The Pacifier

Dr. Elías Jiménez F.

The word "pacifier" indicates with all clarity its main function: to tranquilize small children for a short period of time. Nevertheless, all artificial process that we introduce to modify children's behavior has its advantages and disadvantages, being necessary to know them before making the decision weather to use it or not.

In the process of normal development of a child, there exists a well defined phase, that is denominated the oral phase, which is present since the first months of age. During this phase children learn how to relate with their surroundings, they feel pleasure through the mouth, they get to know their body parts by taking them to their mouth, they want to taste everything. As part of this process, they start sucking on their thumb, which is perfectly normal and it disappears spontaneously as the child matures.

The parents introduce their child to the pacifier during this phase for various reasons: let's analyze some of them and let's see if they really accomplish what we expect.

The first reason why parents use the pacifier is with the objective of regulating the child's schedule. During the first weeks, children who are breast fed, have no schedule, they eat very frequently and they sleep a lot, and they cry more at night than during the day. The production of maternal milk varies during the day as well as its composition, this is why the child sometimes is satisfied with what he ate and sometimes he remains hungry. This is a normal process and cannot be modified with the pacifier during the first weeks. Also, the risk of swallowing the vomit is greater in a small child with a pacifier than in one without it. The advice in these case is very clear: we shouldn't use a pacifier in children who are younger than a month old.

The second mistaken concept is that the pacifier diminishes the colic in children. One of the main causes of colic is the production of gas in the intestine. The pacifier makes the child swallow more gas, this is why a child with colic does not get better with the use of the pacifier.

Another argument that is frequently used is that the use of the pacifier will get rid of the child's habit of sucking his thumb. This statement is incorrect. On the contrary, by using the pacifier during the day we create in the child the habit of always having something in his mouth, and when we try to take the pacifier away from them the child starts sucking on his thumb.

There are some factors, which are clearly established, about the risk of using a pacifier:

1. The risk of contamination: It is very difficult to keep the pacifier clean, especially when it's used during the whole day. This increases the risk of getting diarrhea. On the other hand, it is known that honey can get contaminated with certain bacteria, which will increase this risk if it is used on the pacifier.
2. Deformities on the teeth: If the pacifier is used on children who already have teeth, these can acquire some sort of deformity, especially if the use of the pacifier is carried on for a long period of time.
3. Ear infections: Children over 10 months of age who still use the pacifier, it raises the risk of middle ear infections. The pacifier increases salivation, eliminating bacteria, this favors the presence of fungi and modifies the type of bacteria present in the mouth. Constant sucking favors the transmitance of them into the middle ear.

The only real indication for the use of the pacifier is when we want to entertain the child who is over a month old, for a little longer, in order to regulate his schedule. If a child is being breast fed, and the mother has to go out, it's is better to use the pacifier if the child starts crying than to use powdered milk.

In brief, there are very few indications and a lot of potential problems for the use of the pacifier. If we decide to use it, it should be after the child's first month of age, eliminating its use when the child reaches his 10 months of age. And it should be used for very short periods of time, before eating, and with very strict precautions with respect to its cleaning.