Tag Archives: malocclusion

Don’t be passive about pacifiers (pedcast)

Welcome to another edition of DocSmo.com.  Welcome new listeners and welcome back old ones.  I hope you are having a great day, I am. In today’s pedcast we are going to get into some serious Doc Smo  opinion about a topic that parents often agonize over, pacifiers.  We are going to take on the topics of whether parents should start their children on pacifiers as well explore how and when they should finally say good bye to these devices: you know, the  pacifier’s end game.  How and when should parents consider doing away with the yum yum, the binky, the ya ya.  Let’s do it shall we!


When it comes to pacifiers, everything is controversial.  Emotions are high when it comes to these little pieces of plastic.  Some people, especially breastfeeding advocates don’t think they are ever appropriate for infants or children since some of the infant’s sucking cues can be masked by the paci. The AAP on the other hand, think that there is good evidence that for infants under 6 months, falling asleep with a paci reduces the risk of sudden infant death.  Otolaryngologists are convinced that ear infections are far more common in children who use them. Speech therapists think that language acquisition is slowed by them and orthodontists think they sometimes cause a child’s teeth not to fit properly because the pacifier can change a child’s natural bite. Wow, my head is spinning after reading all these opinions.  I will give you one pediatrician’s opinion, mine, in just a few moments.

There is no right or wrong answer for parents when it comes to starting a pacifier habit. Some babies absolutely refuse them no matter how hard parents try to get them to suck on them. Others babies will use them until they get enough hand control to suck their own thumb.  And others love them and get very attached to them. Go figure. Babies are as different and unique as their parents!  There are arguments both pro and con and ultimately this comes down to a parent’s choice.


I suspect that many of  the listeners to this podcast have children who love their binky and you, the parent, are looking for some information about how to get rid of it.  Maybe you have a 1, 2, 3, or 4 year old? Controversies continue on the best age to stop them just like whether to ever get started. What is the right age to make them go away?  Again, “experts” vary greatly in their opinions about this one as well.  Some say they need to go by 12 months along with the bottles. Others, advocate getting rid of them by age 4 years…you heard me, by 4 years of age.  Most advocate an age somewhere in between 1 and 4 years. Again, my opinion is coming shortly. Stay tuned!


How do you make it go away? Again, there is no consensus about this either. Methods vary greatly.  Here are some I have seen.

– simply making them disappear. Its gone Johnny, get over it!  I call this the direct approach.

-sniping the nipple off and showing the child that the binky is broken and cannot be fixed.  Let them get mad at the binky not the parents. Clever!

-Getting the child to agree to give the binky to a new baby or kitty they know.  Amazingly, this often works with 2.5 year olds and older.

– Then there is the gradual making the binky fade away, limiting it to certain times and places: the method that most parents choose to use.

-I saw one mother once get so fed up with her son’s pacifier that while driving down the road with her crying child who couldn’t get his pacifier to him, she simply rolled back the sunroof, tossing it toward the sky, and declared that the binky was going to “paci heaven”.  That method worked for her.

-One expert that I read said it is crucial to give your child warning that the paci is about to disappear. He is of the notion that you treat children like adults, they will act like them…a definite maybe on that!


So what do I see in my practice? How do I help parents deal with this issue?  First let me say that everything I am about to tell you is based on my experience and is my opinion…lets get that out on the table first. I personally, am not a big fan of pacifiers. I think they can interfere with successful breastfeeding, create too much work for parent, and I think they delay the age when children can learn to sooth themselves.  I also think that children who use pacifiers have far more orthodontic problems their thumb sucking friends.  I can usually tell by age 2, without asking, which children are still using pacifiers.  I think they deform a child’s mouth more than their own thumb.  I also don’t think it matters which type of pacifier a child uses, they all have a tendency to change the shape of a child’s upper teeth, making them not fit properly against the lower teeth.  This malocclusion as dentists call it can cause both speech difficulties, especially a lisp, and an unwanted cosmetic change in a child’s face. Both of these problems can be very expensive to remedy with orthodontic expanders.

I think that pacifiers should be gone by age 2 years. If parents do this, I rarely see a child substitute their thumb for the paci at this age. More importantly, I see any deformity that has developed from the paci disappear fairly quickly.  A child’s natural facial features return to normal without expensive dental appliances. And finally by age two, most children have good enough language to allow them to calm themselves down in other ways other than sucking on a paci.


-As you can see from this discussion, pacifiers can be both a blessing and a curse. On the one hand, they can save lives in  infants and provide mom with a non nutritive sucking outlet for her infants  but they can also greatly increase the number of ear infections in some children, pose a choking hazard, and cause speech delay as well as facial deformity in some children.

– Your call parents.  You can see why pediatricians have trouble giving advice on this issue.  There is no clear answer. What I do strongly believe is,  that if your child is a paci user in the second year, make it disappear by age two. I think you will be glad you did.  Remember, children get more rigid and stubborn not less as they age.  What is hard at 2 years of age may be impossible at 3. Remember that Doc Smo pearl,“Parenting decisions that are easy in the short run may not look so easy in the rearview mirror” or “Parents who chose the path of least resistance are often rewarded with a rocky path”


-Thanks for joining me.

-If this is your first pedcast, take a look at the extensive DocSmo library of pedcasts and articles.

-If you are so moved, send in your comments and join the conversation.

-If you like talking about children, go ahead and subsribe to the feed on my website by hitting the rss feed button or linking to us by facebook or twitter.  We would love to have you.

– This is Dr Paul Smolen, broadcasting from the low country of south Carolina, hoping your little angel doesn’t get too sassy about getting rid of their paci.

-Until next time.


Smo Notes:

Pacifiers: Are they good for your baby? – MayoClinic.com

BMC Pediatrics | Full text | Predictors of and reasons for pacifier use in first-time mothers: an observational study

Bye-Bye Binky: Ending the Pacifier Habit