When should your child stop using a pacifier?

By Kameryn Griesser, CNN

(CNN) — Every night, Lauren Finney Harden and her husband would awaken to the cries of their first-born daughter, and a routine game of “paci pong” — where each parent takes turns retrieving the fallen pacifier — would ensue.

After countless sleepless nights, the Atlanta mother of two said she decided to enlist the help of the “paci fairy,” who would come in the middle of the night to exchange her 18-month-old’s prized binky for a brand-new pack of stickers. And it worked.

“I was shocked at how little fuss my daughter made,” Finney Harden said.

When it comes to anxieties around how and when to intervene on a child’s pacifier or thumb sucking habit, Finney Harden is one of many parents who has struggled, according to a May 19 poll conducted by the University of Michigan’s C.S. Mott Children’s Hospital.

Out of 820 American parents surveyed, about half reported their child used a pacifier, and a quarter reported thumb sucking habits. Most parents said the behaviors were effective to sooth fussiness and prepare for bedtime or naptime.

“These are common self-soothing techniques for children,” said Dr. Susan Woolford, a pediatrician at the hospital and co-director of the poll. “But then parents wonder about how to take it away without causing too much turmoil for the child.”

Children generally ditch these habits on their own between two to four years old as they find new ways to deal with stressors in their environment, Woolford said. However, some parents may want to intervene out of concerns for their child’s oral and emotional development.

Most parents surveyed agreed the pacifier should go away before age two, but parents of thumb suckers shared less of a consensus, with one in six saying they regret not weaning their child off sooner.

When is the right time?

Discouraging a child’s pacifier or thumb sucking habits is not a one-size-fits all decision, said Dr. Sarat Thikkurissy, a pediatric dentist and spokesperson for the American Academy of Pediatric Dentistry who was not involved in the poll. Adverse health outcomes often hinge on the frequency, duration and intensity with which the child uses the sucking reflex to self-sooth.

In some scenarios, the habits can cause the upper front teeth to flare forward, making it more difficult for the child to close their mouth, which could later lead to speech problems and mouth-breathing, said Thikkurissy, who is also a professor in the University of Cincinnati department of pediatrics. “The longer they go past age four, the less the changes are reversible.”

Pediatricians may also advise against a pacifier or thumb sucking habit if it’s getting the child sick. In particular, thumb sucking has been associated with frequent ear infections, said Dr. Dipesh Navsaria, a pediatrician and chair of the American Academy of Pediatrics Council on Early Childhood.

Still, the longer the child relies on the habit, the harder it becomes to break later.

“Ideally, if it’s not a huge challenge, trying to see (the) use of thumb sucking or pacifier use stop by 18 months is a good thing, but I wouldn’t get too worked up about it if it was still happening at age two, maybe even three,” said Navsaria, who is also a professor at the University of Wisconsin School of Medicine and Public Health.

If a child is still using a pacifier or thumb sucking publicly past the age of four, Navsaria said he may consider whether chronic physical pain or a development delay could be at play, in which the child may require more self-soothing behaviors.

Stressful environmental factors may also cause an old habit of thumb sucking to return, said Annie Pezalla, a visiting assistant professor of psychology for Macalester College in Minnesota, who studies child development.

“If you’ve ever had a really hard day and you go home and you want something that reminds you of your childhood, you want to bake cookies or curl up with a soft blanket into the fetal position, this is a psychological phenomenon of regression,” Pezalla said. “We regress back to earlier, sometimes more infantile states of being where we felt safe.”

Oftentimes, starting preschool or kindergarten can trigger the return of a thumb sucking habit, but parents should rest assured it’s likely temporary as the child manages the stress of their new routine, she said. In more extreme causes, early parental loss, military deployment of a parent, witnessing domestic abuse or other traumatic events could cause the habit to return too.

“When it comes to addressing (the habits), I start with one: ‘Are there any other issues going on?’ And number two, ‘what’s the parents’ perspective on what’s happening here,’” Navsaria said, adding that a primary care provider can help assess if intervention is necessary.

Intervention strategies

Parents in the survey listed a wide range of strategies to help end their child’s use of a pacifier and thumb sucking.

Common tactics for pacifier weaning included limiting the use to bedtime only, hiding or “losing” the pacifier, and teaching the child they were too old to use it through books or conversation — all of which Finney Harden suspects helped her daughter.

Parents reported thumb sucking habits were more difficult to end, with most opting to move the child’s hand away from their mouth and simply reminding the child to stop.

“It’s important for parents to talk with (their child) about the benefits of not using the pacifier or not thumb sucking and help them to develop other ways of self-soothing,” Woolford, the poll co-director, said.

Replacement objects such as stuffed animals or blankets could offer the sensory comfort a child is needing, Pezalla said, adding that new self-soothing habits should be rewarded by parents.

“Punishing children for their efforts to find comfort is likely going to make it worse,” she said. “I think showing children as much compassion as possible, and perhaps even being more affectionate with them could lead to a child feeling like, ‘Oh, I don’t need this anymore. I am safe, I am secure.’”

Overall, Pezalla, a mother herself, warned against judging other parents for their choice of how to address a pacifier or thumb sucking habit.

“I think more parents are turning to social media for guidance on the right and wrong way to raise their children,” Pezalla said. “They are losing their sense of intuition of how to simply follow the lead of their child and trust their own parenting instinct.”

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