Sleep and Pacifier Use

By Dr. Nicky Cohen

My 6 month old used to sleep through the night until a few weeks ago. Now he wakes up at least 3 or 4 times whenever his soother falls out!  All I need to do is put it back in and sure enough he goes right back to sleep. We are all exhausted!

It is common for previously good sleepers to develop sleeping problems. Reasons for this include: greater cognitive awareness (they are more aware of what is going on around them), reaching a new developmental milestone (who wants to sleep when you can explore!), illness, and travel. I would classify new problems related to pacifier use in the cognitive awareness category.

Infants who use the pacifier to fall asleep may not have been bothered or aware when it fell out when they were younger. However, once they are older, infants are increasingly aware of the pacifier not being in their mouth when they wake (if that is how they fell asleep) and will need it to return to sleep. This is because they have become accustomed to using the pacifier to fall asleep and may not have developed the skill of self-soothing to sleep (falling asleep on their own).

Infants who have learned to fall asleep independently, without parental intervention, usually do not “signal” out (e.g., cry) during periods of partial arousal. These infants will return to sleep, often without their parents being aware that they were briefly awake. However, infants who, for example, are fed, rocked, or who use a pacifier to fall asleep, will need these same conditions to be re-established following wakings. This may happen several times a night, as we all have several periods of brief arousal throughout the night.

When I see parents for this issue, I often outline the following two choices for dealing with this problem. The first choice is to tolerate this until the infant is closer to 9-10 months of age. At this age, most infants are physically able to find the pacifier and put it back in their mouth, including in the dark. Parents can facilitate this by having their child spend extra time on the floor and in the crib learning to reach to get the pacifier, pick it up, and put it back in their mouth. Keeping several in the corners of the crib and guiding the child to find them (including in dim light) may also be helpful.

The second option, which most parents choose (especially if their infant is young), is to get rid of the pacifier altogether and to encourage the development of independent sleep onset (i.e., without parental intervention). Sometimes introducing a transitional object or “lovey” such as a small breathable “blankie” (no bigger than 10” by 10” with holes), as a replacement, can be helpful.

While it is ultimately a parent’s choice when they want to eliminate their child’s pacifier use, many experts in the field feel that unless it is causing a dental or speech problem, allowing their child to continue using a pacifier during periods of sleep is often fine until 4-5 years of age (before the permanent teeth come in).

A word about pacifier use & sudden infant death syndrome (SIDS)
Some parents find pacifiers to be helpful for soothing their infant; others find them to be a hindrance, as some babies wake repeatedly when they fall out. Parents are often the best judge as to whether pacifiers interfere with their infant's sleep or are helpful.

In the scientific literature, the use of pacifiers has been a hot topic of debate over the last several years. While there has been some research showing a relationship between pacifier use and reduced SIDS risk, the Canadian Paediatric Society (CPS) does not advocate strongly for their use as a protective method against SIDS. The CPS recommendation is that the use of a pacifier should not be generally discouraged. If you do decide to offer your infant a pacifier at sleep times, you should consider discontinuing it after about 8 months of age when the risk of SIDS is very low, if it is causing sleep problems. The Canadian Federation for the Study of Infant Deaths in 2005 concluded that "parents who did not want to use a pacifier should be free to do so".

For more information on establishing safe sleep practices, see the Canadian Paediatric Society handouts “Pacifiers (soothers): A user’s guide for parents” and “Safe sleep for babies”.