Will your child ever be ok with giving up the pacifier? How? Sucking is totally natural. It just feels good to suck! And for parents of a cranky baby, simply a Godsend! But, sucking for comfort (NNS – non-nutritive-sucking) can become a problem as we transition out of babyhood and into toddlerdom.  Pacifier use can inhibit vocal expression, communication and language skills. It can cause dental problems (cross bite and palate issues), is documented to increase the incidence of middle ear infections and can hinder the emergence of adult teeth.  Pacifier use could even stunt emotional development, especially in boys. (**More Findings from studies appear at the bottom of this page.)  A pacifier is also a strong sleep association that might cause frequent night waking when the child comes out of a normal sleep cycle and the pacifier isn’t in the mouth – and they then need help to find it. 

Working first as a preschool teacher and nanny for so many years, and then as a parent coach, I have been with families trying everything to be rid of the binky and below are my proven suggestions.  In general, I tend to go for gentle and gradual methods when attempting to change behaviors and habits in young children. But for certain topics, or for certain children, this can be confusing if you go a bit too slowly. Why? Because when rules are always changing – that can feel unsafe and unstable. Ending the pacifier is usually one of these.

There seems to be two schools of thought out there on pacifier cessation: cold turkey or gradual extinction (frequently and increasingly putting more limits on when and how frequently the child can have it). I prefer to aim for this middle way:

Binky Be Gone: A Plan

1) First, Set One New Boundary around when a pacifier can be had: At nap and bedtime, or just one of those? Only at preschool or daycare because she is newly transitioning into a new situation? Stick with that for a while until the new way becomes comfortable. Decrease usage by way of setting a time-frame boundary and also tell the toddler that he is growing up and will need the pacifier less and less and then one day he won’t need it at all.

2) Plan a Place for the Pacifiers to Go. Talk it up for a few days. Will they go to a new baby you know? They are collecting them at the doctor or naturopath or dentist. I don’t suggest planting it in the ground with some seeds as some websites suggest. We want the pacifiers far away from home and now there the child could stand over it and cry!  If your child is 3 or older, you can let your child choose from two good options for where the pacifiers will go. If your child refuses, you get to choose. Ask people nicely to play along. 🙂

3) Plan Replacement Therapy. This is not bribery. Like any physical habit/addiction, it is much more humane and comfortable to replace the unhealthy habit with a lesser evil as opposed to having nothing to turn to. But stuffed animals aren’t evil. Let your child choose a new one- fully informing them that they will have the new stuffy INSTEAD OF the pacifier tonight. I also know plenty of kids who like to sleep with a hard dinosaur guy – whatever they want! This won’t always work for every child on the first night. Occasionally a child will decide she hates the stuffy when you redirect from wanting a pacifier to holding the stuffy. Comfort your child (without creating new sleep associations like rocking, if you didn’t have them before) and try again the next night.

4) Add Positive Peer Pressure. I’m a big fan of this for learning to eat new foods, being willing to sit on the potty, etc. Children do really well learning from children their age or older. It simply points out that there is a new and different way to be, something to grow into. Resist using this method if you are comparing to a child who is younger and not using a pacifier, as the words we choose in that situation can be shaming without our meaning them to be. Find a play group or preschool with children who are older or who do not use pacifiers or talk with an older cousin about their experience getting through the change.

5) Comforts in Place, Expect Two or Three Hard Nights. Now that you have a plan for how the binky will go, make sure that you write down a list of your child’s best comforts. How do you comfort your child when they are cranky and sick? Remember those thing and write them down so that you can turn to them in a moment of desperation. You can offer a re-direction if it is related to the activity being asked for. Not a distraction or a game, but more like “If you need something to go in your mouth, here are a few raisins.”

NIGHTS:

In giving up the pacifier for sleeping, expect the first nights to be really hard. Keep your boundary, witness the verbalization of challenging feelings. Nobody likes ending a habit. We can have compassion and stay present and let our little ones have their feelings. 

Expect crying and expect to have to physically comfort your child in extra ways for at least the first night. Expect the bedtime routine to be very long and so start earlier than usual with bath and books. If your child attends daycare or preschool, you also will want to begin this on a weekend so any sleep interference doesn’t mess with your child at a time when you can’t be around for comforting. You can cuddle in bed if you bedshare or use a rocking chair for the first night or two with stuffed animals if you already use some rocking, or offer a sippy cup of water.  You could plan the first binky-less night to be one where you have had tons of family fun and activity that afternoon, a sleep-inducing swim, long bath and also a nice calm down period before bed. That combination should help sleep come faster even when there is much crankiness or crying after giving up the pacifier.

If your child typically wakes at night to find the pacifier, you will have to attend to your child when they wake, reminding the sleepy sweetie about the new plan using consistent phrasing. Say where the pacifiers went and let them know it is ok to be sad.  “It looks like you are sad about not having a pacifier. That is sad. I’m sorry. Here, have a sip of water. Hold your little bear.” Resist adding new behaviors in the middle of the night like getting up for food or adding extra milk. 

***Children who have learned to suck to sleep have not learned how to what I call “Work themselves down” to sleep. This comes with any major change in sleep association like giving up the pacifier, feeding to sleep or movement to sleep. It will be an entirely new process for the child to learn how to calm her body and mind after giving up the pacifier. We all must learn this eventually. As adults, we toss, turn, complain, have some more water, our mind races, we process the day, we pee again. Expect that it could take 30 minutes to 2 hours for the first few nights and one or two waking times where your child is a bit upset. If your child is content in the bed alone and you are used to leaving at that time, that is fine, even if it takes a long time to nod off. If your child is upset, I always suggest you be with him in the dark but model sleepiness so that you aren’t keeping the child awake.***

When is a pacifier beneficial? The AAP suggests they may be beneficial in reducing SIDS risks for babies under 6 months. This may be a great idea if your baby does not have the sleep death protections of exclusive breastfeeding and sleeping in the parent’s room or if there are risk factors like nicotine in the home.  However, the American Academy of Family Physicians recommend children giving up the pacifier in the second six months of life to prevent otitis media (ear infection).

If your child only needs non-nutritive sucking when they are supremely ill or supremely tired, if the time with the pacifier is ten minutes or less per day, and the pacifier is not being used as a means to fall asleep at night every time they wake at night – then you don’t have a problem that needs to be fixed. Minimal NNS like this will simply be gone one day on its own.

If you need support with communicating with your toddler/preschooler about this change, see my CAN WE FIX IT Consulting Package

-Rovers et al (2008) Is pacifier use a risk factor for acute otitis media? A dynamic cohort study. Pacifier use appears to be a risk factor for recurrent AOM. Parents should be informed about the possible negative effects of using a pacifier once their child has been diagnosed with AOM to avoid recurrent episodes.

–The American Dental Association (2003) reported that pacifier use in 3- to 5-year-old children led to anterior open bite, posterior crossbite, mean overjet, and smaller intercanine distance of the upper arch.

-Boshart (2001) suggested that dental problems associated with prolonged pacifier sucking could lead to speech articulation problems such as distortion of the fricative and alveolar phonemes.

-Norman, Van (2001) (A recent 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.

-Uhari M, Mäntysaari K, Niemelä M (1996) A meta-analytic multi-country review of the risk factors for acute otitis media. Clin Infect Dis. 1996;22(6):1079–1083. The World Health Organization study reported a positive correlation between pacifier use and increased incidence of otitis media (ear infections). The impact of otitis media on speech and language development is well documented.

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