Table 2 Summary of benefits, risks, implications and recommendations for safe pacifier use

Physiological benefits

• Increased levels of oxygenation

• Decreased heart rate

• Improved glucose-utilization resulting in increased improved digestion.

Gastro-intestinal:

• Does not affect acid and non-acid gastro-oesophageal reflux

Full term up to six months:

May result in:

• Early breast weaning

• Otitis media

• Dental malocclusion

• Suffocation

• Poisoning

• Allergies

• Increased risk of caries

• Infections

• Intestinal parasitic disease

• Nipple confusion (not proven)

• Shortened breastfeeding duration

Medical conditions

• < 1,500 g and/or < 32 weeks gestation

• At risk for hypoglycaemia

• Needing oral stimulation to maintain and develop sucking reflex

• Severe maternal illness preventing breastfeeding (e.g. Herpes Simplex)

• Maternal medication contra-indicated for breastfeeding (e.g. psychotherapeutic drugs)

• NICU infant needing calming, pain relief and stress management

• During tube feedings

General:

• Determine individual feeding programme by qualified health professional

• Counsel parents and caregivers about safe and appropriate pacifier use

• Information provided should include ‘justifiable’ reasons for pacifier use in hospital

• Information should include alternative ways of infant soothing

• Recommendations to minimize pacifier use should be provided.

Delay introduction and limited use:

• Delay introduction of use until one month of age to establish breastfeeding

• Limit use to soothing of a breast-fed infant

• Parents to differentiate between a hungry baby or in need of comforting by means of sucking

• Not used to delay or replace meals

Behavioural:

• Self-consolation and soothing

• Self-regulatory state modulation

• Comforts sick/preterm infant

• Increased time sleeping

• Increased alertness with better feeding

• Lower energy consumption

Combination use:

• Combine pacifier use with maternal voice

• Do not coat pacifier in sweet solution, except when used simultaneously for pain relief

Sleep:

• Use when putting down to sleep and do not re-insert when infant falls asleep.

• Avoid ad lib use throughout the day

• Do not use to replace or delay meals in full term infants

• Pacifier use is a parental choice

Infection:

• Avoid infection by cleaning and replacing pacifier regularly – do not lick

• Never share between siblings

• Bigger children should not play or walk around with a pacifier.

Motor system:

• Improved muscle tone and coordination

Cessation:

• Weaning from six months of age to prevent otitis media and dental problems

• Start cessation at age six months and if situation requires no later than four years of age.

Neurological:

• Precedes nutritive feeding by supporting accelerated maturation of sucking

• Aids neurobehavioral organization and coordination in poor suck, swallow and breathe coordination

• Protects against aspiration

• Faster transition to oral feeds

• Pain management

• Better weight gain

• Earlier discharge

Design safety:

• Use a single-piece unit only

• Made of durable material to prevent choking hazard

• Replace when worn out

• Never tie a string to the pacifier to prevent strangling the child

• Symmetrical nipple shape to support correct tongue position when sucking

• Flanges minimum dimensions of 43 mm to prevent lodging in the soft palate

• Ring behind the flange for removal in case of aspiration

• Mouth shield larger than the infants mouth (over 3 cm)

• Ventilation holes in shields to permit air passage

• Texture inner surface to prevent irritation and rashes from trapped saliva

SIDS:

• Used at bedtime reduce risk for SIDS