Nonnutritive Sucking: Mommy vs. Science

Records of soothing devices used by moms go back to the 1500’s. The first patented pacifier was invented in 1901 by Christian W. Meinecke, he referred to the device as a “baby comforter”. Since then the pacifier has continued to evolve and improve. However, the pacifier has not changed much since the 1950’s. Though there are a plethora of different designs they are essentially all made of latex or silicone with a plastic shield and ring, the same as the design in the 1950’s.

My “babies” are far past the diaper, pacifier, bottle, breastfeeding age, however, one thing that is regularly brought to my attention by patients is “When should I take the pacifier away?” I must be honest and say, I had no idea prior to doing this literature review. I took an unofficial poll on my personal Facebook page as well as in a group of dental professionals. The poll although unofficially and not backed by any science was quite telling. The responses were all over the place, some said never start, others said before 12 months, while others said anywhere from 2-4 years old.

I went to the mommy blogs to see what they recommended. My first stop was the Happiest Baby Blog. It states “The easiest time to wean the pacifier is around 6 or 7 months of age. You can reduce pacifier use from many times a day to nothing, in less than a week.” The blog post goes on to claim, “The American Academy of Pediatrics and the American Academy of Family Physicians recommend limiting or stopping pacifier use around 6 months to avoid an increased risk of ear infections, especially if your child is prone to them.”

Next stop, mom365 this blog states “Before age two, your baby won't suffer any long-term damage to her teeth, according to WebMD.” Then goes on to say, “Frequent pacifier use past 12 months old could interfere with a child's language development skills, say some experts.” So, in this one blog post there are two different recommendations.

The last stop was the old tried and true Parents.com, where they suggest “pediatric dentists recommend limiting pacifier time once a child is 2 and eliminating it by age 4 to avoid dental problems.” The article goes on to give advice on how to eliminate pacifiers in three days.

Out of three different websites I’ve gathered, I should wean my child off their pacifier by 6 months, age 2, or maybe 3-4 years of age. Wow, any mom would be confused. Though several of these posts refer to experts and pediatric organizations, what does the science say about nonnutritive sucking?

There are benefits to the use of pacifiers, one such benefit is a reduced risk of SIDS. In a meta-analysis reviewing case-control studies from 1966-2004 showed a significant reduced risk of SIDS with pacifier use during sleep. The meta-analysis concluded with the recommendation of pacifier use for infants up to 1 year of age. [1]

Other benefits include Analgesia: pacifiers provide a calming effect that helps with pain and anxiety, and preterm infants that used pacifiers had a shorter hospital stay. [2]

As with all things, even nonnutritive sucking is not without complications. Some of the complications I’ve found when reviewing literature include; early weaning from breastfeeding, malocclusion, infections due to bacteria, viruses and fungi, and increased risk for otitis media (ear infections).[2]

I will be focusing on the dental-related complications associated with nonnutritive sucking. I use the term nonnutritive sucking because I don’t want to leave out the issue many parents face, thumb sucking. I reviewed a systematic literature review that included 17 articles. It is important to mention the systematic review acknowledges that 12 of the studies included had a serious overall risk of bias and the other 5 a moderate risk of bias. Here is what was discovered in the systematic review:

Anterior Open Bite

Not all studies reviewed used the same age groups or pacifier type. It was determined the incidence of anterior open bite was between 8.5% and 96.3%. I hate to be Captain Obvious here, but that is a broad range. To be perfectly honest most of the studies reviewed had different conclusions. The duration, if the pacifier was used during the day or just at night were just a few of the concerns that may have led to different outcomes.[3]

Posterior Crossbite

The prevalence of posterior crossbite in children using pacifiers was found to be between 12.8% and 88.9% *Thinks to myself: should I mention the wide range again? No, they probably got it.* Again, the same parameters apply. Some studies found less risk of posterior crossbite if the child stopped using the pacifier by age 2 while others stated no issues if the child stopped using the pacifier by age 3. Higher risk for posterior crossbite was noted in children that sucked their fingers.[3]

Overjet

The studies evaluated for this category were listed as moderate to severe risk of bias. With that disclaimer, the results indicated an increased risk of overjet 2-4mm or more in children that used pacifiers.[3]

Molar and Canine Relationships

Findings again were inconclusive. One study mentioned found a statistically higher rate of distal molar and canine relationship, while two other studies reported no strong association between molar and canine relationships and nonnutritive sucking.[3]

Dental Arch

With no mention of the length of time, a pacifier was used, the study found increased mandibular canine arch width and decrease in palatal depths.[3]

Swallowing

Only one study reported on swallowing. With a severe risk of bias, the study saw an increase in tongue thrust in 16.3% and complex tongue thrust in 27.5% of babies using pacifiers. In comparison, they reported tongue thrust in 8.3% and complex tongue thrust in 21.9% of babies that did not use pacifiers [3]

Types of Pacifiers and Orofacial Structures

I know I sound like a broken record, but again consider the level of bias which is moderate to severe in this case. The studies that evaluated types of pacifiers on orofacial structure found orthodontic pacifiers cause less malocclusion than conventional pacifiers.[3]

The big takeaway from this systematic review is that there is a lack of high-quality evidence addressing the effects of pacifier use on orofacial structures. In the hierarchy of scientific research randomized controlled trials sit at the top, only one randomized controlled study was found and used in this systematic review. That randomized controlled trial showed an improvement in children presenting with an overjet and open bite when using a thin neck pacifier.[3]

I don’t know about you, but I’m more confused now than I was when I began this project. Since there is such a huge lack of evidence where dental health and pacifiers are concerned, I am going to defer to the American Academy of Family Physicians. Their recommendation is “Pacifier use should no longer be actively discouraged and may be especially beneficial in the first six months of life. However, the risks begin to outweigh the benefits around six to 10 months of age and appear to increase after two years of age.” Well there you have it, folks, don’t feel guilty about letting your baby use a pacifier, there are benefits, try to wean them by 10 months to 2 years of age.[2]

Also, let’s stop the mommy shaming we are all trying to figure this mommy thing out. Even science is lacking in this area of knowledge, so how could a new mom possibly know what to do? In addition, I’ve never seen a college student still using a pacifier, so don’t stress too much about weaning them. Just start an orthodontic fund, you’ll probably need it even if you do wean them by age two.

Sources

1. American Academy of Pediatrics. Do Pacifiers Reduce the Risk of Sudden Infant Death Syndrome? A Meta-analysis. Pediatrics November 2005, 116(5) e716-e723. Retrieved from https://pediatrics.aappublications.org/content/116/5/e716

2. Sumi Sexton, Ruby Natale. Risks and Benefits of Pacifiers. Am Fam Physician. 2009 Apr 15; 79(8): 681-685. Retrieved from https://www.aafp.org/afp/2009/0415/p681.html

3. Karin Michele Schmid, Remo Kugler, Prasad Nalabothu, Carles Bosch, and Carlalberta Verna. The Effect of Pacifier Sucking on Orofacial Structures: A Systematic Literature Review. Prog Orthod. 2018; 19: 8. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5847634/