The Tinkerer

PlayWell Pediatric Blog

Pacifier Use In Children and When To Transition

March 21, 2023

Infants are born with certain needs. They find comfort in oral fixation, they eat every 2 hours or so, they take milk throughout the night, they need diaper changes, etc. These are things which are normal and necessary for a time. It then becomes our job to encourage growth, to always anticipate the next stage of development from our kids to encourage progression. But what’s so hard about being a parent, especially first-time, is that we don't always know when to push for what. 

Very commonly, we miss the off-ramp for non-nutritive habits like the pacifier. The American Academy of Pediatric Dentistry (AAPD) and the American Academy of Pediatrics (AAP) are in agreement: the pacifier is recommended from 0 to 6 months as it is associated with reduction in Sudden Infant Death Syndrome (SIDS). The pacifier is also recommended because it's far easier to eliminate one day than a thumb! However, the AAP recommends pulling the pacifier at age 1 in part because continued pacifier use is associated with an increase risk of ear infections (acute otitis media). We know from psychology that around 1 year of age is also when children develop an attachment to what is called a transitional object - an external means by which children find internal calm and comfort as they transition from dependence to independence. During this time, I like to encourage parents to help their kids choose a transitional object. Give lots of options, but try to push a stuffed animal or a blanket, something with a little mommy/daddy smell, something snuggly. It becomes a LOT harder to pull the pacifier the older a child is, especially if they've chosen their pacifier or thumb as their way of coping. 

We talk about this in dentistry not because pacifiers are dirty (though they can be), but because the pacifier is an orthodontic appliance! Like braces, it can move teeth and change the shape and growth of the jaw bones. The orthodontist's job is to fix these things. It's the pediatric dentist's job to teach about these things to try to prevent and mitigate problems. The pacifier, and more importantly, sucking on the pacifier, creates pressures via the pacifier upon the teeth and upper jaw bone. It pushes teeth out, creating a large overjet which will later encourage lower lip sucking (figure 1), and it pushes upper front teeth upwards creating an anterior open bite (back teeth touch, front teeth can't) which will later encourage tongue thrusting (figure 2). The pressure from the pacifier in the middle of the upper jaw bone pushes on the bone, changing its shape over time, "tenting" the upper jaw, creating a high palatal vault, which pulls the back teeth left and right towards the middle, closer together, creating space loss and a posterior crossbite (figure 3). These can be pretty serious problems. While they can often be corrected by the orthodontist, if they aren't fixed early enough, they can require surgery to fix. 

I always like to remind parents that the dentist likes to see children for their first visit around 1 year of age. Non-nutritive sucking habits and pulling the paci at 1 is one of the things we like to talk about to encourage proper growth and development. The goal is never to say that pacifiers are bad, or to use negative reinforcement or punishment in getting rid of them. We want to encourage alternatives and provide kids with a lot of comfort and love, soothing and snuggles, play and distraction. If you have any questions about how to transition away from the pacifier, I encourage you to talk to your pediatric dentist and pediatrician; we have a toolbox of good tips and tricks to make it a little easier for everyone!

A kid playing with his toys

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