I recently participated in the following conversation on Facebook:
Jane: “While at Costco this afternoon, I saw a 4 year old boy with a pacifier in his mouth. My 2.5 year old son pointed at him, giggled and said, ‘baby.’ Exactly.”
Karen: “Sorry, Jane, but you don’t know that child’s developmental or medical history. There are plenty of invisible disabilities that affect more children now than in any previous generation. People have made judgments like this about my parenting for the past 11 years.”
Jane: “Can you explain to me then how a pacifier at such an age is advantageous, because I see it a lot and don’t understand. Seems it would hinder speech if anything.”
It’s not possible to know the exact numbers, but there are many parents who choose to allow their children to continue bottle-feeding or using a pacifier well past infancy and toddlerhood. Every pediatrician, dentist, speech therapist, grandparent and even strangers in the grocery store warn against it – or worse, ridicule it. So why do parents still permit it?
The Need For a Pacifier or Bottle
In most of the cases of which I am aware, parents would love to wean their children off the bottle or pacifier, but see it as the lesser of two evils. Some of the bigger evils are:
Gastroesophageal Reflux Disease (GERD)
The sucking motion helps keep acid in the stomach, and extra saliva helps neutralize acid, often more effectively than medication in young children.
The sucking motion positions the tongue behind the pacifier, which helps keep the airway open.
Grinding the teeth, biting inside the mouth, tongue thrusting or picking at the lips and gums can all lead to infection, discomfort while eating and permanently damaged teeth. A pacifier is an easy distraction for these behaviors.
Sensory Processing Disorder (SPD)
Everyone knows someone with an oral fixation – and a pacifier is often preferable to putting unsafe foreign objects in the mouth. Some children with SPD gag on the textures of solid food and need to be bottle-fed in order to gain weight.
Medical research has consistently demonstrated that sucking triggers a beta-endorphin response, which in turn produces a mild analgesic effect and a feeling of pleasure. Children with special needs may be unable to verbalize physical sensations such as pain, but they will instinctively start sucking to reduce pain.
Most infants outgrow the sucking reflex by age 2, but children with developmental delays may still have the constant urge to suck for several years. Giving a child a pacifier is a safer option than allowing them to suck on foreign objects.
All of these issues are widespread in the special needs community. In fact, some medical supply companies offer adult-size pacifiers to reduce snoring and sleep apnea. My older son never wanted a pacifier, but because of his severe sensitivity to solid food, he was bottle-fed until he was 4.5 years old.
Why my son used a pacifier
My younger son has food allergies and GERD. His digestive problems kept him awake and distressed all night, every night. His pacifier allowed him to sleep for a few hours at a time, and he was unwilling to give it up until he was 3 years old. This was not what I wanted for my children. But I had to find a way to meet their needs and to support their natural development.
In the book Caring For Your Baby and Young Child, published by the American Academy of Pediatrics (AAP), pacifiers are recommended as a harmless tool to help infants fall asleep and to reduce colic. Most cases of colic are now understood to be caused by GERD, according to pediatric gastroenterologist Bryan Vartabedian.
Five Steps to Getting rid of the pacifier and bottles
Interestingly, the AAP does not offer any advice for reducing or eliminating pacifier use. But I know from my personal experience that is absolutely possible to get rid of the pacifiers and bottles with no tears shed. I’m not saying it’s easy or quick. These are the steps I took to help my kids make the transition:
1. Identify Physical reasons
Identify all of the physical reasons for pacifier or bottle usage, then target them one at a time with support from your child’s medical team. For example, a bite guard is a better way to prevent damage caused by grinding teeth. A dentist can also prescribe a specialized mouthpiece to prevent sleep apnea. Ask your occupational therapist to recommend safe items for oral fixations – there are therapy catalogs full of items such as Chewy Tubes or Tri-Chew. An occupational therapist is also a good resource for oral-motor feeding issues. Finally, consult with a physician about other ways to manage chronic pain or acid reflux.
2. Identify Emotional Reasons
Identify emotional reasons for pacifier or bottle usage. Since there is almost always an emotional attachment to a pacifier or bottle, it will be necessary to substitute another attachment item gradually – or substitute hugs or other types of positive attention (such as reading a book together). My 5 year old now falls asleep holding his stuffed animals after a bedtime story.
3. Place limits
Place limits on the time and location for pacifier or bottle use, and slowly reduce the amount of time over a period of several weeks. This will allow the child to see that he or she can function independently of the pacifier or bottle.
4. Find Alternatives
A water bottle with a sport cap or a cup with built-in straw can be introduced as an alternative to a bottle or pacifier. This will satisfy the sucking instinct without affecting the shape of the soft palate or development of teeth. My kids refused sippy cups, but they did very well with water bottles.
5. Positive Reinforcement
Remain positive when discussing the transition. Consider giving a box of bottles and pacifiers to someone with a younger child as a symbolic gesture of growing up. My older son put his own bottles in the trash when he finally learned to drink from a cup. Plan a small celebration that is meaningful to your child.
Ignorance of a family’s private circumstances is an excellent reason to refrain from judgement. When I’m out running errands, I often see older children in strollers, children who suck their fingers or a pacifier, children holding bottles or other attachment items, children clinging to their parents with an anxious expression. They remind me of my own children. Their parents obviously have more pressing concerns. So I try to make eye contact with the parents, and I smile a knowing smile.