When Does My Child Need to Stop Using the Pacifier?

Before we get into the why and how, let me say that I fully acknowledge that not every family will choose to follow the recommendation, and that’s ok, because there are ways to correct the damage caused by prolonged pacifier use (and other forms of “non-nutritive sucking”), and that will be the topic of another blog post. For the time being though, I will focus on why it’s so helpful to get rid of the pacifier sooner than later.  

Why Stop the Pacifier by Age 1?

A baby’s bones are relatively soft and malleable, and their shape can be easily influenced by external forces. A good example is the flat spot that babies can get on their head from lying in the same position for an extended period of time, which then requires wearing a helmet to correct the shape of the malformed skull. Similarly, the shape of the palate (upper jaw bone) is adversely influenced by prolonged pacifier use. The extended use of this “external force” puts pressure on the palate in a way that tends to make it more narrow and high, like in the picture below. (The child in this photo is between 7-8 years old.) 

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The proper anatomic shape of a healthy palate should be much shallower and wider, like in the photo below. (The child in this photo is about 10 years old.)

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Do you see the difference? The shape of the palate has important implications for the tongue and its placement, which, in turn, has important implications for swallowing, speech, and breathing. 

“Big Tiger, Small Cage”

The tongue, which is one of our strongest muscles proportionate to its size, is kept from shaping the palate when there’s a pacifier “roadblock”. The pacifier interferes with the tongue resting on the palate, and as the palate reshapes to become narrower and higher throughout toddlerhood, once the pacifier is finally eliminated, the tongue (the tiger) doesn’t have adequate space (small cage) and will ultimately function somewhat abnormally. A perfect example of this is a tongue thrust, where a child has to protrude the tongue forward to swallow and close the gap that exists between the upper and lower teeth. The photo below shows what we call an “anterior open bite” which is a common consequence of prolonged pacifier use. Notice how the child has “closed” (back teeth are touching at full contact), but no teeth in the front even come close to touching. Biting into foods becomes tricky, and children may have to compensate in all kinds of ways, not the least of which is avoiding many different types of foods, so they may even get mislabeled as “picky eaters”, when there is actually an anatomic problem with their jaw relationship. 

What About Thumbsucking? 

If you’re wondering how this is different than thumb or finger sucking, then I like how you’re thinking. Same problem. The good news is that it’s pretty atypical for a child who was accustomed to a pacifier, to then develop a digit sucking habit once the pacifier is eliminated. A digit sucking habit is most often noted soon after birth (and can many times even be observed in utero with modern technology!), and though no one can say for sure why some newborns are drawn to this as a method of soothing, there is also a theory that says the habit comes from more than just the need for comfort, but also the need to open the airway more. The jury is still out on that one, as far as I can tell, but it’s certainly food for thought.

By the way, if you look at the label on the popular Soothie pacifier, you will find that the indicated age range is 0-3 months. I’m in the camp of providers who believe that it’s perfectly appropriate for a newborn to be given a pacifier if the caregiver chooses to have this as an aid; the key is just eliminating it at the appropriate time. Keeping that pacifier beyond the recommended age range, and  then adding a stuffed animal to it (e.g. Wubbanub) with the extra weight and force, is likely to have undesirable consequences. 

Beyond 3 months, it’s best to transition to an “orthodontic pacifier” that has a thin and flat nipple, such as the Nuk® or MAM pacifiers. I have no financial ties to either company. Those are the ones that I’d recommend, based on the shape of the nipple. I have a slight preference for the Nuk® ones because all the ones I’ve ever seen have the same basic nipple shape, whereas with the MAM, there is still some variance with different types. But both are more appropriate than Soothies beyond 3 months. You can certainly transition sooner than 3 months as well.  

Professional Advice With A Personal Perspective

While it’s easy to say to get rid of the pacifier by age 1, it’s not necessarily easy to do.  Ask me how I know this. For my 1st child, I took the pacifier away around 9 months. We had a couple of fussier bedtimes, and then it was “out of sight, out of mind”. We never looked back, and this child has a textbook-perfect palate, with a set of widely spaced baby teeth, which is great.  

For my 2nd child we waited until closer to age 2. Why? Well, she has the type of high-pitched scream that almost makes your eardrums burst, so it was much more challenging.  But, she has a handful of oral and dental issues now, and I know from my training and experience that chances are slim to none that she will “outgrow” these issues.

Of course, like any mother, the mom in me looks at her and sees nothing but the most beautiful, darling girl. The pediatric dentist in me, on the other hand, sees the need for early orthodontic intervention and is slightly annoyed with myself for not “ripping off the Band-aid” sooner. The only reason I’m sharing the anecdote of my own kids is to say that I understand the real life implications and challenges of the recommendation to eliminate the pacifier by age 1. So, just try your best, and if it’s simply not doable, plan on seeking out early therapy to reverse and correct the damage. 

How Do I Actually Get It Done?

The list below is a step-by-step guide, somewhat influenced by Montessori principles, and I personally really like this approach. This certainly isn’t the only way (cold turkey actually is highly effective also), but I’m sharing this for some specific guidance for those of you that know you want to get rid of the pacifier but are anxious about how to do it. 

Step 1

If your little one is using the pacifier during the day for comfort, begin by limiting it to just bed time.  When your child wakes up, place the pacifier into a container on a high shelf in your child’s bedroom. This will help both you and your child avoid reaching for it to get through difficult moments throughout the day. Instead, offer a cuddle for comfort or distract with a toy or activity. Distraction is highly effective!

Step 2

Get rid of all pacifiers completely from the house. Your child will need extra cuddles for a few days or a week, but most kids make peace with the transition much faster than their parents expect. I can say this with confidence because that is consistently the feedback I’ve gotten in the majority of cases with hundreds of parents. Our kids are capable of “rising to the occasion”. We just have to give them the chance by changing their environment. 

Why are there no more pacifiers in the house? Some fun ideas...

• You can tell your child that you gave the pacifiers to a family with a new baby who needs them. You can explain that babies need pacifiers, but big girls/boys don’t, and she/he is big now. If you need to, you can then re-focus on all the great things big boys/girls can do that babies can’t do. 
• You could cut the pacifiers up so that they are  “broken” and your child may even help you throw them in the trash if they try them out and find they don’t like them anymore in their broken version.
• My personal favorite is “The Binky Fairy” who takes all the pacifiers for new babies and leaves a little toy or stuffed animal instead for the “big boy” or “big girl” who was so nice to do this. This works great for 2+ year olds. 

At Shady Grove Pediatric Dentistry we love to celebrate this milestone with our little patients, and we will gladly give your child a special prize and lots of praise.  Share your child’s success with us! If you take a photo of your child to commemorate the day of “pacifier liberation” and share it on your social media, tag us so we get the memo. 

And remember, it’s easy to think that if the first day or two is rough that it’s not working, but the first days are the hardest. It will help you to mark off the days on a calendar and set a goal for yourself to give it 7 days. Most of you will find it doesn’t even take nearly that long, and you’ll be glad you did it. Remember, you are not “being mean” by taking away the pacifier -- you are doing your child a HUGE favor. Good luck! You got this!

In Health and Happiness,

Dr. Bana Ball