child(ish) Q & A: Pacifiers

Pacifiers are great soothers for a newborn, but could pose problems when a child gets older. When is it no longer necessary and when does it become a problem? Here’s a guide to the ins and outs of pacifiers: 

What is a pacifier?

Called by many cute names (Binky, Paci, bah-bah), a pacifier is a tool designed to soothe infants when they are crying. They are useful for satisfying the sucking reflex necessary for newborn feeding, reducing the risk of SIDS (Sudden Infant Death Syndrome) when napping or sleeping, and they help children learn to self-soothe. 
For this post we are only talking about rubber/plastic/silicone pacifiers. We also aren’t covering teething for this post. If you have any questions, please leave us a note in the comments.

How long should a child have a pacifier?

According to the American Academy of Pediatrics, babies should limit or stop pacifier use after 6 months of age as the risk of SIDS drops. However, we know as parents that doesn’t always go as planned.

Both Occupational Therapists and Speech-Language Pathologists feel that babies should no longer use it after 18-24 months of age. Here’s why:

  • The newborn suck-and-swallow reflex pattern is integrated between 5-6 months of age. This means that the automatic response to suck has lessened, and the physical need to have a pacifier is not necessary. However, infants may rely on it emotionally to self-regulate for a few more months. A good indicator that the suck/swallow reflex is integrated is when they start cooing, which means that they have more control over their tongue to make sounds. 
  • Around 6-11 months, children start babbling and attempting to verbally communicate. If a pacifier is in their mouth, it can distort their speech as it limits movement of the tongue and lips. 
  • From 6-17 months, children learn language vocalizations and words with those around them. If a pacifier is frequently used, they may miss opportunities to “converse” with their parents.
  • Between 1-2 years of age, children are learning to emotionally and physically self-regulate, becoming aware of social expectations and start to develop self-control. Therefore, the need to use a pacifier to comfort starts to diminish. 

What happens if they use it for too long?

Children who overuse their pacifiers are at a greater risk to develop middle ear infections. This is when fluid trapped in the Eustachian Tube (the part that connects the ears to the nose and throat) becomes infected. It is hypothesized that this is due to with changes in equilibrium pressure inside the ear due to sucking. 

Ever heard of pacifier teeth? It’s usually when a child uses a pacifier so much (especially after the age of 2) that their teeth have become crooked. This results in an overbite, an open bite, or a cross bite which can affect a child’s ability to chew food or articulate words. This can also have an impact on their smile which, in turn, can influence their self-esteem as they get older.  

In addition, a 2012 study found that the use of a pacifier could limit a child’s capability to mimic facial expressions and understand emotions, a key for developing empathy towards others. 

How do I get my child to stop seeking out it out?

If you’re lucky, your child will indicate that they are done with pacifiers by pulling it out of their mouth or tossing it. But for most parents, the Paci habit is a hard one to break.

For babies between 6-12 months:

  • Become aware of how often the pacifier is needed. If they are happy and playing, they should not require it. If they need it to calm down or settle prior to nap/sleep, then that is different. 
  • If they are having an emotional moment, try to use the pacifier as a last resort to comfort them. Hug them, squeeze them, talk to them, tell them it will be okay. Give them their favorite toy, stuffed animal, or even a soft blanket to hold instead. Please understand that it will get worse before it gets better as this will not be an easy step. It is a transition and like all transitions, the first few rounds will be difficult. Be patient and don’t give up.
  • As the use of the pacifier fades throughout the day, further reduce its need by establishing routines for nap and bedtime. This will help your child associate other activities to sleep rather than a pacifier. 
  • Once they no longer need it, do not offer it as an option. Out of sight, out of mind. If they ask for it, provide other options to help them settle. Again, this may take a while, so please be gentle and patient with your child and yourself. 

For toddlers 1 year and up:

It can be difficult for toddlers to let go of the pacifier as they have probably developed an emotional attachment to it. They have associated it with comfort and aid through difficult times. 

  • Find all the pacifiers and only keep a few on hand. You are now the ruler of all the pacifiers! If your child needs one, they must come to you. 
  • Keep calm when reducing pacifier use. Take the pacifier away once your child wakes from their slumber. Do it gently while they’re distracted and don’t draw attention to it. If they do throw a fit about it being taken it away from them, tell them that the pacifier needs a break. Provide them with another toy or stuffed animal, as this will help them associate comfort with another object. Once the transaction is complete, walk away and place the pacifier somewhere that they can’t get to. Yes, they will cry at first as this is a transition. Be patient and consistent as this is key to success.
  • If your child has a pacifier in their mouth constantly, try to build their tolerance of not having it by setting a timer to take “pacifier breaks” for 5-10 minutes every hour. Increase the time by 2 minutes with each successful no-tears break.
  • Routines are super important when weaning. The goal is to associate comfort, happiness, and safety without the presence of the pacifier. Keep the routine consistent as much as possible. 

Other methods to help with weaning:

  • Use the pacifier for ONLY NAP AND SLEEP. NO EXCEPTIONS. 
  • Birthdays. Blow out the candles and say goodbye to the pacifier as they are a “big kid” now.

What about thumb sucking?

Thumb sucking usually develops when there is no pacifier available, usually when a toddler has relied heavily on them. If this is the case, your child may be relying on the rhythmical sucking to calm themselves or to focus on tasks since they don’t know any other strategies. An OT can assist with helping children learn how to self-regulate appropriately. 

Pacifiers are a virtue and a vice. Once you know what their intended purpose is, it’s easier to use them appropriately and know when to wean your child away from them. 

If you have any other questions or topics you’d like us to discuss for our next Q&A, leave us a note in the comments!

Sources:
Pacifiers: In or Out?“, Rachel Reiff Ellis. WebMD.
When and How to Get Rid of the Binky!“, Alisha Grogan MOT, OTR/L. Your Kids Table.
Pacifiers Linked to Ear Infections” Melissa Schorr. ABC News, 2006.
Does Sucking on a Pacifier Harm Speech Development?“, by Stephanie Jones. North Shore Pediatric Therapy.
Pacifier Teeth: What It Is, Prevention & How To Deal With It“, Leah Alexander, M.D., F.A.A.P.. Kid Simplified, 2019.
Pacifier Use: an SLP Perspective“, Emily Cohen. Tandem Speech Therapy, 2018.
Pacifiers may have emotional consequences for boys“, Chris Barncard. University of Wisconsin, 2012.
Why is my Child Still Putting Things in Their Mouth? A Post on Oral Sensory Seeking“. Griffin OT, 2019.

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