated with a smaller incidence of otitis media. When parents follow this simple only-in-the-crib rule for pacifier use, their child will never be seen wandering around with a plug in her mouth, interfering with her speech. It also means that, as the child gains more stamina, she will outgrow her need for the pacifier gradually, without the parents feeling the pressure to get rid of it by a certain age.

But any rule is meant to be bent. When the child is old enough to travel, the pacifier helps create a place to sleep when her crib isn’t handy. And, of course, for some children, pacifiers can be soothing in times of distress. When she falls and bumps her nose, the solution may be, "Let’s go to your room and you can sit on my lap with your pacifier until you feel better."

I see Marilyn beckoning me to grab my umbrella and head out for dinner. I can guarantee that, even though it’s almost 9 o’clock at night, we’ll encounter at least one Spanish toddler with a plug in his mouth.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at [email protected].

As I write this, I’m sitting in a hotel lobby in Seville, Spain, waiting out a rain shower – one of many. Sunny Spain has chosen to replenish its sorely depleted aquifers during our 2-week holiday. Along with the tree-lined avenues and Moorish architectural motifs, one of the more striking images I will take home is that of Spanish toddlers, who are probably old enough to scribble their names, sucking on pacifiers ... at all hours of the day.

So while I’m waiting for a break in the weather, I’ve decided to share some of my observations on pacifiers. My family and I were all thumb suckers. In fact, I still have a shallow depression across the middle of my right thumbnail as evidence. If we had been asked prior to parenthood if we planned to offer our babies pacifiers, I’m sure Marilyn and I would have answered, "Definitely not! They don’t seem natural and we don’t like the looks of toddlers wandering around with plugs in their mouths." However, it doesn’t take long for pragmatic and sleep-deprived parents to alter their long-held and unrealistic principles.

For whatever reason, none of our three children could figure out how to keep the darned things in their mouths for longer than a few seconds. There may be some association with the fact that none of the Wilkoffs are particularly talented whistlers, either.

Despite my prior prejudices and our family’s experience with pacifiers, I have come to realize that, if used properly, they can be an effective parenting tool. Proper use, though, requires some anticipatory guidance by pediatricians and a little bit of discipline on the part of parents. Although I don’t think we should encourage parents to give their babies pacifiers, I do believe that how and when to use them should be a topic that is touched on at prenatal visits and 3-day weight checks.

First, with rare exception, a pacifier should not be offered to a neonate until her mother’s milk is established and regular weight gain has been demonstrated for several days. This may take a week or more. Hopefully, by then, parents will begin to have some inkling of when the baby is hungry and when she is just cranky (in other words, sleepy). In the interim, many mothers will be nursing much more often than they may have anticipated. They will need support and reassurance that getting their milk established is a temporary phase.

When the risk of nipple confusion and insufficient breast stimulation has passed and the baby is gaining weight, it’s safe to offer a pacifier to a fussy baby, with one important rule – only in the baby’s crib and only with her sleeping on her back. This makes the clear statement that a pacifier is first and foremost a sleep aid. It also emphasizes that a crib is the best and safest place for a child to sleep.

Of equal importance is the message this advice sends to parents: "If the baby is fussy and isn’t hungry and wants her pacifier, she is sleepy and needs to be put to bed." This is one lesson that will continue to pay dividends for years – provided the parents stick to the rule.

Used in this manner, pacifiers may decrease the risk of crib death and might even be associated with a smaller incidence of otitis media. When parents follow this simple only-in-the-crib rule for pacifier use, their child will never be seen wandering around with a plug in her mouth, interfering with her speech. It also means that, as the child gains more stamina, she will outgrow her need for the pacifier gradually, without the parents feeling the pressure to get rid of it by a certain age.

But any rule is meant to be bent. When the child is old enough to travel, the pacifier helps create a place to sleep when her crib isn’t handy. And, of course, for some children, pacifiers can be soothing in times of distress. When she falls and bumps her nose, the solution may be, "Let’s go to your room and you can sit on my lap with your pacifier until you feel better."

I see Marilyn beckoning me to grab my umbrella and head out for dinner. I can guarantee that, even though it’s almost 9 o’clock at night, we’ll encounter at least one Spanish toddler with a plug in his mouth.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at [email protected].

As I write this, I’m sitting in a hotel lobby in Seville, Spain, waiting out a rain shower – one of many. Sunny Spain has chosen to replenish its sorely depleted aquifers during our 2-week holiday. Along with the tree-lined avenues and Moorish architectural motifs, one of the more striking images I will take home is that of Spanish toddlers, who are probably old enough to scribble their names, sucking on pacifiers ... at all hours of the day.

So while I’m waiting for a break in the weather, I’ve decided to share some of my observations on pacifiers. My family and I were all thumb suckers. In fact, I still have a shallow depression across the middle of my right thumbnail as evidence. If we had been asked prior to parenthood if we planned to offer our babies pacifiers, I’m sure Marilyn and I would have answered, "Definitely not! They don’t seem natural and we don’t like the looks of toddlers wandering around with plugs in their mouths." However, it doesn’t take long for pragmatic and sleep-deprived parents to alter their long-held and unrealistic principles.

For whatever reason, none of our three children could figure out how to keep the darned things in their mouths for longer than a few seconds. There may be some association with the fact that none of the Wilkoffs are particularly talented whistlers, either.

Despite my prior prejudices and our family’s experience with pacifiers, I have come to realize that, if used properly, they can be an effective parenting tool. Proper use, though, requires some anticipatory guidance by pediatricians and a little bit of discipline on the part of parents. Although I don’t think we should encourage parents to give their babies pacifiers, I do believe that how and when to use them should be a topic that is touched on at prenatal visits and 3-day weight checks.

First, with rare exception, a pacifier should not be offered to a neonate until her mother’s milk is established and regular weight gain has been demonstrated for several days. This may take a week or more. Hopefully, by then, parents will begin to have some inkling of when the baby is hungry and when she is just cranky (in other words, sleepy). In the interim, many mothers will be nursing much more often than they may have anticipated. They will need support and reassurance that getting their milk established is a temporary phase.

When the risk of nipple confusion and insufficient breast stimulation has passed and the baby is gaining weight, it’s safe to offer a pacifier to a fussy baby, with one important rule – only in the baby’s crib and only with her sleeping on her back. This makes the clear statement that a pacifier is first and foremost a sleep aid. It also emphasizes that a crib is the best and safest place for a child to sleep.

Of equal importance is the message this advice sends to parents: "If the baby is fussy and isn’t hungry and wants her pacifier, she is sleepy and needs to be put to bed." This is one lesson that will continue to pay dividends for years – provided the parents stick to the rule.

Used in this manner, pacifiers may decrease the risk of crib death and might even be associated with a smaller incidence of otitis media. When parents follow this simple only-in-the-crib rule for pacifier use, their child will never be seen wandering around with a plug in her mouth, interfering with her speech. It also means that, as the child gains more stamina, she will outgrow her need for the pacifier gradually, without the parents feeling the pressure to get rid of it by a certain age.

But any rule is meant to be bent. When the child is old enough to travel, the pacifier helps create a place to sleep when her crib isn’t handy. And, of course, for some children, pacifiers can be soothing in times of distress. When she falls and bumps her nose, the solution may be, "Let’s go to your room and you can sit on my lap with your pacifier until you feel better."

I see Marilyn beckoning me to grab my umbrella and head out for dinner. I can guarantee that, even though it’s almost 9 o’clock at night, we’ll encounter at least one Spanish toddler with a plug in his mouth.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at [email protected].