View source for Pacifier

{{Short description|Rubber, plastic or silicone nipple for infants or toddlers to suck upon}}
{{About|the baby pacifier}}
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A '''pacifier''' is a rubber, plastic, or silicone nipple substitute given to an infant or toddler to suckle on between [[Breastfeeding|feedings]] to quiet their distress by satisfying the need to suck when they do not need to eat. Pacifiers normally have three parts: an elongated [[teat]], a handle, and a mouth shield that prevents the child from swallowing or choking on it.

Pacifiers have many informal names: ''binky'' or ''nookie'' (American English), ''dummy'' (Australian and British English), ''dokey'' (informal Scots), ''soother'' (Canadian English), and ''dodie'' (Hiberno-English<ref>{{cite web| url = https://www.herfamily.ie/the-1st-year/6-tips-to-get-rid-of-the-soother-once-and-for-all-265636 |title = 6 tips to get rid of the soother once and for all |first=Alison |last=Bough |website=HerFamily}}</ref>).

==History==
[[Image:Baby Comforter 1900.jpg|thumb|150px|left|Baby comforter design, 1900]]

In England in the 17th–19th centuries, a "coral" was a teething toy made of coral, ivory or bone, often mounted in silver as the handle of a rattle.<ref>
''[[OED]]''; [http://www.metmuseum.org/toah/hd/roco/hod_47.70.htm Examples from the Metropolitan]
</ref>{{verification failed|date=March 2023}} A museum curator{{who?|date=March 2023}} has suggested that these substances were used as "sympathetic magic"<ref>[http://www.vam.ac.uk/moc/collections/childcare/rattle/index.html Victoria & Albert Museum of Childhood]. Vam.ac.uk. Retrieved on 2013-04-14.</ref>{{verification failed|date=March 2023}} and that the animal bone could symbolize animal strength to help the child cope with pain.

Pacifiers were a development of hard teething rings, but they were also a substitute for the softer ''[[sugar tit]]s'', ''sugar-teats'', or ''sugar-rags''<ref>''Oxford English Dictionary''
</ref> which had been in use in 19th century America. A writer in 1873 described a "sugar-teat" made from "a small piece of old linen" with a "spoonful of rather sandy sugar in the center of it", "gathered ... up into a little ball" with a thread tied tightly around it.<ref>{{cite book |last=Jamieson |first=Cecilia Viets |year=1873 |chapter-url=https://archive.org/details/cihm_37076/page/n18/mode/1up |title=Ropes of Sand |chapter=Chapter 2: Top's Baby |page=11 |via=Internet Archive |access-date=2023-03-21}}</ref> Rags with foodstuffs tied inside were also given to babies in many parts of Northern Europe and elsewhere. In some places a lump of meat or fat was tied in cloth, and sometimes the rag was moistened with brandy. German-speaking areas might use {{lang|la|Lutschbeutel}}, cloth wrapped around sweetened bread or poppy-seeds.

[[File:Madonna with the Siskin by Albrecht Dürer - Gemäldegalerie - Berlin - Germany 2017.jpg|thumb|300px|upright=1.2|[[Albrecht Dürer]], ''Madonna with the Siskin'', 1506]]
[[Image:Madonna and Siskin detail.jpg|thumb|300px|upright=1.2|Albrecht Dürer, ''Madonna with the Siskin'' detail, 1506]]
A [[Madonna (art)|Madonna]] and child painted by [[Dürer]] in 1506<ref>[http://www.wga.hu/html/d/durer/1/05/06siski.html "Madonna and Siskin"]. ''Web Gallery of Art''. Retrieved 21 March 2023.</ref> shows one of these tied-cloth "pacifiers" in the baby's hand.

Pacifiers were settling into their modern form around 1900 when the first teat, shield and handle design was patented in the US as a "baby comforter" by [[Manhattan]] pharmacist Christian W. Meinecke.<ref>
[http://www.uspto.gov/main/search.html Design Patent number D33,212], C. W. Meinecke, September 18, 1900</ref>  Rubber had been used in flexible teethers sold as "elastic gum rings" for British babies in the mid-19th century,<ref name=r1>[https://web.archive.org/web/20060202134628/http://www.babybottle-museum.co.uk/dummies%20breast%20sheilds.htm "The history of the feeding bottle"]. Baby Bottle Museum.</ref> and also used for feeding-bottle teats. In 1902, [[Sears|Sears, Roebuck & Co.]] advertised a "new style rubber teething ring, with one hard and one soft nipple".<ref name=r1/> In 1909, someone calling herself "Auntie Pacifier" wrote to the ''New York Times'' to warn of the "menace to health" (she meant dental health) of "the persistent, and, among poorer classes, the universal sucking of a rubber nipple sold as a 'pacifier{{'"}}.<ref>Auntie Pacifier (July 2, 1909) 
[https://query.nytimes.com/gst/abstract.html?res=9900E6D61E31E733A25751C0A9619C946897D6CF "The 'Pacifier' a Menace to Health"]. ''The New York Times''.</ref> In England too, dummies were seen as something the poorer classes would use, and associated with poor hygiene. In 1914, a [[London]] doctor complained about "the dummy teat": "If it falls on the floor it is rubbed momentarily on the mother's blouse or apron, lipped by the mother and replaced in the baby's mouth."<ref>{{cite journal |url=http://rcnarchive.rcn.org.uk/data/VOLUME055-1915/page123-volume55-07thaugust1915.pdf |title=The Dummy Teat |journal=The British Journal of Nursing Supplement: The Midwife |date=7 August 1915 |page=123}}</ref>

Early pacifiers were manufactured with a choice of black, maroon or white rubber, though the white rubber of the day contained a certain amount of lead. ''Binky'' (with a ''y'') was first used in about 1935 as a trademarked brand name for pacifiers and other baby products manufactured by the Binky Baby Products Company of New York. The brand trademark is owned by [[Playtex]] in the U.S. (and other countries).<ref>[http://www.uspto.gov/main/search.html According to trademark registration documents 1948]. Uspto.gov. Retrieved on 2013-04-14.</ref>{{nonspecific|date=March 2023}}

==Drawbacks==
[[Image:BabySuckingFingers.jpg|thumb|upright=1.2|Infants may use a pacifier, their fingers or thumb to soothe themselves.]]

There are negative effects from using a pacifier during [[breastfeeding]] for healthy babies. The AAP suggests avoiding pacifiers for the first month. Introducing a pacifier can lead to the infant ineffectively sucking at the breast and causing "[[nipple confusion]]". Babies will take their suck out on the pacifier instead of nursing or comfort nursing at the breast which is good for the mother's supply.  Evidence in premature infants or infants that are not healthy is lacking but shows that it can have benefits.<ref name=Jaafar2016>{{Cite journal|last1=Jaafar|first1=Sharifah Halimah|last2=Ho|first2=Jacqueline J.|last3=Jahanfar|first3=Shayesteh|last4=Angolkar|first4=Mubashir|date=2016-08-30|title=Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding|journal=The Cochrane Database of Systematic Reviews|volume=2016 |issue=8|pages=CD007202|doi=10.1002/14651858.CD007202.pub4|issn=1469-493X|pmid=27572944|pmc=8520760 }}</ref> It may have clinical benefits for preterm babies, such as helping them progress from tube to bottle feeding.<ref>{{Cite journal|last1=Foster|first1=Jann P.|last2=Psaila|first2=Kim|last3=Patterson|first3=Tiffany|date=2016-10-04|title=Non-nutritive sucking for increasing physiologic stability and nutrition in preterm infants|journal=The Cochrane Database of Systematic Reviews|volume=10|issue=3 |pages=CD001071|doi=10.1002/14651858.CD001071.pub3|issn=1469-493X|pmid=27699765|pmc=6458048}}</ref>

Infants who use pacifiers may have more ear infections ([[otitis media]]).<ref name="Nelson 690–9">{{cite journal|last=Nelson|first=AM|title=A comprehensive review of evidence and current recommendations related to pacifier usage.|journal=Journal of Pediatric Nursing|date=December 2012|volume=27|issue=6|pages=690–9|pmid=22342261|doi=10.1016/j.pedn.2012.01.004}}</ref> The effectiveness of avoiding the use of a pacifier to prevent ear infections is not known.<ref>{{cite web|last=Institute for Quality and Efficiency in Health (IQWiG)|title=Middle ear infections: prevention|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0016291/|publisher=Institute for Quality and Efficiency in Health (IQWiG)|access-date=4 June 2013}}</ref>

Although it is commonly believed that using a pacifier will lead to dental problems, it does not appear to lead to long-term damage if used for less than around three years.<ref name="Nelson 690–9"/> However, prolonged use of a pacifier or other non-nutritive sucking habit (such as finger or blanket sucking) has been found to lead to [[malocclusion]] of the teeth, that is teeth sticking out or not meeting properly when they bite together.<ref>{{cite journal |vauthors=Vázquez-Nava F, Quezada-Castillo JA, Oviedo-Treviño S, etal | year = 2006 | title = Association between allergic rhinitis, bottle feeding, non-nutritive sucking habits, and malocclusion in the primary dentition | journal = Archives of Disease in Childhood | volume = 91 | issue = 10| pages = 836–840 | doi = 10.1136/adc.2005.088484| pmid = 16769710 | pmc = 2066013}}</ref><ref>{{cite journal |author1=Paroo Mistry |author2=Moles David R |author3=O'Neill Julian |author4=Noar Joseph | year = 2010 | title = The occlusal effects of digit sucking habits amongst school children in Northamptonshire (UK) | journal = Journal of Orthodontics | volume = 37 | issue = 2| pages = 87–92 | doi = 10.1179/14653121042939 |pmid=20567031 |s2cid=5519168 }}</ref>  This is a common problem and the dental ([[orthodontic]]) treatment to correct it can take a long time and can be expensive.  A Cochrane Review of the evidence found that [[orthodontic braces]] or [[psychological intervention]] (such as positive or negative reinforcement) were effective in helping children stop sucking habits where that was necessary.<ref>{{cite journal | author = Borrie FRP, Bearn DR, Innes NPT, Iheozor-Ejiofor Z | year = 2015| title = Interventions for the cessation of non-nutritive sucking habits in children | journal = Cochrane Database of Systematic Reviews | volume = 2021| issue = 3| pages = CD008694| doi = 10.1002/14651858.CD008694.pub2 |pmc=8482062  | pmid = 25825863}}</ref> An orthodontic brace that used a palatal crib design seems to have been more effective than a palatal arch design.{{clarify|reason=What do these terms mean? Citing a reliable source for this information would also be nice.|date=July 2022}}

There appears to be no strong evidence that using a pacifier delays speech development by preventing babies from practicing their speaking skills.<ref name="Nelson 690–9"/>

==Benefits==
The American Academy of Pediatric Dentistry's (AAPD) policy on pacifier use in the first months of life is to support the parental decision.<ref name=":0">{{Cite journal |last=American  Academy  of  Pediatric  Dentistry |date=2024 |title=American Academy of Pediatric Dentistry. Policy on  pacifiers |url=https://www.aapd.org/globalassets/media/policies_guidelines/p_pacifiers.pdf |journal=The Reference Manual of Pediatric Dentistry. |publisher=Chicago, Ill |pages=79-82}}</ref> Pacifier use is associated with a lower risk of developing a habit of [[Thumb sucking|finger sucking]].<ref name=":0" /> The messaging from the AAPD is that prolonged use of a pacifier after 1 year of age can increase the risk of otitis media and use of a pacifier after 1.5 years (18 months) can have a negative effect on the development of the baby's orofacial complex that can lead to bite and cross bite problems.<ref name=":0" /> 

There is some evidence that pacifiers can decrease the risk of [[sudden infant death syndrome]] (SIDS).<ref>{{Cite journal |last=Psaila |first=Kim |last2=Foster |first2=Jann P. |last3=Pulbrook |first3=Neil |last4=Jeffery |first4=Heather E. |date=2017-04-05 |title=Infant pacifiers for reduction in risk of sudden infant death syndrome |url=https://pubmed.ncbi.nlm.nih.gov/28378502 |journal=The Cochrane Database of Systematic Reviews |volume=4 |issue=4 |pages=CD011147 |doi=10.1002/14651858.CD011147.pub2 |issn=1469-493X |pmc=6478106 |pmid=28378502}}</ref> The researchers are divided over whether this association is sufficient reason to prefer pacifier use. Some argue that pacifiers should be recommended on the strength of an association, just as [[Sudden infant death syndrome#Sleep positioning|back sleeping]] was recommended on the strength of an association.<ref>[http://pediatrics.aappublications.org/cgi/content/abstract/116/5/e716 Do Pacifiers Reduce the Risk of Sudden Infant Death Syndrome? A Meta-analysis]. Pediatrics.aappublications.org. Retrieved on 2013-04-14.</ref><ref>[http://pediatrics.aappublications.org/content/116/5/1245.full#sec-6 The Changing Concept of Sudden Infant Death Syndrome]. Aappolicy.aappublications.org. Retrieved on 2013-04-14.</ref> Others argue that the association is not strong enough or that the mechanism is unclear.<ref>{{cite journal|last=Horne RS|author2=Hauck FR|author3=Moon RY|author4=L'hoir MP|author5=Blair PS|title=Dummy (pacifier) use and sudden infant death syndrome: potential advantages and disadvantages|journal=J Paediatr Child Health|year=2014|issue=3|doi=10.1111/jpc.12402|pmid=24674245|volume=50|pages=170–4|s2cid=23184656|doi-access=}}</ref>

Pacifiers can help premature infants as they develop their reflexes including the sucking reflex.<ref name=":0" /> 

Pacifiers can also provide comfort and some amount of pain-reliever effect if an infants requires a minor procedure. Pacifiers have also been found to reduce infants'  crying during painful procedures such as [[venipuncture]].<ref>{{cite journal |vauthors=Blass EM, Watt LB | year = 1999 | title = Suckling- and sucrose-induced analgesia in human newborns | journal = Pain | volume = 83 | issue = 3| pages = 611–23 | doi=10.1016/s0304-3959(99)00166-9| pmid = 10568870 | s2cid = 1695984 }}</ref><ref>{{cite journal |vauthors=Curtis SJ, Jou H, Ali S, Vandermeer B, Klassen T | year = 2007 | title = A randomized controlled trial of sucrose and/or pacifier as analgesia for infants receiving venipuncture in a pediatric emergency department | journal = BMC Pediatrics | volume = 7 | page = 27 | doi=10.1186/1471-2431-7-27| pmid = 17640375 | pmc = 1950500 | doi-access = free }}</ref>

Researchers in Brazil have shown that neither "orthodontic" nor standard pacifiers prevent dental problems if children continue sucking past the age of three years.<ref>{{cite journal|author=Zardetto, Cristina Giovannetti del Conte, Célia Regina Martins Delgado Rodrigues and Fabiane Miron Stefani|year=2002|title=Effects of Different Pacifiers on the Primary Dentition and Oral Myofunctional Structures of Preschool Children|journal=Pediatric Dentistry|volume=24|pages=552–559|pmid=12528948|issue=6}}
</ref>

It is commonly reported anecdotally that pacifier use among [[stimulant]] users helps reduce [[bruxism]] and thus prevents tooth damage.{{Citation needed|date=January 2025}} It is also known to help infants and toddlers to get to sleep and also keeps infants and toddlers calm.{{Citation needed|date=January 2025}}

==Medical policies==
The [[American Academy of Pediatric Dentistry]]'s "Policy on Thumb, Finger and Pacifier Habits" says: "Most children stop sucking on thumbs, pacifiers or other objects on their own between 2 and 4 years of age. However, some children continue these habits over long periods of time. In these children, the upper front teeth may tip toward the lip or not come in properly. Frequent or intense habits over a prolonged period of time can affect the way the child's teeth bite together, as well as the growth of the jaws and bones that support the teeth."<ref>{{cite web |url=http://www.aapd.org/publications/brochures/tfphabits.asp |url-status=dead |archive-url=https://web.archive.org/web/20080201005753/http://www.aapd.org/publications/brochures/tfphabits.asp |archive-date=2008-02-01 |title=Thumb, Finger and Pacifier Habits |author=American Academy of Pediatric Dentistry}}</ref>

A study of [[sudden infant death syndrome]] (SIDS) states that "It seems appropriate to stop discouraging the use of pacifiers." The authors recommend the use of pacifiers at nap time and bedtime throughout the first year of life. For breastfeeding mothers, the authors suggest waiting until breastfeeding is well established, typically for several weeks, before introducing the pacifier.<ref name="Mitchell_2005">
{{cite journal |vauthors=Mitchell EA, Blair PS, L'Hoir MP |title= Should Pacifiers Be Recommended to Prevent Sudden Infant Death Syndrome? |journal=Pediatrics |volume=117 |issue=5 |pages=1755–1758 |year=2005 |doi=10.1542/peds.2005-1625 |pmid=16651334|s2cid= 19513208 }}
</ref>

The British Oral Health Foundation recommends: "If you can, avoid using a dummy, soother or pacifier and discourage thumb sucking. These can both eventually cause problems with how the teeth grow and develop. And this may need treatment with a [[Dental braces|brace]] when the child gets older."<ref>{{cite web |url=https://www.dentalhealth.org/tell-me-about/topic/childrens-teeth/dental-care-for-mother-and-baby |title=Dental care for mother and baby |author=Oral Health Foundation |access-date=21 March 2023}}</ref>

==Prevalence of attachments to pacifiers and their psychological functions==

In the late 1960s researchers dispelled the notion that pacifiers were psychologically unhealthy and aberrant. Richard H. Passman and Jane S. Halonen at the University of Wisconsin-Milwaukee traced the developmental course of attachments to pacifiers and provided norms.<ref name="Passman, R. H. 1979">{{cite journal |last1=Passman |first1=R. H. |last2=Halonen |first2=J. S. |year=1979 |title=A developmental survey of young children's attachments to inanimate objects |journal=Journal of Genetic Psychology |volume=134 |issue=2 |pages=165–178 |doi=10.1080/00221325.1979.10534051}}</ref> They found that 66% of their sample of babies who were three months old in the United States demonstrated at least some attachment, according to their mothers. At six months of age, this incidence was 40%, and at nine months it was 44%. Thereafter, the rate of attachment to pacifiers dropped precipitously until, at 24 months of age and later, it was quite rare.

These researchers also provided experimental support for what were then only anecdotal observations that pacifiers do indeed pacify babies.<ref>{{cite journal |last2=Passman |first2=R. H. |last1=Halonen |first1=J. S. |year=1978 |title=Pacifiers' effects upon play and separations from the mother for the one-year-old in a novel environment |journal=Infant Behavior and Development |volume=1 |pages=70–78 |doi=10.1016/S0163-6383(78)80010-1}}</ref> In an unfamiliar playroom, one-year-old toddlers accompanied by their pacifier evidenced more play and demonstrated less distress than did babies without them. The investigators concluded that pacifiers should be considered to be attachment objects, similar to other security objects like blankets.

Passman and Halonen<ref name="Passman, R. H. 1979"/> contended that the widespread occurrence of attachments to pacifiers as well as their importance as security objects should reassure parents that they are a normal part of development for a majority of infants and toddlers.

==See also==
*[[Pacifier-activated lullaby]]
*[[Comfort object]]

==References==
{{reflist|35em}}

==External links==
{{Commons category|Pacifiers}}
* [https://www.nytimes.com/2014/06/22/magazine/who-made-that-pacifier.html "Who Made That Pacifier?"], by Dashka Slater, ''[[The New York Times Magazine]]'', June 20, 2014
* [https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0016291/ Information for parents on preventing middle ear infections] from [[PubMed Health]]

[[Category:Dental equipment]]
[[Category:Infancy]]
[[Category:Rubber products]]