Have you ever seen an ultrasound picture where the tiny baby is sucking its thumb? This has always amazed me! It is amazing that this behavior is a natural response even at such an early age. The suck response is seen as a comforting behavior. Researchers call sucking without getting any nourishment, “nonnutritive sucking” or NNS.
As a Speech-Language Pathologist and mother-to-be, I’ve been thinking a lot about early development in infants. One of the questions I’ve been asking is…are pacifiers bad for my child? I need to know!
Some of the topics Speech Pathologists are familiar with are thumb sucking and pacifier use. I have worked with some preschool kids who have yet to break their thumb sucking habit by age 4 or 5. Their moms are pretty frustrated and have asked me for advice on how they could help their child decrease thumb/finger sucking. But as for the infants and toddlers, a question that comes up occasionally is about pacifier use.
I thought it might be helpful if I summarized an article I just read on prolonged pacifier use to give you more information. I hope it will shed some light on the issue of pacifier use for you and your child. As with many topics in the field of speech-language pathology, more research is needed.
In the article, The Impact of Prolonged Pacifier Use on Speech Articulation: A Preliminary Investigation by Laura L. Shotts, D. Mike McDaniel, Richard A. Neeley from Arkansas State University, Jonesboro from the Contemporary Issues in Communication Science and Disorders, Volume 35 • 72–75 • Spring 2008 © NSSLHA 1092-5171/08/3501-0072, the authors investigated the amount of pacifier use between 3 groups of kids, all with different amounts of pacifier use ranging from very little to quite a bit, and then compared their scores on an articulation test.
The study looked at three groups of children who had different amounts of pacifier use. The range was from “little use” to “55 months of use”. Group 1 had 30 children who had very little pacifier use. Group 2 had 16 children that had a history of pacifier use for up to 15 months. Group 3 had 22 children who had used a pacifier that ranged from 18 to 55 months. All of the children were given an articulation test (Goldman-Fristoe Test of Articulation – Second Edition (GFTA-2; R. Goldman & M. Fristoe, 2000). In this study, they decided to compare the mean or average standard scores for each group.
Some Interesting Facts from the Authors
Before I get into the findings of this article, here are some interesting tidbits that the authors included in their study.
- “The optimal age for discontinuation of pacifier use is the subject of debate, in part because of the potential impact of sustained NNS on the development of oral structure and function, which is critical for speech production.”
- “A recent study of dental malocclusions from approximately 15,000 children from one orthodontic clinic concluded that a sucking habit resulted in 60% of the dental malocclusions that were seen in those patients (Van Norman, 2001).”
- “The American Dental Association (2003) reported that pacifier use in 3- to 5-year-old children led to anterior open bite, posterior crossbite, mean overjet, and smaller intercanine distance of the upper arch.”
- “Boshart (2001) suggested that dental problems associated with prolonged pacifier sucking could lead to speech articulation problems such as distortion of the fricative and alveolar phonemes.”
- “In addition to speech articulation problems, it is plausible that NNS might negatively impact development because the oral cavity is partially obstructed by the pacifier and babbling and imitation of sounds and words could be limited. Also, it is conceivable that if the child is babbling with the pacifier in its mouth, those vocalization may be distorted or inhibit the child from making any vocalizations.”
- “The World Health Organization (1989) reported a positive correlation between pacifier use and increased incidence of otitis media. The impact of otitis media on speech and language development is well documented (Niemela, Pihakari, Pokka, Uhari, & Uhari, 2000).”
This particular study wanted to see if prolonged pacifier use negatively effected speech production. It looked at the speech of kids with very little pacifier use (less than 1 month) or no history of pacifier use, kids with normal pacifier use, and then kids who had used a pacifier for a longer period of time. (The authors defined “typical pacifier use” as routine pacifier use between the ages of birth to 15 months and prolonged pacifier use was defined as routine pacifier use beyond 18 months of age).
Some Things the Study Didn’t Look At
There were several factors not really taken into account in this particular study. Some of these were the amount of time spent sucking on the pacifier. Investigators relied just on parent reports. They also didn’t take into consideration thumb sucking. They didn’t look at the type, brand, or shape of the pacifier. There also may not have been enough kids participating in the study. Clearly, more research is needed on the topic of non-nutritive sucking (NNS), pacifier use, and its impact on early speech development and production.
What they did find…The Conclusion
There is no doubt that there is a correlation between nonnutritive sucking or NNS, and dental development. There is also a known link between poor dental development and speech sound development, production, and articulation. However, this study was not conclusive enough to say that pacifier use alone leads to articulation delays or disorders. Because this study didn’t specify certain parameters, it is hard to give a very definitive answer either supporting or discouraging pacifier use at all. However, pacifier use beyond age 3 is a concern.
As a speech-language pathologist, I am always concerned about dental development as it relates to speech sound production. Since we know that prolonged NNS does cause poor dental development, I would counsel parents to be careful when offering the pacifier or when encouraging thumb sucking for any prolonged period of time. These comfort measures, though seemingly harmless, could lead to habits that are difficult to break and that could negatively affect dental development. Too much of anything is never a good thing. Just as you would limit your child’s time spent in front of the television, if your child is around age 3, it is probably a good idea to try and find creative ways to help soothe them that don’t include the pacifier. You could slowly try and ween your child off of the pacifier little by little.
Some things you can do to reduce use of the pacifier include:
• Keeping the pacifier out of sight. As the saying goes, “out of sight out of mind.”
• Be consistent. It may be challenging at first, but don’t give up. If you give in
on one occasion, the child learns that he/she will get what he/she wants just by
pushing hard enough.
• Designating certain times of the day for the pacifier. For example, you may
allow the pacifier at naps or at bedtime.
• Slowly reducing the amount of time allowed for pacifier use. Your child
doesn’t have to go “cold turkey.” Rather, many children will respond more positively to a gradual change.
• Encouraging good dental care. Put more emphasis on teaching mature oral
activities such as brushing/flossing, and why they’re important.
• Finding other ways the child can comfort himself/herself versus resorting to the pacifier. A favorite toy can work as a good substitute.
• Decreasing use at developmental stages. For example, when a child is learning to crawl, you may want to begin limiting his/her access to the pacifier. You could continue to decrease availability as the child begins to talk.
Other Points to Remember:
• A pacifier should NOT be a substitute for nurturing. A fussy baby may also be calmed through cuddling, massage, reading, playing, rocking, or with music. So, when an infant cries, these other methods should be attempted first to increase the bond between parent/caregiver and child.
• Children learn from each other. Children may be more motivated to stop pacifier use if other kids in his/her environment are not using them.
• Purchase a pacifier that’s dishwasher safe. Pacifiers need to be washed often for good oral hygiene.
• Avoid too many changes at one time. Assess what’s going on in the child’s life (e.g., moving to new place, adjusting to new baby) and whether it would be appropriate to expect him/her to decrease pacifier use at that particular time.
• Be patient. You’re probably not going to see an overnight change, so allow your child the time he/she needs.
• Give praise often! In order to keep your child’s attention away from the pacifier, praise him/her while engaged in other activities.
• You can always consult your child’s pediatrician, dentist, and/or speech-language pathologist with any questions/concerns.
Click here to download and print the entire handout from SuperDuper, Inc. on decreasing pacifier use!
Until more conclusive evidence is available, my advice would be, don’t worry if your child likes the pacifier and is using it in moderation or infrequently. With that said I would still begin to find other comforting and soothing methods for them so that they don’t become dependent on just the pacifier or thumb. The article I was summarizing didn’t really address thumb sucking so look for a thumb sucking article coming soon. I have lots of parents concerned about that one. Speech-Language Pathologists know that prolonged thumb sucking can have a negative effect upon dental development and speech production. I will share more with you on that soon!