The Best Way to Ditch the Pacifier and How To Tell When It's a ProblemSep 28, 2021
Your baby’s pacifier can be a great tool for helping them settle and become soothed for sleep. The use of pacifiers has even been shown to reduce the risk of SIDS (Sudden Infant Death Syndrome).
Pacifiers can also support self-regulation and soothing, and can even help lengthen your little one’s nap when used in the early newborn and infancy stages (though, it can actually be a culprit of short naps as baby grows!). But what if your little one has become attached to their pacifier and NEEDS it to fall asleep and stay asleep? Did you know that falling asleep with a pacifier is not considered independent sleep?
Here’s how to determine if your baby’s pacifier has become a problem and what steps you can take to address it.
Pacifier Use and SIDS
According to the American Academy of Pediatrics, the use of pacifiers is encouraged in the first six months of life , as there are many benefits. A few of them are:
- Supports infant soothing
- Encourages and protects the suck reflex
- Lowers the risk of SIDS 
Even though pacifiers can reduce the risk of SIDS, it’s important to understand that if you choose to not use a pacifier or if your baby will not take a pacifier, their risk of SIDS will not be increased, but simply remain at the baseline. There is only an association between the two; it is not a cause and effect scenario. .
In fact, the correlation between a pacifier and SIDS is not actually about the pacifier itself, but rather the benefits that the pacifier provides. When your baby uses a pacifier, they are less likely to roll into a prone position, their airway is maintained, their respiratory drive is increased, and gastroesophageal reflux is decreased .
SIDS is a complex occurrence and the root cause is still unknown. Do not be discouraged or worried if your little one will not take a pacifier. Multiple factors take part in this. A pacifier is just one way that you can help reduce the risk for your baby and there are many others! The AAP also recommends room-sharing (not bed sharing) for 6-12 months, breastfeeding, avoiding smoking and drug use; and of course, the basic safe sleep recommendations like putting baby down on their back for sleep, using a firm mattress, and making sure there is nothing in the crib or bassinet with the baby. This includes bedding, stuffed animals or toys, and bumpers (even the mesh ones, which can still post a strangulation risk).
Has Your Baby’s Pacifier Become a Problem?
In newborns and infants 0-6 months, pacifiers and other sleep associations are not as much cause for concern. Sleep is so important during these first few months (for both you and baby), and if your little one needs some extra help falling asleep, that is totally ok and very common!
If your baby uses a pacifier, but they can put themself back to sleep during naps and nighttime sleep without needing to be actively sucking on the pacifier, this is great! In this instance, their pacifier has not become a problem.
When a pacifier becomes a sleep association, it means that your baby is no longer using it for only soothing, but they also rely on it to be able to fall asleep. Once your child needs the pacifier to initially fall asleep and relies on the sucking sensation to get back to sleep when waking between sleep cycles, it can become really disruptive and it could be time to consider getting rid of it.
But the main telltale sign I like to give to parents is: if it’s become a problem...it’s a problem. If your child is waking a million times a night solely needing the paci to be put back in their mouth by a caregiver, it’s a problem. This is where I would recommend helping your child learn to fall asleep independently so the middle of the night paci game comes to a halt.
How to Get Rid of Your Baby’s Pacifier
Whether or not your baby’s pacifier has become a sleep prop, there is really no right or wrong time to take it away (other than when your child is nearing age two, for dental reasons). Not all babies take pacifiers, so there is actually no real need for one. After six months of age, pacifiers simply become an object of affection that gives children a sense of security, and the risks begin to outweigh the benefits .
Once you’ve determined it’s the right path, there are three options I recommend for removing the pacifier:
1. Wean Slowly
Allow your child to use the paci to soothe and fall asleep at bedtime and remove the paci once your baby is asleep. Then, for any night wakings, try using other methods of helping your child get back to sleep, other than the paci.
For younger babies, some alternatives you can try while weaning your baby’s pacifier could be :
- A firm hand on baby’s tummy or back
- Gently jiggling baby’s body
- A combination of multiple of the above
If your little one is 12 months or older you can introduce a small “lovey” that they can replace as their security/affection object. If your toddler uses a pacifier while playing or even just walking around, try distracting them from their pacifier with different activities and toys . Slowly over time, the reliance on the paci lessens. There is no set time frame for this process, but it is the slowest option.
2. Use for soothing, not for sleeping
If your child is upset or fussy, use the pacifier to help calm and soothe your child, but the pacifier never enters into the sleep situation, period. As soon as your child is calm, the pacifier comes out and we move on to other things. For example, if your baby is crying at bedtime and has already been fed, use the pacifier to help calm your baby down. Then, once calm, paci comes out and we move on to books! This is a great way to distract away from the fact that the paci is not going to bed with your baby. This method can be used while working simultaneously on developing independent sleep habits - meaning, your baby goes into the sleep space completely awake and puts themselves to sleep. This method works more quickly than the slower weaning method above, but can still take weeks to accomplish since it can be confusing.
3. Cold Turkey
In this scenario, you remove the pacifier completely and use only other methods to soothe your baby when they’re fussy or to fall asleep. If your baby is younger, there really isn’t any explanation needed. You simply do not give them access to a paci and things like rocking, patting, shushing, contact sleep, wearing baby, etc. can be used to calm your child when they’re fussy or to get over the rough patch of the contrast difference. However, you do want to be careful not to create a different strong sleep association instead. Sleep associations like feeding or holding to sleep are difficult to change as well, so using one new method alone can present a new problem. It’s best to alternate soothing and sleep methods when needed and focus on practicing independent sleep habits as consistently as possible. This method is the least confusing and works the fastest to solve the problem.
If your child is old enough to understand, you can also try the “Paci Fairy” method, which has worked extremely well for my clients over the years! You explain to your toddler that the pacifier is for babies and ask them if they are a baby still. You then explain to them that there is another baby who needs this pacifier and that by putting it under their pillow before bed, the “Paci Fairy” will come and collect it to take it to the next baby who needs that pacifier. You say goodbye to the paci at bedtime and let the Paci Fairy know that it’s ok to come and take the paci. Some toddlers will, of course, back out of this agreement the next day and wonder where the paci is, but by then you have already said goodbye and it’s already on its way to a baby who needs it!
If you find yourself still struggling with your little one’s sleep or some extra help with weaning your baby’s pacifier, please know that you are not alone and that I am here to help. Download one of my comprehensive sleep guides or schedule a call with me for some personalized support.
     https://www.aafp.org/afp/2009/0415/p681.html
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