To Pacify or Not to Pacify: The Dummy Debate

The Dummy Debate Is it damaging to use dummies? By Dr Zareena Hyder, NHS GP and TV doctor on Channel 5’s GPs Behind Closed Doors Dummies, also known as soothers or pacifiers, are artificial teats that parents typically give to their babies to suck on when they are crying or distressed. They are not a modern phenomenon. The use of dummies actually dates back thousands of years - there are records of pacifiers made of silver, pearl, clay and sugar. (1) Thank goodness today we have tried and tested, hygienic choices at hand nowadays! Dummies divide opinion – some parents swear by them and others curse them. And it isn’t a clear-cut issue. Some studies have reported that dummies result in early weaning, increased rates of ear infections and dental problems. Other critics believe they interfere with the development of speech and sleeping routines. Yet, conversely, others cite the benefits seen with dummy use – such as calming little ones during painful procedures and helping babies to learn to sooth themselves and to be soothed without the need for a feed. There is even growing evidence that dummies may possibly be protective against sudden infant death syndrome (SIDS).

In my opinion, whether or not you should use a dummy is dependent on a number of factors but, most importantly, it hinges on the age of your child.

Newborn 0-2 months

The use of a dummy would not usually be recommended with a newborn baby, especially whilst you are establishing breastfeeding, for three main reasons:

Nipple confusion - sucking and swallowing is a complex mechanism. We as adults take for granted the act of coordinating swallowing whilst breathing, to avoid choking on our food or drink, but it’s a skill that babies need to learn. So the less confusion with different shaped teats/nipples the better.
Reduced motivation to breastfeed - let’s face it, breastfeeding can be hard to establish and maintain. It takes persistence and without early successes it can be demoralising. A hungry baby is a crying baby and whilst the use of a dummy at this early stage may stop baby crying for a while, it can make breastfeeding even harder and make it more tempting to give up.
Reduced bonding – with a baby under 2 months, it’s hard to tell if your baby is crying for a nappy change, colic, hunger or cuddles. The process of figuring out why your baby is crying and then trying to sooth them with cradling, cuddling, feeding or burping is all part of the bonding process and success gives the parent a great sense of satisfaction. Some say that a dummy is a “quick-fix” that results in less bonding.

Infant 2-6 months

By this time your baby will typically be well-established with breast or bottle feeds – and it’s not going to be long before weaning starts to be considered. Between the ages of 2 and 6 months, it is my personal opinion that if your baby is growing well and meeting the expected developmental milestones, then the occasional use of a dummy can be helpful for both the infant and their parents. At this stage, you are probably trying to get life into some sort of routine. You are also most likely very sleep-deprived, and a dummy may help with the odd moment here and there. When my children were little, I clearly recall giving a dummy to my son so I could focus on an important phone call - and he seemed to enjoy it! It is referred to as non-nutritional sucking. Sucking is a natural, automatic reflex babies have that can be seen in foetuses at the time of ultrasound scans in pregnancy. Dummies can also be beneficial as pain relievers during this period and can reduce the need for other pharmacological pain relief remedies.

Infant 6-12 months

If your baby is having chronic or recurrent middle ear infections (Otitis Media) at this age, there is some research that suggests that soothers could be at least partly to blame. This is thought to be because the prolonged sucking of a dummy may cause the Eustachian tube to be patent (open and unobstructed) for longer than it would normally be. This tube connects the middle ear to the upper throat at the back of the nasal cavity (nasopharynx) and if it is patent for too long, it could become more prone to infections. There have been a number of studies that have found this link, although there are several other causes of recurrent ear infections to consider such as parents/carers who are smokers, admission into nursery school, recurrent upper respiratory tract infections, allergies and overgrown adenoids (lymphoid tissue that usually shrinks with age).

From 12 months

Your baby’s first few teeth have usually erupted by this stage. With dentition there are a few problems with sucking a dummy beyond 12 months. One study (2) compared the teeth of children at 2 and 3 years old, and showed that there were significant differences in dental arch and occlusion characteristics (the position of the teeth in relation to top and bottom teeth at rest – where they occlude) between children still using dummies at 2 and 3 years, compared with those who had stopped using a dummy at 12 months. Another study (3) looked at children aged 2 to 5 years and also found significant differences in overject (top front teeth coming too far forward), openbite (where the teeth of the top and bottom jaw don’t touch each other even when the mouth is closed) and crossbite (where the top and bottom teeth are not aligned when the mouth is closed). The study showed that as dummies were used for longer periods, the association between dummy use and openbite and crossbite got stronger. Having said this, pacifiers are probably better than thumb sucking. Partly because it is easier for the parent to control the sucking habit - it can be thrown away (I mean posted to the Dummy Fairy!) It is also less damaging to the development of teeth than thumb sucking. It is recommended that dummy sucking should stop before permanent teeth erupt.

Parental wellbeing and mental health

Although there have been a number of studies as mentioned above looking into the harm dummies can cause, a dummy may be able to help a parent keep calm and focus on the task ahead. Many women with new babies find the continuous or frequent crying of their baby distressing, and the first few months (or even years!) of parenthood can be extremely stressful for anyone. Postnatal depression and parental anxiety are both mental health issues, and if the use of a pacifier can play a small role in making life more manageable for a parent, this could well mean it is playing a protective role with regards to their mental health. For parents with other children, the relief that a pacifier might bring could also give them the space and time to better look after the baby’s siblings and give them some of the attention that they want and need.

In Conclusion

Dummies remain a controversial topic. There are clearly sound arguments both in support of, and against, their use – and in the absence of an obvious answer as to whether or not we should use a dummy, the decision becomes a personal one. As with so many things in life and parenthood, we need to weigh up the risks and benefits involved and make the decision that best meets our needs and the needs of our family. Hopefully this article has made that process a little easier and more informed!

About the Author Dr Zareena Hyder is an NHS GP and TV doctor on Channel 5’s GPs: Behind Closed Doors. To catch Dr Hyder and her team on TV, tune in to series 4 of GPs: Behind Closed Doors on Channel 5 at 8pm on Wednesdays or catch up on My5. @ZareenaHyder @channel5_tv #GPsBehindClosedDoors References and Useful Links: https://www.ncbi.nlm.nih.gov/articles / www.NHS.uk/conditions/Otitis-media

Levin S. A history of dummies. Nursing RSA 1990;5:17-20
Warren JJ et al. Effects of oral habits’ duration on dental characteristics in the primary dentition. J Am Dent Assoc. 2001;132:1685-93
Adair SM et al. Effects of current and former pacifier use on the dentition of 24-59-month-old children. Pediatr Dent. 1995; 17:437-44.