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Pacifiers

Pacifier buying guide

Last updated: November 2012
Getting started

Getting started

A pacifier--a latex or silicone nipple mounted on a wide plastic shield--can be a sanity saver, especially when your baby is fussy. "The sucking action will calm babies and can even help some of their jaw muscles develop properly," Julie Barna, a doctor of dental medicine and spokeswoman for the Academy of General Dentistry, said. Pacifiers also may reduce the threat of sudden infant death syndrome (SIDS). In fact, the American Academy of Pediatrics (AAP) recommends that babies up to 1 year old use pacifiers at bedtime and naptime because studies suggest that pacifiers cut that risk.

If you're worried that pacifiers can interfere with breast-feeding or damage teeth, consider this: AAP guidelines say there's little evidence that pacifiers harm babies' teeth before they are 1 year old or cause infants to lose interest in breast-feeding. But the AAP recommends waiting until your breast-fed baby is 1 month old before introducing a pacifier, to ensure that breast-feeding is firmly established.

You can give your baby a pacifier at bedtime or naptime during his first year or so, when the risk of SIDS is greatest. Using pacifiers at other times of the day probably won't harm your child, provided he stops by the time he's 2, when the practice may cause protruding front teeth, an improper bite, and prevent the jaw from forming properly.

For some parents, a pacifier may be a godsend. For others, it's a waste of money because some babies, especially those who are breast-feeding, don't like pacifiers and will repeatedly spit them out, no matter which brand or type you try. Will your baby crave a pacifier or be satisfied with the breast or bottle? You'll know soon enough. But don't force your baby to use a pacifier if she doesn't want to.

Recommendations

If you decide to go the pacifier route, buy several in infant size, and then buy more according to the manufacturer's age recommendations as your baby gets older. Try different brands and nipple shapes until you find one that your baby likes (if she likes them at all). Some brands of newborn bottle sets come with a pacifier or two, so you might start there. Don't worry about buying the same brand of pacifier as the bottle your baby is using. Pacifier and bottle nipples may resemble each other, but they're not always exactly the same.

Pacifier vs. thumb-sucking

A pacifier is healthier for your baby than thumb-sucking. Why? As a baby sucks on her thumb, she pushes the top jaw forward and bottom jaw backward, which can cause jaw misalignment and malformation over time. And a baby's thumb can be dirty, which introduces bacteria into the mouth that could cause illness. It can also be a tough habit to break because a baby's thumb is always handy. You might want to discourage the habit by giving your child a pacifier whenever you catch her with her thumb in her mouth. Babies tend to thumb-suck when they're tired, which is another reason to have a pacifier ready at bedtime and naptime.

Types

If you find yourself in the pacifier aisle, you'll see a large variety. Pacifiers range from less than $2 to about $6 or so for a package of two. Novelty pacifiers, such as those with personalized sayings on them, may cost $10 or more apiece.

We recommend silicone over latex pacifiers because some babies can develop an allergy or sensitivity to latex. Silicone eliminates that potential problem and tends to hold up longer. Although silicone-nipple pacifiers are dishwasher-safe (top rack only), latex pacifiers are not and deteriorate faster when heated.

Basic

These are round-tipped, sometimes advertised as "most like mother."

Orthodontic

These are angled pacifiers with a wide tip. "Orthodontic means that your baby's top and bottom jaw are in a correct position when he's sucking on it," said Julie Barna, a doctor of dental medicine and spokeswoman for the Academy of General Dentistry. That position doesn't interfere with normal jaw growth and development and, in fact, may promote it. According to Barna, most pacifiers sold in the U.S. are orthodontically correct, whether or not they're labeled "orthodontic." Pacifiers come in several sizes and are classified by age on the package, so it's easy to see which size to buy.

Features


As cute as they may be, avoid pacifiers with decorative features that could fall off and pose a choking hazard. A number of pacifiers have been recalled for this reason (Check www.cpsc.gov for a list of recalls.) Here are the pacifier features to consider.

Handles

Some pacifiers have buttons on the back; others have rings. Babies don't care either way, though some parents do. Ring handles make pacifiers easier to retrieve, but button-back pacifiers may be easier for babies to grasp.

Snap-on caps

Some pacifiers have a snap-on cap. It's one more thing to keep track of, but it can help keep your baby's pacifier clean when you're out and it's not in use. Don't let your baby play with the cap, though; it could be a choking hazard.

Illumination

Some pacifier handles glow in the dark, which can help you find the pacifier in the crib at night.

Carrying cases and clip-on ribbons

Short, clip-on ribbons that attach the pacifier to clothing and prevent it from ending up on the floor or the street are available separately. As noted in shopping tips, we don't recommend using any type of clip-on ribbons. To help you keep track of your baby's pacifier, consider a pacifier pod or case. A small pacifier pouch accessory can also attach to your stroller, diaper bag, or anywhere else you need to keep your baby's pacifier within arm's reach.

Self-closing models

Some pacifiers have a built-in cover that automatically snaps closed if the pacifier is dropped. That's a "neat" idea if your baby will take to the pacifiers with this feature.

Avoid the glitz

Don't buy pacifiers that have been gussied up with anything that could fall off and become a choking hazard, such as faux crystals or beads.

Shopping tips

Buy silicone pacifiers only

Babies can develop an allergy or sensitivity to latex.

Be sure the base or shield has ventilation holes

In the highly unlikely event that a baby sucks her pacifier into her mouth, ventilation holes will admit air. Pacifiers are required to have at least two ventilation holes in the shield, but check just to be sure. The holes should be at least 0.2 (about three-sixteenths) inch wide.

Don't buy pacifiers with strings or anything else attached to it

Babies drop their pacifiers a lot, and clips that attach a pacifier to a baby's shirt are a convenient way to avoid that problem. But babies can find ways to get themselves into all kinds of trouble, so even a short pacifier cord (a.k.a. a pacifier keeper or holder) can be a strangulation hazard. To meet current Consumer Product Safety Commission (CPSC) safety standards, pacifiers can't be sold or distributed with any ribbon, string, cord, chain, twine, leather, yarn, or similar attachment. Also, a short cord can snag on a stroller or carrier, or on something a toddler is walking past or playing near, stopping the child short. We've heard stories of toddlers who get attached pacifier cords caught on end table corners and cabinet drawers, then fall forward and bang their heads on the edge of the table or cabinet. The injuries weren't serious, but could have been avoided. It's a hassle to have to constantly keep track of your baby's pacifier. But cordless is the safest way to go and should definitely be considered.

Check for recalls

Check the CPSC website, www.cpsc.gov, to see whether the pacifier or other baby items you plan to buy have been recalled. Even better, sign up for free e-mail notices of recalls at www.cpsc.gov/cpsclist.aspx. In the past, pacifiers have been recalled because the pacifier's shield was too small and could easily enter the mouth of an infant. In other cases, the pacifier's ventilation holes were smaller than required and not positioned to accept a tool to remove the pacifier should it get lodged in a child's mouth. Other pacifiers continue to be recalled because the nipple could easily detach or because the pacifier has small parts that can break off, posing a choking hazard. It's up to retailers to remove recalled products from store shelves, but products can fall through the cracks, so it pays to do your homework.

Pacifier use

Check them regularly

Over time, pacifiers can crack, tear, and swell. They can also become grainy or sticky, losing their original smooth texture. Check your child's pacifiers carefully and often, and if you discover those problems, throw them away. Pull on the bulb portion from time to time to make sure it's firmly attached. If it's not, toss it. Some manufacturers recommend replacing a pacifier every four weeks.

Keep some spares

Once you settle on a brand/type, buy several so you don't waste time scouring the house for that precious pacifier--or running to the 24-hour pharmacy in the middle of the night to get your baby's favorite brand and model. Keep two in the diaper bag--it's nice to have an extra in case you drop one or your baby spits it out onto the floor and you don't have access to soap and water. (If you're near a drinking fountain or a restroom, give your baby's pacifier a quick rinse-and-dry before giving it to her.) Disperse several in key locations--the baby's car seat, near the changing table, by the rocking chair--so you always know where they are. And on family trips, bring extras.

Clean with care

Before you use a new pacifier, boil it for five minutes to remove any chemical residue. After that, wash your baby's pacifiers often with warm soapy water by hand and squeeze the bulb to remove excess water. Hand washing will help to lengthen the life of your baby's pacifier. Frequent washing is particularly important for pacifiers used by babies younger than 6 months, whose immune systems are especially immature.

When to use them--or not

Use a pacifier between meals when you sense that your baby needs something but isn't hungry. Don't sweeten the deal by dipping a pacifier in juice or anything sugary. If you want to dunk it in something, use water. But giving a pacifier to a baby who wants food isn't a good idea--it can make a baby so distraught that he may have trouble calming down enough to eat.

The five-second rule is a myth

Some people may think it's okay to give your baby a dropped pacifier without washing it first, if you pick it up within five seconds because that's not enough time for it to get germy. That's false. Large numbers of illness-causing bacteria that survive on the floor (and even a table or kitchen counter that hasn't been disinfected) can transfer to a soft, sticky surface such as food or a pacifier. So no matter how fast you are on the uptake, wash a pacifier that has been dropped with at least water if you don't have access to soap, and dry it thoroughly with a paper towel, before giving it back to your baby.

Pacifier weaning

Between your child's first and second birthday, it's a good idea to wean him off the pacifier. Cold turkey is one possible method. Out of sight, out of mind. A more gradual strategy is to begin allowing the pacifier only at certain times, such as bedtime and naptime--and not at random moments throughout the day. Then, after awhile, eliminate the pacifier at bedtime and naptime, too. You'll save on dental bills later because prolonged use of a pacifier can change the shape of your baby's growing jaw and palate. The sucking action can narrow the jaw in the wrong places and widen it in others. If pacifier use continues into the preschool years, there's a strong possibility that your child will need orthodontic treatment, says Julie Barna, a doctor of dental medicine and spokeswoman for the Academy of General Dentistry.

There's another reason to ditch the pacifier even closer to the one-year mark. "When a child is sucking on a pacifier, the auditory tube in the middle ear actually opens, allowing bacteria that naturally reside in the mouth to pass through, which increases the chance of infection," Barna said. If your toddler wants something to suck on, Barna recommends graduating to a water-filled sippy cup with a collapsible rubber straw, rather than the rounded, plastic-spout style. The suction action required with a straw helps to promote normal facial muscle development and won't lead to ear infections. It also helps children learn to drink from a cup, because sucking through a straw and sipping from a cup use the same muscles.

Safety

The Consumer Product Safety Improvement Act of 2008 requires third-party testing to ensure that pacifiers meet federal safety standards. Pacifiers must also conform to limits on lead and phthalates. Any pacifier not in compliance may be recalled.

  • To prevent choking on a nipple, handle, or small part that may detach from the pacifier guard, the Consumer Product Safety Commission requires that pacifiers be able to pass a "pull test." The pacifier must not come apart if the nipple is pulled away from the guard in any direction with a force of 10 pounds or for 10 seconds.
  • The nipple, along with the handle or ring, must pass this same test after the pacifier has been boiled and cooled six times, which simulates how parents sterilize pacifiers at home.
  • To verify that the pacifier's shield won't suffocate a child, the CPSC requires that it pass a different pull test. With the pacifier placed in a test fixture, the nipple is pulled at a force of 2 pounds, which is held for 10 seconds. If the shield pulls completely through the test fixture, the pacifier fails.
  • The pacifier shield must be large enough so that it can't easily enter an infant's mouth. In the highly unlikely event that a baby sucks her pacifier into her mouth, ventilation holes will admit air. Pacifiers are required to have at least two ventilation holes in the shield, at least 0.2 (three-sixteenths) inch in diameter and no closer than 0.2 inch from the shield's outside edge.
  • Pacifiers must be labeled with this warning: "Do Not Tie Pacifier Around Child's Neck As It Presents a Strangulation Danger." Take that warning seriously. The CPSC continues to receive reports of infants strangling on pacifier cords or ribbons tied around their necks. Never use a cord of any kind, because even short cords can catch on objects, such as crib posts or doorknobs.
  • Parts cannot stick out more than 0.63 (about nine-sixteenths) inch from the face of the shield on the side opposite the nipple. Pacifiers may not have sharp points or edges. As of August 2009, paint may not contain more than 90 parts per million of lead, down from 600 parts per million.
  • Three types of phthalates, a chemical in plastic that may affect development and the reproductive system, are banned from children's products such as pacifiers. Three other phthalates are prohibited pending further study and may eventually be banned.
   

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