Pacifiers and Sleep

Have you ever tried to get a straight answer when it comes to the pacifier? The sleep books dance around it, online information is so conflicting, and frankly there just isn’t a lot of research when it comes to the ifs, ands, or buts of pacifier use. Fortunately, Meg and Erin have thousands of hours of experience with this very issue and have created what has to be one of the most comprehensive blogs out there when it comes to the pacifier, babies, toddlers and sleep. If you find anything in this blog helpful and want to keep up with our daily tips, blog posts and product give aways please LIKE us on Facebook!

Now, about the paci….sucking is soothing. Not just the warm, snuggly breast feeding or bottle feeding sucking in someone’s arms, but non nutritive sucking on a pacifier too! It may also help reduce the risk of SIDS. As part of the American Academy of Pediatrics SIDS and sleep safety guidelines updated in 2011, pacifier recommendations expanded. As you make your personal journey with the pacifier and make informed decisions about its use, you should know that the AAP recommends using the pacifier when placing your baby down for sleep at all naps and night sleeps during the first year after breastfeeding has been established. Here’s the full link for your reference.

That statement has, quite literally, caused parents to lose sleep! Parents now feel guilt ridden if they don’t use a pacifier (or if their baby won’t take one) and yet in some cases find themselves being awakened 5, 10, even 20+ times a night to replace it if their baby is hooked, yet too young to find it on his own.

Of course, we recommend following the AAP guidelines on paci use, yet we know those recommendations aren’t always what families do. Some babies won’t take a pacifier. Some babies are in a bed-sharing breast-feeding dyad with their mother that doesn’t include pacifier use. Some babies love their pacifiers -too much – and their sleep -deprived parents aren’t able to take naps due to work demands or multi-aged children. Those parents may make the choice to STOP the pacifier before the age of one after weighing the risks of their own sleep deprivation while driving or performing their job tasks vs their baby’s individual risk factors for SIDS (of which the pacifier is just one small part)!

If you find yourself making an informed choice to stop using the pacifier due to extreme sleep deprivation, it’s typically best if you stop it sometime between 4 1/2-12 months. Here’s how it breaks down:

For babies under 4 1/2 months:

Keep the pacifier if she’ll take it! Even if you wanted to stop it at this young age, your options are very limited in terms of the type of sleep training you can do to help your baby learn to sleep and self soothe in a new way (without the pacifier). Your baby is very young and long bouts of crying or frustration are inappropriate. Don’t force it, but if the pacifier is soothing for your baby, please use it! For more information on newborns and sleep see our blogs on the four month regression , dream feeding, swaddling and common age by stage schedules. Safety note: never tie, clip, or attach the paci to your baby in the crib.

For babies between 4 ½ -7 months:

The Hardest Months: This is the age when sleep associations, such as sucking, are powerful and paci replacement wakings may be occurring as often as every nighttime sleep cycle (60-90 minutes) during the last half of the night. Your exhaustion is setting in because your baby is still too little to find and replace her pacifier on her own. But, she IS now old enough to start some first half of the night sleep training (using a method YOU feel good about) if needed.

Some parents stop the pacifier completely at this point because it’s just too tiring to keep replacing it so many times a night. You may choose to do sleep training in the first half of the night and/or rock , hold, or soothe your baby in another way as she gets used to the change. Expect several difficult nights.

Other parents opt to try a split night paci option (kind of like the split night swaddle) as a step on the path towards independent sleep. With a split night you would stop using the pacifier at bedtime and throughout the first half of the night, pairing any non-feeding wakings with a sleep training method that feels like a good fit for you and your baby. At this age your baby’s circadian rhythm is promoting deeper sleep in the first part of the night making it easier for your baby to learn this new skill. As you cross into the second half of your night, when sleep may still be maturing, sleep pressure is low, and lighter sleep dominates, you may find yourself using the paci and/or a feeding or two as a way to just survive the rest of the night until your baby gets just a little older and is ready for full night sleep training. You can end up with one LONG stretch of paci – free sleep, followed by the last irregular stretch of the night. It’s not perfect, but it’s a step in the direction of independence from the pacifier.

During this time, you may continue to use the pacifier during the day for naps! It’s actually important to keep your baby well rested during the day while you are working on nighttime changes so go ahead and keep using the paci during the day if it’s helpful for the daytime naps. Since babies are exceptionally good at compartmentalizing how they sleep during the day vs nights you can get away with this.

Sometimes we’ll talk about trying to incorporate paci into a sleep intervention for parents who really want to keep using it for the whole night, but who are just so tired from all the replacements, but this is only moderately successful and too complicated for the purposes of this sleep blog. For more personalized information on options like this, you might want to consider a sleep consult with Meg or Erin.

For babies over 7 months:

Most babies can start to learn to find their pacifiers on their own around this age. Practice, practice, practice the skill during the day and be sure your baby has access to plenty of pacifiers in the night. Creating a paci corner with a stash of them in the same spot may be helpful as your baby learns to reach up and grab another if one falls out of the crib. Allow your baby to be in charge of the paci now. Hold one up in your hand and say, “get your paci” with some verbal coaching. Or, when bedtime routine is over, place him into his crib and coach/cue him by saying, “find your paci” and then rub his tummy or cheek for a moment or two as some last steps in your bedtime routine. In other words – around the 7 months mark is the time for you to step back and let your baby be in charge of his paci as much as he can! If you find yourself needing to start some sleep training and you’d like to keep the pacifier, be sure you let your baby be in charge of finding it for soothing as your go through your responses! Safety note: Never tie or clip the pacifier to your child or anything in the crib.

If you decide to stop the paci at this point, it’s generally best to stop it for the full night. Your baby is old enough now for full night sleep training if needed and consistency is always best. You may continue to keep the paci for naps while you work on nights to preserve daytime sleep but when nights are on track, you’ll probably want to work on naps shortly thereafter. In some cases babies keep their pacifiers at daycare or with a nanny although they never use one for their parents.

Please do not allow your baby to fall asleep at bedtime WITH the pacifier and then later deny it to him when he’s having trouble going back to sleep. Removing the pacifier after he’s fallen asleep is also largely useless since the sucking-to-sleep association has already occurred at bedtime and will then likely need to be repeated in the night.

Age One +

As you approach age one you’ll find yourself at another paci-crossroads. You’ve made it as far as the AAP recommends and now you have a decision to make. Keep it for the long haul, or stop it altogether. If the pacifier is not on your radar at all as a soothing tool for your toddler, now’s the time to stop it completely.

If you are open to extended pacifier use, you might be surprised to hear us say that if you’ve kept the pacifier as long as one year AND your child loves it and you do too, keep it until he’s at least three! That’s right, at least age three!

After the first year, chances are your baby has become very bonded with his paci as a soothing tool and it’s embedded in the quality of his sleep. If you stop the pacifier at, say 18 months or 27 months your child may have trouble figuring out what to do for soothing and may pick up something more maladaptive like body rubbing, rocking or banging AND, most importantly if you pull the pacifier at age 2, you may pull the nap with it!

Some important ground rules for extended pacifier use during ages 1-3+:

1. Coping and Speech: The paci is for sleep and lives in the crib. There may be a few other exceptions like on a long car trip, or at a religious service but for the most part, the paci is for sleep only. This will help you avoid using it as a coping tool for your toddler when he gets upset. Help him learn other age appropriate coping strategies instead. Keeping paci use limited to sleep times will also prevent the paci from impacting speech. Toddlers who walk around with their pacifiers for hours a day are at real risk for speech problems and delays.

2. Soft pallet : We have been assured by several pediatric dentists that as long as the paci is stopped by age 4 (!!!) soft pallet changes will reverse themselves. Yes, we know they can start to look a little funny in that adorable paci-mouth way, but you will be amazed at how quickly bucked teeth will start to return to normal when pacifier use ends.

3. Oral care: Be sure you are doing mouth/gum care AFTER milk and BEFORE inserting a pacifier. At this age, pacifier or not– you need to brush or clean your baby’s mouth and gums AFTER any milk and before bed.

4. Ear Infections: Some studies indicate paci use may contribute to ear infections. If your child suffers from chronic ear infections, talk to his/her pediatrician about her risk factors.

5. Child Lead Use: At bedtime and in the night let your child be in charge of the paci! Your job is simply to make sure she has access to them if she needs them. Keep a little stash in the same corner of the crib each night or have a small, child friendly bowl of them on a dresser or floor next to a toddler bed.

6. Extended Crib Time: Paci lovers tend to hang out in their cribs more than other babies – don’t abuse this. Just because your child will happily lie in her crib if it means she can suck on her pacifier, doesn’t mean you should let her. Meet your child’s developmentally appropriate sleep needs.

Stopping the pacifier with older toddlers: Keep the Pacifier until at least age 3– but please don’t stop it on the birthday itself (that’s really not such a great present). If your child is not climbing out of a crib, stop the pacifier FIRST in the crib and establish good sleep there, and then move your child to a bed. Stop the paci around times of relative developmental calm (ie: not while toilet training, not the week new sibling arrives or at the start of the school year)

  1. First try limiting paci use: if you haven’t already done step 1 from above, be sure the pacifier is only being used at sleep times and that your child is learning age appropriate coping tools for frustration, anger, and sadness during the day. This will help her deal with the new transition more easily.

  2. Start offering a replacement lovey – something you hope will take the place of the pacifier. You might take your child to a store together and pick out something soft, small and appropriate for sleep. At first, this lovey can be used frequently during the day( such as in a carseat, stroller, or while reading a book to promote bonding while the pacifier is not in use) as well as night. Later, if’s often helpful if loveys, like pacifiers, are used for times of sleep.

  3. Give your child a heads up for a day or two in advance. Try to avoid making your child anxious. Stay calm and keep the tone light, but do give him a heads up that a change is coming and you will help him through it. Please don’t make this transition about a new baby, going to school, or time to “be a big boy”.

  4. When the big night arrives – just do it! Start at bedtime FIRST when the two sleep drives (circadian rhythm and homeostatic pressure) are working in your favor. There’s really no 50/50 with the pacifier – your child either has them or he doesn’t.

Here are some popular paci strategies for 3 year olds:

The Dentist: At his 3 year old dental check up, call ahead and ask the dentist to talk to your child briefly and gently about keeping healthy teeth and the big teeth that will be growing in. The dentist (and you!) can talk about how one of the ways to keep teeth healthy is to stop using the pacifier. Later, you can pack them up, and drop them off at the dentist – all of them!

Paci Donation: Take this opportunity to start an age appropriate conversation about babies who might be less fortunate than yours and who might not have any pacifiers of their own. Package up the pacifiers and give them to your local clergy or donation center. Of course, egocentric toddlers won’t necessarily get those feel – good vibes of a donation, but it’s an early start to social awareness!

Paci Fairy: Just like it sounds – the pacifier fairy comes in the night, gathers up all of the pacifiers and leaves a small gift in their place.

Paci as Currency: Allow your child to “buy” a special toy or experience he’s been hoping for with his pacifiers.

Balloons: Some parents have a little party, wrap the pacifiers up, and send them off on a big bunch of balloons. Although this sounds enchanting, it’s really not the most “green” choice!

When deciding what will be the best fit for your child as she transitions into life without the pacifier, please don’t trick your child and please don’t cut the nipple (sabatoge the paci) as this could be dangerous

The Post Paci Adjustment period could be 3 days or three weeks. It depends on how old your child is and how strong their habit was! Be prepared to be very supportive and assure your preschooler you know this will be hard and you’ll help her through it. Plan a sleep training method of your choice that feels like a good fit for you and your child – probably one leaning on the more interactive side as a starting point for toddlers.

As always, if you need help, more step by step guidance, or have questions – we’d love to work with you in a Sleep Consult! Thanks for reading, Meg and Erin