Choosing and Using a Safe Pacifier
4 Times to Pull the Plug
Pacifier Research
When Pacifiers Help
Pacifiers vs. Thumb
3 Bye-Bye Binky Tactics

Prefers Binky to Breast
Ban Nighttime Binky
Pacifier Habit
Harmless Habit
Binky Fairy

DR. BILL'S BINKY ADVICE
In the early weeks, only the real nipple belongs in a baby's mouth. If you have a baby who really needs a pacifier, then use it, don't abuse it, and quickly try to lose it.

• Select a one-piece model that will not break into two pieces, allowing baby to choke on the bulb. Also, be sure it is dishwasher safe and easy to clean.
• Be sure the base of the pacifier has ventilation holes. Avoid large circular shields that may obstruct baby's nasal passages when baby draws in the pacifier during intense sucking.
• One size doesn't fit all. Choose a smaller, shorter, newborn-sized pacifier for the early months.
• Pacifiers come in a variety of nipple shapes. Some are symmetrically round, like a bottle nipple. Others are preshaped, supposedly to duplicate the elongated, flattened breast nipple during sucking. Preshaped nipples, however, may not always fit baby's mouth, especially if the pacifier turns during sucking or is inserted upside down. Some pacifier manufacturers claim orthodontic benefits, but these are questionable. Try various shapes and let baby's discerning mouth decide.
• Avoid attaching the pacifier to a string or ribbon around baby's neck or pinning the pacifier string onto baby's clothing. This is a setup for strangulation. "But it's always falling on the floor," you plead. Answer: Keep one hand on baby and the other hand on the pacifier. (Or pin the pacifier ring directly onto baby's clothing.) Perhaps babies are not meant to be left unattended with anything in their mouths. Good safety and good nurturing go together.
• Avoid making your own pacifier out of a cotton-stuffed bottle nipple. Baby may suck the cotton through the hole.
• Resist the temptation to sweeten the offering by dipping the pacifier in honey or syrup. If baby does not yet have teeth, he is too young for honey or syrup. If he has teeth, he is too old for the decay-producing sweets – and probably the pacifier, too. If he has to be enticed to suck by sweetening, he would probably benefit from some other form of comforting – having a change of scenery, going out in the fresh air, playing, cuddling with you, rocking to sleep, and being held more.

Babies have an intense need to suck, and some have more intense needs than others. Babies even suck their thumbs in the womb. Next to holding and feeding, sucking is the most time-tested comforter.

1. In the newborn nursery. Peer through any newborn nursery window and you're sure to witness contented babies lying quietly in plastic boxes all plugged in with no place to go. Pull the plug on this scene. These babies should be plugged into their mothers.

2. In the early weeks of breastfeeding. When learning how to breastfeed, a baby should have only mother's nipple in his mouth. About the only thing a newborn has to "learn" is how to suck on mother's nipple the right way to get the most milk.

• A baby sucks on a pacifier differently than on mother's nipples. Some newborns, develop nipple confusion when given a pacifier or bottle nipple when they are learning to suck from mother. Pacifiers have a narrow base, so baby doesn't have to open his lips wide. This often results in poor latch-on techniques, sore nipples, and a difficult start at breastfeeding.
• Many sensitive babies gag on every pacifier you might try. The texture, taste, and smell are rejected hands down. Other babies make the transition from rubber to flesh nipples without any confusion or complaint.
• Our advice: Avoid pacifiers until your newborn learns to latch on properly and you have a good milk supply. If your own nipples are wearing out, or at least the mom they are attached to is, use your finger (or, better yet, get dad or someone else to give you a break). The skin-to-skin element is still there, and your index finger (or dad's little finger) can be placed more properly in baby's mouth to stimulate sucking at the breast. Many of our babies have been soothed by the touch of my well-scrubbed pinkie.

3. When pacifier overuse is harming the teeth. Between two and three years of age, toddlers can cause their upper front teeth to protrude by sucking intensely on a pacifier, especially at night.

4. As habitual substitutes for nurturing. Ideally, pacifiers are for the comfort of babies, not the convenience of parents (but I have yet to meet the ideal parent or the ideal baby and, believe it or not, you probably won't meet any on this site.) To insert the plug and leave baby in the plastic infant seat every time he cries is unhealthy reliance on an artificial comforter. This baby needs picking up and holding. Always relying on an alternative peacemaker lessens the buildup of baby's trust in the parents and denies the parents a chance to develop baby-comforting skills. Pacifiers are meant to satisfy intense sucking needs, not to delay or replace nurturing. A person should always be at the other end of a comforting tool. The breast (or the finger) has the built-in advantage of making sure you don't fall into the habit of just plugging up the source of the cries as a mechanical gesture. When baby cries, if you find yourself, by reflex, reaching for the pacifier instead of reaching for your baby, pull the plug – and lose it.

Both scientific research and parents observations reveal:

1. A 1999 study reported in Pediatrics showed that babies who used pacifiers in the first six weeks tended to wean earlier.

2. One study correlated pacifier use with frequency of ear infections.

3. Prolonged pacifier use can lead to crooked teeth.

If used sensibly and for a baby who has intense sucking needs – in addition to, not as a substitute for, human nurturing – pacifiers are an acceptable aid. If you have one of these babies and experience times when the human pacifier wears out, use the silicon sub, but don't abuse it. There will be times when being a baby is socially unacceptable, for example, during a sermon in church or in a quiet theater. If baby is finished feeding and won't accept finger sucking, a pacifier may keep the peace.

Pacifiers bother adults more than they harm babies. I confess that while examining a baby and needing an unobstructed view of baby's face, I wish "that thing" were not there. Besides, pacifiers obstruct those adorable smiles. But in defense of the much-maligned pacifier, I soon relax my unfair judgment of the rubber comforter as baby sucks contentedly during the entire exam.

We would vote for the thumb. It's easily found in the middle of the night, it doesn't fall on the floor, it tastes better, and baby can adjust the flesh feel to her own sucking needs. Pacifiers get lost, get dirty, and are always falling on the floor. Those of the pacifier mindset claim, however, that it is easier to "lose" the pacifier than the thumb: and intense thumb-sucking, if prolonged three to four years, may lead to orthodontic problems. Parents of tiny thumb-suckers don't choose your child's orthodontist yet. All babies suck their thumbs at some time. Most outgrow it, and if their sucking needs are appropriately met in early infancy, they seldom carry the thumb-sucking habit into childhood.

Pacifiers are just that – "peacemakers" – which children return to as an attachment object. Some infants and young children have an intense need to suck for comfort, which lasts well into their preschool years. Seeing a plug in a three-year-old's mouth actually bothers adults more than children. This does not imply a psychological problem or a need unfulfilled by parents. On the contrary, the ability to use objects to self-comfort is a sign of psychological health. The only problem with pacifiers at three years of age is the likelihood of exerting pressure on the upper front teeth, resulting in an overbite. If your child does not use a pacifier long enough and suck hard enough to be causing mal-alignment of the teeth, then there is no need to break this habit. If it is beginning to bother her teeth, here's how to wave bye-bye to her "binky."

1. Use the distract and substitute technique. As soon as she reaches for her comforter, distract her ("Let's play…") and substitute an alternative activity.

2. Here's a binky-breaking trick I have oftentimes advised in my pediatric practice. I call this the trade-in technique. Take your child to the toystore and let her pick out a toy to "trade" for the pacifier. Experienced toystore clerks are used to this trading game. By making the pacifier less convenient to use, distracting her, and substituting a treasured toy, you should be able to close the pacifier chapter of normal childhood.

3. Lose it. Make his plug less convenient to find. When he starts to look for it, engage him in such a fun activity that he forgets his rubber friend. Then, arrange for the pacifier to be permanently "lost," meanwhile substituting other touches of comfort, such as lots of snuggling, and a few cuddly toys.

Help! My 14-week-old son sometimes prefers the pacifier to my breast.Infants are born with an intense need to suck, and sometimes they go through a stage where the sucking need intensifies. It can be even more frustrating when, for unexplained reasons, your baby prefers a pacifier to you.

To decrease your little one's dependence on the pacifier and woo him back to the breast:

• Feed him more frequently. Sucking on a pacifier won't meet your baby's nutritional needs.
• Eliminate distractions during nursing. At this age, your infant 's more acute visual development makes him more easily distractible during nursing, so that he becomes Mr. Suck-a-Little-Look-a-Little. At feeding time, take him into a quiet room and get down to the business of nursing.
• Establish a routine. A daily nap-nursing routine has worked for our family. At least twice a day lie down with your baby and nap nurse – much like you did when he was a newborn. This peaceful reconnection in a quiet room is likely to bring him back to the breast.
• Offer your finger. Periodically, let your baby suck on your finger instead of the pacifier – even during the nap-nursing time – if he doesn't want to feed.
• Try nursing on the move. When one of our babies went through a similar nursing quirk, Martha wore him around the house in a babysling and nursed him frequently while she tended to other things.

My two-year-old still uses a pacifier to sleep. I think it's time to wean him. Is that right?You likely know that young children suck on their fingers, thumbs and pacifiers. From the early months, the sucking action becomes an activity that babies associate with comfort and sleep. Later in life, many toddlers will resort to sucking to unwind after a long day of exploring and growing. Many pacifier babies grow into toddlerhood with a rubber-nipple nighttime routine.

However, for every child there comes a time to pull the plug. The trouble with using a pacifier as a sleep-aid is that their overuse can result in an overbite – the upper teeth protruding far in front of the lower teeth. To see if it's time for a binky ban, rub your finger along your son's teeth as he sleeps to check for too-prominent top teeth. If you detect the beginnings of an overbite, it's time to wean him off this particular bedtime habit.

The best methods for all types of weaning are gradual and involve substitutes. At first, continue letting him drift off to sleep with his pacifier. But one he's deep in dreamland, ease it out of his mouth. If he has a strong sleep-pacifier association, however, he may need something to help him back to sleep when he wakes in the middle of the night. Introduce some alternative non-oral "pacifiers," like a cuddly teddy bear or favorite blanket. In time, the stuffed animal should replace the pacifier as your child's bedtime companion of choice.

Remember, pacifier means "peacemaker." Artificial pacifiers should be in addition to, not a substitute for, parental nurturing. A person should always be at the other end of a comforting tool. You are your baby's pacifier in falling asleep; the other pacifiers are an extra help.

I have slowly been weaning my 10-month-old daughter from the pacifier, but recently I've noticed she has started sucking her thumb. Since the thumb is a harder habit to break than the pacifier, my thought is to let her have the pacifier.

Your 10-month-old is in an in-between stage of development, as she is crawling but not yet walking. Once she begins walking and exploring, she will occupy those busy hands so much that she will have less time and interest to suck her thumb or use a pacifier. You are correct; it is easier to lose a pacifier than a thumb. Suggest you keep her hands busy with hand toys and crawling games until she reaches the magical one-year age of walking. It's easier to lose a pacifier when she's a toddler and can understand games like "trading in the pacifier." If she still wants her pacifier within another year, take her to a toystore and trade it in for a more desired toy.

My son is four-weeks-old and is showing no signs of wanting to give up his binky. I work full-time, so he is in daycare all day. I feel in one sense that he has so little control over things in his life that maybe he should be able to keep it until HE is ready to give it up. What do you think?Your intuition is absolutely right – he does have so little control over things in his life, and the pacifier is one thing he can control. The only problem with pacifiers is when they damage the teeth. If his upper teeth are not protruding due to the pacifier, then you don't need to worry. He will give it up. There are so many habits that children can get into, and certainly prolonged use of the pacifier is one of the more harmless ones, as long as there are no dental problems associated with it.

I have a nine-month-old and a three-and-a-half-year-old. Both use pacifiers. I think my oldest son is ready to give his up. My question is, when the "Binky Fairy" comes to visit next week, should I take all the pacifiers away, including the one for my baby? I'm worried that taking it only from the older child wouldn't be right. Best results would be if the "binky fairy" takes both pacifiers away, otherwise you will need some clever marketing to justify the baby having one and the older one not having one. It's probably easier to take a pacifier away from a nine-month-old than it would be a two-year-old. Remember, anytime you want to break one habit, you have to substitute a more desirable habit. This is especially true for the nine-month-old, who may need more holding time and a human pacifier for a few days. Ditto that for the three-year-old.