A pacifier is an “artificial” nipple, composed either of silicone, plastic or rubber, given to an infant to suck upon. A typical pacifier consists of three components: an artificial nipple, a mouth shield - large enough so as to avoid the child from swallowing it - and a handle.  Sucking is a natural reflex producing a calming and comforting effect upon an infant. Use of a pacifier by an infant may prevent anxiety.  For example, in one study of one-year-old infants placed in an unfamiliar playroom, those with pacifiers showed less distress, exhibited more play, and tolerated longer separation from their mothers, than those infants without pacifiers.  Pacifiers reduce infants’ crying during minor, yet painful, procedures, such as circumcision, venipuncture, immunizations, etc.

During the first six month of life the use of pacifiers is completely acceptable and understandable. Furthermore, there may be a health advantage of pacifier use by an infant.  The American Academy of Pediatrics recommends that an infant one month and older should be offered at the onset of sleep a pacifier to reduce the risk of sudden infant death syndrome (SIDS).  Conversely, in the second six months of life pacifier use by an infant should be reduced. According to the American Academy of Pediatrics, otitis media (ear infection), in infants, has been linked to the overuse of a pacifier after the age of 6 months. Furthermore, increased pacifier use was associated with more speech and language problems. Apparently, the benefits of pacifier usage to an infant are age dependent, being beneficial before 6 months of age and potentially detrimental after 6 months of age.

Pacifiers also have a major impact on the development of teeth, jaws and oral musculature.  The shape of the jaw and muscles of mastication (biting), and the emergence of erupting teeth are greatly influenced by frequent and habitual use of a pacifier.  Therefore, the earlier a child can be weaned off a pacifier, the more advantageous for normal growth and development of the oral cavity.  Prolonged use of a pacifier will contribute to malocclusion (i.e., the undesirable relative positioning of the upper and lower teeth when the jaw is closed), and misalignment of teeth.

The most common malocclusions noted in children who suck pacifiers is an “open bite” in which an obvious gap is seen between the upper front teeth and lower front teeth when the jaw is closed.  Less common adverse effects due to constant sucking include “posterior crossbite,” seen  when the upper back teeth are tucked inside the lower back teeth, and  an “overjet,” manifested when the upper teeth are pushed outward (“buck teeth”)over the lower teeth.  These malocclusions will require extensive orthodontic intervention.

Like any other habit, the use of a pacifier is a habit that is easier to break in a younger child, preferably before age 2.  Pediatric medical and dental specialties, all concur, that while early use of a pacifier is acceptable, thereafter, pacifier use should be eliminated as early as possible.