To use a pacifier or not to use a pacifier?
That was the question posed by two families one office morning, and though their question was the same, my answer was not. Was I being inconsistent? No, it's just that one child was 2 months old, so the answer was "sure," while the second was well past his second birthday, so my advice was, "it's time to break the habit."
The first parents were troubled by the thought of introducing their little one to a pacifier. At the same time they found that their baby, who was nursing and growing well, often seemed to want to suck even after she had completed what should have been a satisfying breast-feeding.
The second couple reported that their boy was already talking in short phrases and showing signs of independence, but the 2-year-old still smiled up at me with a pacifier firmly planted in his mouth.
About 75 percent to 85 percent of children in western countries use a pacifier, according to Drs. Sumi Sexton and Ruby Natale in their article in the journal American Family Physician. After reviewing current medical literature, the two authors find that there are a few pros and cons to pacifier use, with positives outweighing negatives in the first six months of life.
Once breast-feeding is well-established, pacifiers can be introduced at the onset of sleep. Pacifier use appears to decrease the risk of Sudden Infant Death Syndrome, though the protective mechanism is not well-understood.
Sexton and Natale caution that parents do not need to force a pacifier on an infant who refuses one and do not need to keep reinserting a pacifier once their sleeping baby spits it out during the night.
Pacifiers can also help reduce pain and anxiety in younger infants undergoing procedures such as blood draws and immunizations.
Since pacifier use is linked to an increased risk of ear infections, both the American Academy of Pediatrics and the American Academy of Family Physicians recommend cutting back on or eliminating pacifier use after 6 months of age, when ear infections tend to increase in frequency.
Sexton and Natale report that while pacifier-related dental problems such as misalignment of teeth may occur even after the second year of life, negative dental effects are considered "more significant" in children over the age of 4.
Experts at the American Academy of Pediatric Dentistry explain that over long periods of time both thumb sucking and pacifier use can potentially push upper front teeth outward and may affect jaw alignment. The group "votes for" pacifiers over thumbs for comforting younger infants since of the two, pacifiers are an easier habit to break.
If pacifiers are used, the AAPD advises parents to choose a pacifier with a shield wider than the infant's mouth, to avoid choking, and to check the pacifier frequently to make sure it is not cracked or sticky and in need of replacement.
Pacifiers should not be fastened to the baby or the crib by potentially dangerous strings, ribbons or cords, and pacifiers should not be coated with sugary substances, which can lead to tooth decay.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.