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 in this page as 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 and they often looked for invisalign near me 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!
I’m an Early Childhood Educator for toddler children.
We have a couple who provide a pacifier for their toddler. The child has been with us for approximately 2 months now and once at sleep-time he went on his cot and fell asleep without the pacifier. My co-worker and I decided to try the next day without his pacifier and he slept again. We continued this for about a week and all was great.
We shared this information with mom and the first thing she did was take the pacifier and plop it into his mouth. He wasn’t crying, fussing, or (with his limited speech) even asking for it.
When he arrives in the morning it’s in his mouth; when he leaves at night it’s the first thing that goes into his mouth. I’m finding this very troubling, because it’s not as if the child is asking for it. I “feel” that it is their way of not having him cry. But the boy doesn’t cry through the day, other than when he’s hungry.
I am including some information on the room’s newsletter regarding pacifier use, but I feel that they will not heed our concerns.
Do you have any suggestions?
Thanking you in advance.
Hi! Thank you so much for your comment. I hope my post on pacifier use was helpful to you.
I can see why you are concerned that this child may be using the pacifier too frequently and unnecessarily. We know this could lead to a habit that is very hard to break. If this habit persists beyond age 3-4, it may become a dental issue and then can become a speech issue. If I were working with this mom, I would continue to share with her just how much you see her child growing more independent of the pacifier. This is big step. It is great that the child is demonstrating the ability to self-regulate and soothe without the pacifier at nap time. You could also try to introduce another favorite object or activity and see how he responds so you can tell mom that he also enjoys another object/activity when he may be getting fussy. For example, in the post I wrote, a favorite toy or song can work for this alternative soothing strategy.
It’s also a really good idea that you sent home a newsletter to give parents some information on pacifier use. It is so important to educate parents. In this field, we are learning new information all the time that can help our kiddos! During the hours that this child is in your care, you can keep encouraging independence of the pacifier and decrease the “in the mouth all the time” behavior.
Sometimes our job as early childhood educators is a difficult one, but the best thing you can do is educate mom (which you are doing) and help encourage the child to talk, sing, play, and nap without a pacifier in his mouth. Keep reinforcing speech (you mentioned the child has limited speech) with verbal praise. For example, “I like when you talk!” “I like when you use words!” Read books together, go for walks and name things you see, play finger-play games, and sing nursery rhymes. Try to introduce other comforting toys/routines when he/she gets fussy, and if they are successful, share with mom! : ) Keep me posted on how this little one is doing!
Please let me know if there are any other questions you have. I am happy to help you in any way I can.
Thought I’d pull my hair out with our first child. She wouldn’t stop sucking her thumb for anything. And it’s not like a pacifier you can throw away and be done with! We tried thumb cages and bandaids–she could get them off. We tried hot sauce and vinegar on her thumb–she seemed to like the taste.
Finally when she was FIVE years old her brother (one year younger) made fun of her saying her teeth were going to look like a beaver’s. And few sing-songy taunts and she NEVER sucked her thumb again EVER.
Well, I don’t recommend ridiculing your child into giving up her thumb–but I was so grateful that she finally stopped! LOL!
(I know…..so off-topic…..sorry!) 🙂
LOL… too funny Daja!!
So my step son is over 2 years ld step son doesn’t talk at all. The most he says is ma ma and da da. He also still sucks on a pacifier not sometimes but all the time and cries for everything and doesn’t use words or points. Should my husband and I be concerned?
You might find the article “Speech and Language Development Milestones” helpful. It gives you an idea of how many words children should have depending on their age range. It also lists activities you can do to help encourage language development! It is always good to have your child evaluated to rule out any delays and to get some speech therapy as early as possible – if that is recommended. Most pediatricians will refer to speech therapy if there are delays in communication development. A great way you can encourage your step son to use words is to offer two choices. For example, at meal time, you say, “Do you want milk or water?” At snack time, “Do you want pretzels or crackers?” Getting dressed…”do you want your red shirt or your green shirt?” And wait for him to use any verbal response and praise him for using words! i.e. say, “Good talking! I like when you talk to mama!”
Keep me posted! And like I said, suggesting an evaluation is always a good idea – the earlier you can begin speech therapy the better!
Do you happen to have any information regarding prolonged bottle use in young children?
I do hope that your beautiful daughter Gia Joy is doing much better and is continuing to recuperate by God’s grace. I check in with her status and your blog whenever I have the time to. You provide such a wonderful resource for us and I trust that God will continue to strengthen and keep you and your beautiful family. My specialty is working with children (school-aged) with Autism disorders, but I try to act as a resource for the families in my church with young children (0-3). Recently, one of our Mom’s asked for tips on how to reduce pacifier usage in her 13 month old son. I will give her the above info that you wrote as well as the super duper article. I am very much interested in the strategies for reducing thumb sucking as well. Could you please suggest some strategies for this habit as well ? I am thinking of a 2 yr old (another family) whose Mom has also asked for suggestions, Thank you so very, very, much for all that you do. May God continue to abundantly bless in very way!
Hello and Thankyou for your interesting article.
As a previous maxillofacial surgery trainee- hence a doctor and dentist I am very aware of the link between prolonged pacifier (dummy as we say in the UK as it dumbs the crying!) and dental malocclusion.
However your article does not mention the very pertinent subject of children with additional needs.
For example my son is autistic and has sensory processing disorder , social communication disorder, sleep disorders and ADHD as part of this.He also has a rare autoinflamatory periodic fever syndrome resulting in canker sores and arthritis monthly. He uses a dummy as a sensory seeker for oral stimulation, and for comfort.
I have tried fruitlessly replacing with chewellery, chewing tubes, straws etc to no avail.
Autistic children will mainly not replace dummies with soft toys or such like- my son sleeps with metal trains and mechanical devices! They cannot get comfort from soft toys etc.
We have been in occupational therapy since age 2 and I have seen private SALT.i try to limit use of dummy until sleep or during meltdowns/distress however he uses it as his transition aid, in stressful circumstances. He needs to know there is a dummy available at all times even though he is not using it.
My sons tests show him to be extremely intelligent so I am using his understanding and gentle weaning off the dummy. He is 4.5 years and my aim is to have it gone by age 5 when he starts school.
(As myself and his biological father are both class 2 div 2 skeletal pattern and I have had osteotomies for this my son will need orthodontics anyway).
I really think a SALT and orthodontist could make a fortune if they made a sucking device for older children with additional support needs as I have read of ASN children using pacifiers up to age 12!!!