The pacifier is one of those sleep aids that people tend to shy away from fearing their baby will become addicted to it and will end up a social pariah when they show up at the Senior Prom with their adult-sized binkie pinned to their lapel. But despite all the bad press pacifiers have gotten, pacifiers are a powerful tool that I encourage ALL parents of newborn babies to embrace, along with swaddling and white noise, WHENEVER their baby is sleeping. Pacifier use has many benefits including:

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• Sucking on a pacifier while falling asleep has been shown to reduce the risk of SIDS. (Note: You don’t need to put it back if it falls out, the benefit comes from having it WHEN falling asleep, not necessarily after.)
• Pacifiers are enormously soothing to babies and can when combined with other soothing techniques (notably swaddling and white noise) can significantly improve sleep and reduce crying.
• Pacifiers can meet baby’s need to suck while giving Mom’s boobs a much deserved break (and give Dad a chance to step in). And despite previous beliefs about pacifier use undermining breastfeeding efforts, current research suggests pacifier use doesn’t negatively impact breast feeding and may even help.
• Pacifier use leads to more saliva which is a natural antacid (especially useful for refluxing babies).

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Do you Need to Wean Off the Pacifier?

MAYBE.

Many babies can happily use the pacifier for months or even years. Dr. Karp suggests that babies should continue to use the pacifier for up to a year or longer. He also suggests that getting rid of the pacifier is no big deal. Which seems to contradict all the parents for whom the paci has become the bane of their existence.

So it seems that some proportion of babies will have no issues weaning the pacifier but the remaining babies will wake up screaming about the pacifier every 1-2 hours all night long until they are 3. Which means their parents will need to get up 4,380 times to reinsert the paci before their child a) outgrows it or b) figures out how to get it and replace it for themselves.

If you’re running into any of these issues then it’s time for the pacifier to go:
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• Your whole life has devolved into paci hell. If the path between your bed and baby’s crib has become your own personal Trail of Tears as you shuffle back in every 45 minutes all night long to reinsert the paci.
• Baby has chronic ear infections.
• Baby is over two years old. There is some conflicting recommendations about dental care and pacifier use. But there does seem to be some evidence that consistent use of a pacifier past 2 can lead to tooth misalignment (although the real issues seem to happen when using a pacifier past 4). It’s also been linked to tooth decay.

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When to Lose the Pacifier?

The easiest time to stop using the pacifier is just before ~4-5 months of age. Babies don’t remember things exist at this point so out of sight is literally, out of mind. If you’ve been giving them lots of soothing sleep cues (swaddle, white noise, sleep routine), the loss of pacifier at 4 months may go virtually unnoticed.

HOWEVER

If you stop using the pacifier before 4 months you…
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• Miss out on the SIDS protection provided by pacifier use at the time when the risk of SIDS peaks (the risk significantly decreases after 6 months).
• Remove a powerful tool from your arsenal in successfully navigating the dreaded 4 month sleep regression.
• For some particularly oral babies, even WITH all the great soothing you’ll continue to provide, you’ll see more night waking and shorter naps.

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Still for most of you, gradually weaning off the pacifier before your baby is 5-6 months old is probably the easiest and least error-prone option. I would encourage you to discuss this decision with your pediatrician to help weigh the potential advantages (ease of weaning) against the disadvantage (forgone reduction in SIDS risk). Babies at greater risk of SIDS (preemies, exposure to smoking, etc.) might be encouraged to continue to use the pacifier until their first birthday for safety purposes.

But what if you DIDN’T ditch the pacifier by 4 months? What if you’re now the parent of an 8 month old baby who screams as if in physical pain if the paci isn’t reinserted within 5 seconds after waking throughout the night?

It’s time to come up with and execute a paci weaning plan.

Weaning the Pacifier

There are two basic strategies to getting out of paci hell. But regardless of which strategy works for you, every parent who is working on ditching the pacifier should do ALL of the following:
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1. Give your baby MANY sleep cues.

   If you’ve been popping in a paci then plunking baby in bed you’ve got a “not enough sleep cues” problem. When you remove the paci you’ve left….nothing! So before you lose the paci, make sure you’re giving your baby as many age-appropriate sleep aids as possible. At any age, this should include a consistent bedtime routine, loud white noise, and a dark room. For younger babies (under 6 months), also use a swaddle. For older babies/toddlers, a lovey.

2. Cut down paci use during the day.

   Lots of babies simply exist WITH a pacifier. But if you’re ready to drop the pacifier at sleep time, it’ll go easier if you start with day time. Start with small windows of time and use lots of distraction (songs, play, go outside) to distract baby from the loss of beloved pacifier. Gradually increase those windows until there is little or no paci use during the day. (It’s OK to keep using the paci for particularly rough spots if you need it.)

3. Market the lovey.

   Talk about the fairy who said good-bye to her paci but had a magic lovey who cuddled with her whenever she slept. Wear the lovey under your shirt so it smells like something wonderful (YOU!). Play with the lovey together.

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Two Methods to Quit the Paci

#1 – Go Cold Turkey

I love Ferber. His book isn’t fabulously entertaining but it’s a fantastic resource based in credible science. This is a direct quote from his book about how to loose the paci.
[pullquote type=”2″ ]Often, falling asleep just once or twice without the pacifier is enough for a child to master sleeping without it. If he is very sleepy at bedtime, the learning will be even easier, so starting with a later than usual bedtime for the first two nights will help. Sleeping without the pacifier should certainly be routine after one or two days.
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So simple, right? Honestly I don’t know what all the pacifier fuss is about. Just stop using it.

However if we squint a little, it should be clear that what Dr. Ferber is talking about here is CIO. And depending on how things are going, your baby’s age and temperament, and just how exhausted everybody is, this is definitely an option to consider. Or at least consider it as a fallback plan. But first you might want to have a go with….

#2 – The Pull Out Method

Of course if you were successful with this strategy you wouldn’t have a baby to begin with (badum-CHING!). Some of you may know this method as the Pantley Pull Out/Off. You do your normal soothing bedtime routine and put baby down in the crib with the paci. When baby’s sucking slows you gently break the seal and remove the pacifier BEFORE baby is fully asleep. If baby drifts off to sleep, it’s time to catch up on Survivor.

If not try to use minimal soothing to settle baby back down without the pacifier. Often jiggling the crib (so baby’s head jiggles lightly) or gently patting baby’s back like a tom tom are good non-invasive techniques. If your baby continues to fuss, reinsert the pacifier and repeat the removal process until baby falls asleep. This may take a while (hours) so it’s best to Tivo Survivor or you might miss out.

Repeat this process when your baby wakes up looking for you to provide your standard paci reinsertion services throughout the night.

The process should get easier with subsequent nights until eventually you don’t use the pacifier at bedtime at all. Some lucky parents will be done with this within a few days but don’t be surprised if you’re still at it for 10-14 nights. This technique requires consistency and patience. Just don’t give up and LEAVE the pacifier in baby’s mouth as this will undo all your hard work.

If you feel it’s not getting you anywhere or your baby is just getting frustrated/angry with you and you’re ready to give up and just pop the pacifier back in, don’t feel bad. You aren’t the first parent who couldn’t make the “no cry” option work. There are many factors that feed into your ability to make “the pull out” work and most of them (baby’s temperament, level of attachment to the pacifier, sleep deprivation) are beyond your control. But it’s probably time to take Ferber’s advice and just. Stop.

So, anybody have any paci stories they care to share? Any super secret paci tricks that worked for you? Stories from the trenches?
{Photo Credit: Julie Chapa}