Ask: How to move past the pacifier?

Posted by Joan Comrie on November 26, 2013 

Q. At what age should I get rid of the pacifier?  And how do I do it?

A. Pacifier use is very controversial among professionals and emotional for many parents who depend on it.  While there are many benefits to pacifier use, there are certainly risks to overuse and not weaning in a timely manner.

There is a time and a place for pacifier use.  Pacifiers are often a necessary tool to calm a newborn.  Professionals training efficient suck patterns in breast- or bottle-feeding infants will often use pacifiers as part of the treatment plan. And pacifiers can sometimes reduce reflux symptoms in infants.

When used inappropriately or for too long, pacifiers can be problematic and result in the following complications:

  • Anterior open bite:  Chronic pacifier use can cause an anterior open bite, in which the back teeth touch but the front teeth do not.  
  • Overjet (when the teeth are pushed out) is another consequence of pacifier use.
  • Increased ear infections.
  • Increased speech and language problems.
  • Increased feeding problems (especially with the transition to chewing).

When is the best time to start weaning off the pacifier?  The literature often says that the pacifier should be discontinued before a child’s second birthday.  As a speech pathologist specializing in feeding and swallowing difficulties, I would prefer that a child starts the transition off of the pacifier at 6 months of age and eliminate its use by 12 months of age.

Why wean so early?  The tongue patterns used during pacifier sucking is primarily a front to back motion.  Swallowing solids and the production of speech sounds require that the tongue uses a variety of movements including elevation, retraction and lateralization (side to side).  It also requires that the tongue is able to move in isolation of the jaw.  The pacifier limits these movements.  In addition, overuse of the pacifier can:

  • Maintain immature tongue patterns 
  • Limit a child’s tongue range of motion 
  • Reduce a child’s ability to explore and practice a variety of tongue patterns that are necessary for speech production and the transition to mature chewing patterns  

Giving up the pacifier doesn’t have to be a daunting task.  There are many approaches.  The following are suggestions.  Find one that agrees with your style of parenting.  Just make sure you have a plan and follow through with it. Not following through can make weaning the pacifier significantly more difficult for you and your child.   Most parents report that weaning off the pacifier was easier than they thought and that they had more anxiety about the process than their child did.  

  • Step down:  Gradually reduce pacifier opportunities during “less stressed” situations and move progressively toward “more stressed” situations.  Work toward using the pacifier only in the crib and then only at night.  Then eliminate it all together.  This technique works well for very sensitive children who seem to “need” the pacifier to calm.  The downside is that it takes a long time to wean.
  • Replace:  If your child uses the pacifier when anxious or in stressful situations, find an alternative to the pacifier.  A blanket or stuffed animal may be a good replacement.
  • Keep your child busy:   If your child is actively engaged, say, playing with a puzzle or when he is running and jumping, he will be less likely to want the pacifier than when he does something passive like watching a video.
  • Cut it:  By cutting the top off of the pacifier, it becomes “broken” and less appealing.  Some children do great just throwing the broken pacifier away.
  • Give it away:  Big boys don’t need the pacifier anymore but newborn babies do.  Pack up the pacifiers and send them to a newborn.  It allows the child to feel like it was his or her decision and also makes a great holiday gift.
  • Pacifier Fairy:  Have your child collect the pacifier so that the Pacifier Fairy can come at night and give it to a brand new baby.  The Pacifier Fairy may want to leave a present in exchange for the pacifier.
  • Trade:  If your child understands this concept, he can trade the pacifier in for a prize or a privilege.
  • Cold turkey:  If the pacifier is taken away cold turkey, it can be quite painful for the first 24 hours, but usually in 1-2 days, your child will move on and won’t even miss it. 

Pacifiers are not a bad thing when used appropriately.  But if overused, the pacifier can cause many complications.  Weaning off of the pacifier is much easier sooner than later.    

Got a question about your child's health or happiness? Ask Joan or any of our experts by sending email to mom2mom@newsobserver.com.


 

Joan Dietrich Comrie of Carolina Pediatric Dysphagia (919-877-9800) has dedicated her entire career to studying, teaching and practicing in the area of dysphagia, specifically pediatric dysphagia. She received her bachelor of science degree and then her master of science degree in the area of speech pathology at the University of Wisconsin-Madison in 1986. Before starting Carolina Pediatric Dysphagia in 1996, she worked at several hospitals (Cardinal Hill Rehabilitation Hospital, Lexington, Ky., Vanderbilt Medical Center, Nashville, Tenn., and WakeMed, Raleigh) where she developed or reorganized the hospital's pediatric dysphagia program.

Joan has spoken on the topic of pediatric dysphagia nationally and internationally. She has published in a professional journal.  She co-taught the first dysphagia course offered at UNC and continues to guest lecture to several university graduate level speech pathology programs and to the UNC Medical Students who complete their rotation at WakeMed. She has served as chairman and member of a subcommittee of the Special Interest Division 13 of the American Speech Language Hearing Association (ASHA). She has received her certificate of clinical competence (CCC) through ASHA and is licensed in the state of North Carolina.

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