Pacifiers: In or out?

“The sucking motion is not only a reflex, but it’s actually a hormonal process that promotes calm in the baby.”

Dr. Amy Conrad, Host of the “Ask Doctor Amy” podcast

Pacifiers are so convenient… until they’re not. At some point, there can be concerns about developing teeth and interference with speech, and weaning a child off a pacifier can be challenging.

The American Academy of Pediatric Dentistry, the American Academy of Pediatrics, and speech and language therapists recommend starting that weaning process between 6 to 12 months, and weaning entirely before a child’s third birthday. 

To guide us through that transition, My New Life host Jessica Rolph welcomes Dr. Amy Conrad to today’s episode. Dr. Amy is a mother to a 10-month-old, a Lovevery customer, and the host of the Ask Doctor Amy podcast.

Highlights:

[1:19] Dr. Amy talks about the pros and cons of pacifier use.

[3:42] What red flags should parents be looking for with regard to pacifier use?

[5:52] Dr. Amy shares her thoughts about the paci fairy approach.

[7:25] If a child is using a pacifier all through the day and at night, is it advisable to wean them from the pacifier during awake times, and then eventually extend that to nap-time and finally bedtime? 

[8:38] Can we revert to pacifiers when a child gets sick or during a trip?

[9:30] What about gradually shortening the tips of the pacifier? 

[10:40] How much of a concern is tooth decay, and how and when should we wean our child from the bottle?

[11:08] What are some signs that your baby is ready for a drinking cup? 

[12:31] How and when to use sippy cups, open cups, and bottles? 

[13:52] Jessica shares her takeaways from the conversation with Dr. Amy.

Transcript:

Pacifier pros and cons

Dr. Amy: Thank you, Jessica. I’m so excited to be here.

Jessica: Oh, it’s so great to have you. So I’d love to hear from your expert perspective, what is your position on pacifier use? Can we talk about the pros and cons? 

Pacifiers and breastfeeding babies 

Dr. Amy: For a new born, the first time a parent hears about the pacifier, often it gets brought up in the context of breastfeeding, and there’s a lot of fear, I feel like, these days, because some people think that it can affect breastfeeding in a negative way. There can be a warning that pacifier use can somehow confuse the baby. Now, in my experience, for my own son and also for my patients, I don’t actually find this to be an issue, we don’t have to be afraid that it’s going to stop breastfeeding. Breastfeeding is a wonderful process and relationship that as long as you’re being diligent and doing the feeding every few hours, I’ve never seen a patient where, because they use the pacifier, they cannot breastfeed.

Now, pacifying for babies is a natural process, like you said, and in the times and the parts of the world where there are no pacifiers, thumb sucking is something that babies do naturally. The sucking motion is not only a reflex, but it’s actually a hormonal process that promotes calm in the baby. So it’s not actually just the habit, but they literally release hormones that are calming and makes them go to sleep, so it’s a wonderful way to activate that process. So personally, I think pacifiers, I think it’s a wonderful tool in the beginning, especially to help that baby get into the rhythm of calming and soothing, whether it’s the thumb or the pacifier.

Jessica: One thing I want to clarify for listeners is that we do need to have breastfeeding established for us to feel comfortable introducing a pacifier to a young baby, so generally, breastfeeding is established between two and six weeks, it means that your baby’s nursing regularly, they seem satisfied after feedings, they’re peeing frequently, pooping frequently enough, gaining weight. That all means that breastfeeding is going well, and so then we can feel comfortable with that pacifier.

And then if you’re bottle feeding, there is no issue with introducing the pacifier, is that right? 

Dr. Amy: I think the element of confusion or the fear of it would not be there.

Pacifier side effects: teeth damage and speech delay 

Jessica: So there are these pros when they’re little, but then there can be cons later, what red flags should parents be looking out for? 

Dr. Amy: Most kids with regular use, if you leave them alone, a lot of them would independently drop that pacifying gesture, whether it’s the thumb or the pacifier. Beyond that, the problems that might arise include teeth, so you should be taking them to the dentist starting at one or at least by two years old, and the dentist would be monitoring the teeth, the shape of the teeth, the trajectory. So hopefully by three you have established dental care and past that point, we worry that having something in the mouth could affect the teeth. The speech aspect, one thing is if the kids permanently have something in their mouth, whether it’s a pacifier or a thumb, it could be robbing them off of the opportunity to try sounds and try to speak, and we do expect one or two words right around age one, give or take a few months, so pay really close attention to the speech language milestones, are they hitting the words, are they gaining the words, and are they able to remove the pacifier or the thumb, and actually answer back and speak? So we think of three as the cutoff for when they should be weaned, but even way before then, I would say by age one, those language milestones really should be hit, and if they’re not, then out of the many things that we think of, to try to diagnose that prolonged pacifier use could be one of them.

Approaches to get rid of the pacifier

Jessica: I remember noticing my daughter’s palette changing, like her teeth was trying to stick out, and she had good speech and language, but she just loves to suck. She’s a very kind of oral child. And so I just remember really feeling motivated when I started seeing her teeth moving, I was like, “Okay, we really gotta get serious here.” So let’s talk about parents who are ready, like I was to wean their child from the pacifier. I had a lot of stops and starts. I know I could have done it better. Some of our community has employed this paci fairy approach, which I didn’t know about, but they pick a date in the calendar, or they left their pacifier in an envelope, and the next morning the child finds a toy or a big party or a cake or something instead of the pacifier, tell us, what do you make of this approach? 

Dr. Amy: I like approaches that keep things positive rather than, I’m taking this away. If you can get the child aligned with, this is a step forward in some way, and I like the idea of having a party or some celebration to mark the fact that they are moving on past the paci. So I think every kid is different, and each parent knows their child best, but at a time when you feel like they might understand that we’re taking a symbolic moving on, maybe they can understand they’re replacing it with a lovey or something else. Or a party to celebrate that stage being over. I think that’s a fantastic idea, and I also love the idea of picking a date and sticking to it instead of slowly weaning, I feel like sometimes the off and on strategies don’t work as well.

Jessica: If a child is using a pacifier all through the day and at night, do you recommend maybe weaning them from the pacifier during awake times and then thinking about eventually nap and finally bedtime? 

Dr. Amy: I don’t think either approach is wrong, to me, I think that it might be more confusing for the child, but it depends on that child. In my experience, I feel like it’s been more effective when the patients, like you said, pick a date and stick to it. And I think it’s important to remember that changes often involve some discomfort. It’s probably not possible to wean the pacifier, especially if they’re very dependent without any sort of protest, but the protests are temporary and this is the step we have to go through, so I would say both strategies I’ve seen it work, but again, it might be less confusing if the paci is moving on all together.

Timing is important 

Jessica: I think it’s also about just getting ready as a parent, you’re like, “Okay, am I really ready to not sleep for a few nights or even a week, or am I really… Like is this a good time? Are we going to have a trip coming up.” So yeah, that is the hard part. I also think there’s a question of when the child gets sick, if they, I don’t know, get hurt, you do go on a trip and your off schedule, it’s so tempting to bring the paci back for those tricky times. What do you think? What do you say about that? 

Dr. Amy: It’s a crutch as much for us, maybe even more for us than for them, certainly we’ll remember it more. I think that, just like I say about potty training, picking the timing is important. So maybe not around holidays, not when people are coming to visit, Taking a trip is probably not a good time to wean because that’s the one time they really need something connecting them to home and something pacifying. So I think timing is probably more important than anything else, and then just keeping in mind, like I said, change takes discomfort, it’s okay that they’re protesting for a few days. So I think mentally, we just have to be ready and if we are confident, I think the child picks up on that, if we approach it as a positive thing, “Hey, you don’t need this anymore. Here is something else.” If we make it feel alright, I think the child picks up on that.

Jessica: What about cutting the tips off the pacifier slowly or doing… I think Frida Baby has a product that kind of the pacifier sort of just disappears as you stage through the progression of weaning.

Dr. Amy: The gradually disappearing one, I think I’ve heard of one or two parents using that again, for some babies, it works great. We’re going into this area where there’s not a lot of evidence-based approach of what is the best way. I think it’s more about knowing your child and seeing how they’re taking that. So some kids by temperament might take longer to make a transition, if that’s your child that needs a little bit longer to potty train to learn to sleep, to learn new things. I think that might be a good approach. Other kids, it depends on how they deal with transition, I think like ripping off the band-aid a couple days or the gradual approach, need to read the child.

Bottle weaning and tooth decay

Jessica: My daughter used a bottle for a long time. She just loves to suck, so we got in the habit of giving her a bottle before a nap time in bed when she was a toddler, and then I just started worrying about tooth decay. How much of a concern is tooth decay and how and when should we wean our child from the bottle? 

Dr. Amy: Tooth decay is certainly a real worry, and it’s something that, again, the pediatric dentists are always talking to us. I would prefer it if as soon as they have teeth that they don’t go to bed with the bottle or at least after the bottle, you do some sort of cleaning of the teeth. I would say by age one and a half, hopefully that they’re not going with a bottle to bed, which would make their sugars and everything stay on the teeth overnight.

When to introduce a cup 

Jessica: What about introducing a cup, what are some signs that your baby is ready for a drinking cup? 

Dr. Amy: I like to say that cups should be introduced as soon as they’re starting solid foods, which for most babies is around six months old. So the signs of readiness are the same, the ability to sit up independently, interest in putting things in their mouth. And in the beginning, it takes a while because especially for breastfed babies, their tongues need some time to take the food into their mouth. It’s a great time to also introduce that open cup and just like the cup that love every offers in the kits, the stainless steel ones, something that they cannot break, and I would just give it to them empty for the first few times, let them play with it, let them put their mouth on it, get familiar. Then I would slowly put a little bit of water in it at a time and just letting them have small sips and that’s the motor control that it takes to drink from an open cup, like that actually helps with speech development which is right around six months, the baby is starting to babble all those things go together. So I would say six months, as long as you’re introducing the food, I would throw the cup in there.

Should I use a sippy cup? 

Jessica: That’s really great to hear. And we do put that in the seven-month-old kit for a reason, and we think that that’s the right time, and I think my children used open cups, they also use their bottle. They also use sippy cups. So where do you come down on the use of sippy cups, how that relates to an open cup and how it relates to bottles? 

Dr. Amy: So there’s no physiologic reason for a baby to use a sippy cup, but I think they’re a very helpful tool. Obviously, a parent invented them to try to prevent messes, which I think is a perfectly legitimate tool. So I would say using a sippy cup when you’re saying the car or somewhere where they shouldn’t spill, is a perfectly good way to go, but I wouldn’t use that as the default because some kids can actually get dependent on the sippy cup and it delays those skills they need to drink from an open cup, which again are good for their mouth and muscle development. So I think the sippy cups are not bad to have around, but I would only use them when you really need to prevent that spill.

Jessica: This has been so helpful. Anything else you’d like to share with our listeners? 

Dr. Amy: No, I would say in general, the kids have… I believe there’s an innate knowing that they have, and I would say keep it positive, keep it lighthearted, just keep the timeline that we talked about in mind before three years wean the pacifier around six, seven months introduce the cup, and the rest of it, I would let the kid take the lead and keep it fun.

Jessica: Great, thank you so much for being with us today.

Dr. Amy: Of course, thank you so much.

Takeaway #1:

A baby’s sucking motion releases hormones that help them sleep. Pacifiers are one way to activate that process. Your baby’s thumb achieves the same thing.

Takeaway #2:

Dr. Amy says that most children will independently drop the pacifier or thumb by the age of 3. Past that point, there is a concern that having something in the mouth can affect the trajectory of the teeth. Pacifiers may also interfere with an opportunity to try out sounds, so keep a close eye on language milestones if your child is using a pacifier. 

Takeaway #3:

Rather than gradually removing the pacifier, Dr. Amy recommends picking a date, embracing the discomfort that will follow, and acknowledging your child for moving past this stage. Stay positive – your child will pick up on your enthusiasm and confidence!

Takeaway #4:

Open cups can be introduced with solid foods – so around 6 months. Your baby should be sitting up and showing an interest in putting things in their mouth. Start your baby with a small, empty cup during mealtime. Slowly add a little bit of water at a time. Fun fact: The motor development required to drink from an open cup helps with speech development. 

Children can get dependent on the sippy cup, so reserve these for times when you’re concerned about spilling, like in the car.

You can find more tips on pacifiers and cups on our Lovevery blog.