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  • Becky McArthur, S-LP(C)

The Great Pacifier Debate

Updated: Jul 5, 2019

Pacifier. Soother. Suckie. Binky. Paci. It has many names but the debate is not about what you call it; the debate is about their impact on children. I often have parents ask me whether I recommend using pacifiers and at what age to curb the habit. I will preface all of the information outlined in this blog with the fact that there is still lots of research to be done to determine the impact of pacifiers on various areas of development, including speech and language.


A bit of background terminology to start us off. Pacifiers are one form of non-nutritive sucking, which allows a child to suck without getting nutrition. Other types of non-nutritive sucking include thumb- or finger-sucking or sucking on blankets and clothing. Nutritive sucking, in contrast, is sucking when a child gets nutrition (like through the breast or bottle). Pacifier use is incredibly common, with estimates of 84% of children having used them (Canadian Paediatric Society, 2003). So let’s dive in to what the research says about this ultra-common habit!

Pros

-Reduce the likelihood of sudden infant death syndrome (SIDS), although researchers have yet to determine why this is (Canadian Paediatric Society, 2003).

-Non-pharmacological pain management during minor painful or stressful procedures, for example needles and physical examinations (Canadian Paediatric Society, 2003).

-Provides ‘warm up’ opportunity before a nutritive feed (Zimmerman, 2019). A recent literature review by Zimmerman and Thompson (2015) found the majority of research refutes pacifier use reducing breastfeeding (majority of research supports bottle use reducing breastfeeding). It should be noted, however, that these relationships are not yet well understood as to causation (Zimmerman & Thompson, 2015).


Cons

-Increase likelihood of dental malocclusion (misaligned teeth) and cavities (Canadian Paediatric Society, 2003; Schmid, Kugler, Nalabothu, Bosch & Verna, 2018).

-Increase risk of injuries (Keim, Fletcher, TePoel & McKenzie, 2012). In a review that looked at emergency department data over 19 years, it was estimated that pacifiers caused approximately 9,000 injuries in young children in USA. Injuries were most often to the face, lacerations, and when children are around 1 year of age (likely because children are still prone to falls).

-Increased risk of otitis media (middle ear infection) and various infections (although risk does appear to be higher in children who thumb- or finger-suck; Canadian Paediatric Society, 2003).


The Big Maybe:

-May impact speech development [Note: speech is the way we sound when we speak. If you want clear definitions of terms like speech, phonology and articulation, check out a previous blog post of mine here.]


It is unlikely that this impact is phonological in nature, meaning impacting a child’s overall sound system (Baker, 2018). It is more likely that pacifier use may impact articulation, potentially as a secondary impact of changes in the mouth and face. The emphasis is on may because the early research looking at pacifier use impacting articulation has been conflicting (Barbosa et al., 2009; Shotts, McDaniel & Neeley, 2008) and a recent literature review highlighted the lack of strong evidence for pacifiers changing orofacial structures (Schmid, Kugler, Nalabothu, Bosch & Verna, 2018). However, there is some early research that points to an indirect link between pacifiers and articulation.

Figure 1. Possible relationship between pacifiers and articulation.

As with all habits, there are many factors that would play a role in the overall impact a pacifier has on a child including:

-Frequency- how often does a child use the pacifier (e.g., many times daily, once daily, medical appointments only).

-Duration- how long a child uses a pacifier (e.g., minutes, hours, years).

-Type- some early evidence to suggest that pacifiers with a thinner neck (aka “functional” or “orthodontic” pacifiers) cause less issues with teeth alignment (Schmid, Kugler, Nalabothu, Bosch & Verna, 2018). It should be noted that there is not yet a regulation for the labelling of such pacifiers.


All of this being said, there are pros and cons to using a pacifier plus a lot we do not know yet. A parent always needs to do what is best for their child and family. If you are unsure, I would recommend consulting various professionals including your doctor, dentist, orthodontist, and speech-language pathologist. Each of these professionals may have a perspective that helps you make your decision.


Download a free handout with all of the information here.


Note: this blog post is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.


References

Baker, E., Masso, S., McLeod, S., & Wren, Y. (2018). Pacifiers, thumb sucking, breastfeeding,

and bottle use: Oral sucking habits of children with and without phonological impairment.

Folia Phoniatrica et Logopaedica, 70(3-4), 165-173.

Barbosa, C., Vaquez, S., Parada, M. A., Carlos, J., Gonzalez, V., Jackson, C., Yanez, N. D., Gelaye, B. & Fitzpatrick, A. L. (2009). The relationship of bottle feeding and other sucking behaviours with speech disorder in Patagonian preschoolers. BMC Pediatrics, 9(66).

Canadian Paediatric Society. (2003). Recommendations for the use of pacifiers [Position statement]. Retrieved on June 9, 2019 from

https://www.cps.ca/en/documents/position/pacifiers

Keim, S. A., Fletcher, E. N., TePoel, M. R. W. & McKenzie, L. B. (2012). Injuries associated with bottles, pacifiers, and sippy cups in the United States, 1991-2010. Pediatrics, 129(6), 1104-1110.

Leavy, K. M., Cisneros, G. J. & LeBlanc, E. M. (2016). Malocclusion and its relationship to speech sound production: Redefining the effect of malocclusal traits on sound production. American Journal of Orthodontics and Dentofacial Orthopedics, 150(1), 116- 123.

Schmid, K. M., Kugler, R., Nalabothu, P., Bosch, C. & Verna, C. (2018). The effect of pacifier sucking on orofacial structures: a systematic literature review. Progress in Orthodontics, 19(8).

Shotts, L. L., McDaniel, M. & Neeley, R. A. (2008). The impact of prolonged pacifier use on speech articulation: A preliminary investigation. Contemporary Issues in Comunication Science and Disorders, 35, 72-75.

Zimmerman, E. & Thompson, K. (2015). Clarifying nipple confusion. Journal of Perinatology, 1-5.

Zimmerman, E. (Guest). (2019, March 26). Episode 4: Is feeding the new play? Are all pacifiers created equal? Pediatric Feeding, Speech, and Language with Emily Zimmerman [Audio podcast]. Retrieved from

https://podcasts.apple.com/ca/podcast/seehearspeakpodcast/id1440635512


#slp #speechpathology #articulation #pacifiers #dentition #orthodontics

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