Those Little Suckers!

Pacifier Use and the Potential Effects on your Child’s Speech Development

Pacifiers. Where do I even begin? As a first time mom, especially one who went back to work after 12 weeks, I can say that I’m a pacifier lover. It was my savior at 3am when I just needed a solid 5 hours of straight sleep. Or at a restaurant when my newborn wouldn’t stop screaming. But as a pediatric speech pathologist, to say “I’m not a fan” of pacifiers would be putting it kindly.

When my son was born, I attempted a complete pacifier ban. “No no, no pacifier, he’s fine”. “Honey” my husband would say, “He’s 8 weeks old and he’s screaming. He’s not going to have a speech delay. RELAX.” My type-A self reluctantly relinquished control and sure enough, the pacifier did the trick. Within a few moments I had a peaceful infant. By the time my son was 7 months old, he had moved on from his pacifier. I did a little dance and enjoyed a few glasses of wine to congratulate myself. Good work Rachie!

But I’m fortunate. For starters, I have the knowledge. My education is in speech and language development. Secondly, I’ve had first-hand experience treating children with speech and language delays. Two children, in particular, that I work with are experiencing speech delays related to extended pacifier use. Third, my son wasn’t very attached to his pacifier, which made for a smooth breakup. And lastly, I’m type-A, did I mention that? I like to get things done, check it off my list. And this was one of them.

As many of my friends are becoming first time moms, the biggest question I get is “When should I take away the pacifier?” While I do have an approximate age for that (10 months, but more on that to come), I think it’s important to educate ourselves on WHY our babies love these little suckers (no pun intended) so much. What do pacifiers do for our infants that some become so attached to them?

Babies like to suck – pacifiers, fingers, thumbs, you name it. This is referred to as Nonnutritive Sucking Behavior (NNSB), or sucking that does not provide nutrition to the infant. Sucking is a natural reflex for babies and it’s completely normal. Sucking helps soothe our little babies who are new to our hectic world. It helps them feel calm and secure, and as a result, fall asleep easier. So naturally, infants come to enjoy their pacifier. But when is the pacifier not being used properly? When does it begin to have adverse effects on our infant’s development? And how do we prevent ourselves from building bad habits with a pacifier?

At approximately 10 months of age your child will begin to produce some sounds. Currently, my 12 month old son communicates using a combination of pointing and babbling “ah!”, “ga”, “da”, “gada”, and variety of other syllables. As both a professional in the field and a mom watching my son develop, I can tell you that children grow at rapid speeds. Their brains are like sponges; absorbing every sight and sound around them, and with that they attempt to communicate and speak more each day. But what happens when something is blocking that natural speech development? Before looking at the research, I want you to ask yourselves these questions: If there is something in your mouth when you are trying to speak, are others going to be able to understand clearly? And if that something is in your mouth for extended periods of time, is it promoting natural and appropriate speech or growth of the mouth?

David Beckham with daughter Harper, age 4.

Refer to these term explanations below while reading the upcoming research:

Malocclusions: misalignment of the teeth and therefore improper bite.

Nonnutritive Sucking Behavior (NNSB):a sucking behavior that does not provide nutrition to the infant.

A 2010 study from the University of Iowa on the Effects of Prolonged Pacifier Use on Speech Articulation found that non-pacifier users scored greater on all articulation tasks than pacifier users. In other words, non-pacifier users demonstrated better articulation skills that pacifier users. While they suggested extended pacifier use may have affected overall articulation skills, the data did not represent a clear relationship between the two. Similarly, a 2018 study at the University of Arkansas was unable to confirm a direct relationship between pacifier use and articulation skills. However multiple studies have established a link between extended pacifier use (and other NNSB) and dental and mouth development. A study of dental malocclusions from approximately 15,000 children from one orthodontic clinic concluded that a sucking habit resulted in 60% of the dental malocclusions that were seen in those patients (Van Norman, 2001). The American Dental Association (2003) reported that pacifier use in 3- to 5- year-old children led to improper growth of the mouth, palate, and a variety of dental malocclusions (open bite, cross bite, overjet).  Dental development is directly linked to the production of certain speech sounds such as /f/, /v/, /th/ in thick, /th/ in these. Palate growth and shape is directly related to the production of sounds such as /t/, /d/, /sh/, and /ch/. So, while the research fails to confirm a clear cut relationship between extended pacifier use and articulation skills, it suggests one.

 Anterior Open Bite (above photo)

Posterior Cross bite (above photo)

Overjet (above photo)

Have I lost you yet? Are you still with me?

Now I’ll share with you my professional experiences with pacifiers. I’ve treated two children of whom exhibited speech delays associated with malocclusions due to prolonged pacifier use. Both children were 2+ years old when I began working with them. Child A presented with a significant anterior open bite and high palatal arch, and continued pacifier use through the first 6 months of therapy. Child B presented with a less severe anterior open bite, and stopped pacifier use shortly before therapy began. Child B graduated from therapy after 1.5 years. (Mazel Child B!)  Child A continues to receive therapy (I should mention he also has a language delay). Therapy continues to address both his speech and language. He has been in therapy for 2.5 years and has made significant progress with both his speech and language skills. However he continues to have difficulty with a few age-appropriate sounds, so we still have some work to do (You’ve got this Child A!).

BOTTOM LINE

Prolonged pacifiers use and other NNSB cause a variety of dental malocclusions and improper growth of the mouth and palate. As a result of poor dental and/or palate development, children can and may develop speech production delays. Infants begin producing sounds at approximately 10 months of age. 10 months is when I would suggest cutting ties. At that time, pacifiers should be weaned to allow for proper growth of the mouth and natural speech development. Let’s remember that infants suck to soothe and relax themselves. And as children get older, there are other items and ways to calm the emotions (I personally held on to my sweet Chicky until an age I’m too embarrassed to say, but that’s for a later time). The earlier you boot the pacifier, the easier the process will be.

For those out there who are struggling to part ways with your infant’s pacifier, I can promise you that their cries won’t last forever. And they won’t remember this at all! For those out there who have a 2+ year old who remain besties with their pacifier, here are some helpful hints and resources to help you.

• For using the pacifiers with the soft animals at the end, try cutting the animal off. The animal itself may continue soothe them without the pacifier attached.

 

• Time it right – don’t remove the pacifier when there’s a major change going on. For example, starting school, moving, a new sibling, etc.
• Weaning is more successful than cold turkey.
• Limit pacifier use – For example, only use when it is time to sleep. Then limit to only night time sleeping.
• Team effort – get everyone on board. Mom, dad, babysitter, grandparents and any other caretaker should know the plan.
• Star Chart – For older children, find something he/she really wants. I mean, really, really, really wants. Put a picture of it at the bottom of the star chart. For every day they go without the pacifier, they get a star. By the time they reach the end I’m confident they’ll have forgotten about the pacifier because they’re too excited for their prize!
• Books – below are some stories that older children can relate to.

1. Good-bye Pacifier! by Patricia Geis

2. Chupie: The Binky That Returned Home by Thalia & Ana Martin Larranga

3. No More Pacifiers for Piggy! by Bernette Ford

4. Bea Gives Up Her Pacifier by Jenny Album (Also try Ben Gives Up His Pacifier)

5. Caillou: Rosie’s Pacifier by Christine L’Heureux

6. Pacifiers Are Not Forever by Elizabeth Verdick

From your fellow first time Mom and Pediatric SLP, I hope this helps. Always feel free to reach out.

Rachel Kirson M. S. CCC-SLP, TSSLD

References

American Dental Association (2003). Dental effects persist regardless of type of pacifier used: Study, 2003 [Data file]. www.ada.org

American Speech and Hearing Association Convention (2010). Effect of Prolonged Pacifier Use on Speech Articulation. American: Study, 2010. www.asha.org

Shotts, L.L., McDaniel, D.M., and Neeley, R.A. (2018). The Impact of Prolonged Pacifier Use on Speech Articulation: A Preliminary Investigation. Contemporary Issues in Communication Science and Disorders, 35, 72-75.

Van Norman, R (2001). Why we can’t afford to ignore prolonged digit sucking. Contemporary Pediatrics, 18, 61-81.