The Pacifier and Thumb Sucking

When is it appropriate and when is it not?


The use of a pacifier and/or thumb sucking as an infant is common and does not have any negative effects if utilized for a short duration.  If the use of pacifier and/or thumb sucking is persistent for an extended period of time, it can result in various unwanted conditions.

When using a pacifier or when thumb sucking for an extended period of time, the muscles in the front of the mouth (including the lips) are used and developed more than the other muscles in the mouth.  It also influences positioning and use of the tongue within the mouth.  A forward position of the tongue may develop and continue to exist more when at rest or when swallowing.  This can influence various things include alignment of teeth, oral muscle development, the passageway of the mouth to the throat, and the development of the palate arch within the mouth. These deficits (misalignment of teeth, decreased oral muscle development, high palate) often impact oral motor feeding skills, articulation in speech, and most likely warrant orthodontics to correct alignment of teeth and/or correct the palate.  Tongue thrust should naturally phase out with normal development after early childhood.  Though if tongue thrust continues as a result from pacifier use or extended thumb sucking, it can result in additional articulation errors.  Pacifiers and thumb sucking can also highly influence the speech and language development of communication with limiting the opportunity for verbal communication secondary to something frequently being in the mouth and the inability for verbal expression for wants and needs (leading children to point or grunt for things they want or need instead of using words as they should).  Research has shown benefits of phasing out a pacifier and thumb sucking starting at 12 months.  Continuance past the age of 2 years old, increases the impact on the structure of the mouth.  Common ways to get children to stop include:

  • Begin phasing out with the use of a pacifier only during naps and/or bedtime
  • Exchange the pacifier for a different self-soothing object such as a blanket, stuffed animal, or an age appropriate oral motor chewy
  • Facilitate the use of an oral motor chewy in replace of thumb sucking; have it easily accessible for consistency and use prompts often to encourage the use of the chewy instead of thumb sucking

If the use of a pacifier or thumb sucking seems to be a sensory need, it is encouraged to replace the need with something more appropriate such as an age appropriate chewy (chewy tube, chew necklace, chew bracelet, pencil topper chewy).  Sometimes vibrating teethers or vibrating toothbrushes are also a great substitution.  Some resources for these types of items include:

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