What is non-nutritive sucking and when can it cause a problem?
Non-nutritive sucking and its effects
Sucking on a pacifier, thumb, another digit, a blanky, or a stuffed toy all fall under the broad label of non-nutritive sucking (NNS). The child is not sucking on the bottle or at the breast, i.e., the act of sucking is not yielding any nutrition, hence the name. But even though it’s not nutritious, is it pointless? Hardly. We see babies on sonograms sucking their thumbs in the womb. Sucking is part of the rooting reflex and is a normal and healthy occurrence in development.
Prolonged NNS, however, can produce unwanted dental changes as the child ages. Oral habits sch as NNS habits apply pressure to the dental and bony structures of the mouth and face. The object being sucked on, the lips, the tongue, and the cheeks all exert forces that can result in movement of the teeth and shifting of the bite position. The degree of change to the teeth and bite position depends upon the frequency (how often), intensity (how strong), and duration (how long) of the habit. If a child is engaging in an NNS habit often, with great force, and for long periods of time, then noticeable changes to the child’s bite will likely result.
How to know when a non-nutritive sucking habit might be a problem
Most children stop a non-nutritive sucking (NNS) habit on their own between the ages of two and four years. Studies have shown that the longer an NNS habit persists beyond 3 years of age (36 months), the more likely any concurrent dentoalveolar (teeth and bone) changes may persist. These dentoalveolar changes, such as narrow palate, crossbite, open bite, buck teeth, tongue thrust, and long face height, may require costly orthodontic interventions for correction. The American Academy of Pediatric Dentistry recommends that dentists provide counseling and anticipatory guidance to children (and their parents) with a persistent NNS. Most pediatric dentists consider a potentially problematic NNS habit one that persists beyond age three years.
How do I help my child stop a persistent pacifier habit?
A pacifier habit is easier to stop than a thumb habit, simply because the pacifier isn’t permanently attached to the child’s body. If your child has a persistent pacifier habit, try the tips I list below (I’ve also created some accompanying video demos that I’ll list on Instagram, Tiktok, YouTube, and Facebook over the coming week). I’ve counseled many parents and children in the office who found success with one of these methods. Also take a look at Part 2 of this post, which goes into the psychological reasons behind persistent sucking habits. The information in that post also applies to pacifier habits and may further increase your odds of successfully kicking the persistent habit.
Tricks for ditching the pacifier (updated 08/10/21)
**DISCLAIMER** for the two methods below that use cutting or hole-poking, be aware that doing so could pose a choking hazard to your child. It compromises the integrity of the pacifier bulb so that the pacifier’s safety standards (Consumer Product Safety Commission) no longer apply – so do not let the child use the modified pacifier unsupervised. The best practice would be to simply note that the pacifier is now broken (due to a hole) and together with the child throw it away.
- **The hole-y grail: Poke holes in the bulb tips of all pacifiers (consider dwindling your supply to just a handful over the days leading up to this) with a sewing pin or scissors. Show the child the holes and explain that the pacifier is now broken and throw it away. You can purchase a product like the Ditch the Dummy (Amazon), but I am not aware of what safety standards it underwent and if they are the same as those for true pacifiers. For that reason I would still only allow the child to use it when supervised. Also keep in mind that your child may simply refuse it if the pacifiers she’s used to do not match the Ditch the Dummy’s shape.
A mom reported to me that after performing this hole-poking trick her daughter simply handed her the pacifier and said, “No work,” and that was that. She never used it again!
- **The Chopping block: This method is similar to the one above but more aggressive. Take your dwindled supply of pacifiers and cut off the end of the pacifier bulb. Like above, explain to the child that it is broken and now needs to be thrown away. There’s a Fridababy (Amazon) weaning kit available that contains pacis at pre-shortened lengths, but like the Ditch the Dummy, I’m not aware of the safety standards it underwent, and the bulb shape also may not be similar enough to your child’s current preferred pacifier to be effective. I’d still only use it under supervision.
- The Beary Effective: Plan a trip to build-a-bear. This is my personal favorite and a frequent crowd-pleaser as reported by my patients and their caregivers. The pacifier is placed inside the stuffed animal at the shop and sewn closed, all with a big to-do and much praise! The child still receives psychological comfort from the stuffed animal, but will no longer use the pacifier. This one is probably the most expensive of all of the methods, but many caregivers report success using this method. This trick can also work if you perform a little outpatient surgery on a teddy you have at home, and that would make the method a little more cost-effective as well. I’ll be uploading a video to social media shortly demonstrating that version.
- The Re-Gift: Make a big to-do and gather up all of the pacifiers to “give them/mail them” to a neighbor, family member, friend, or dentist. Have conversations with your child over a series of days and get her on board with helping either a new baby in her life or the babies at the dentist by “giving” the pacifiers to the babies. Many kiddos have “mailed” me their pacifiers over the years and I just love informing them at their next visit just how proud I am of their kind hearts and how happy they’ve made all the little babies. They love it! (P.S. You’re not really mailing them, but taking the time to address the envelope with your child and even sacrificing a few stamps and putting the package in the mailbox before you toss it in the trash goes a long way!)
One final word about pacifiers
Please don’t be in a hurry to ditch the pacifier if your child is younger than a year old. Pacifier use has been shown in numerous studies to be protective against SIDS in the first year of life when it is placed for each naptime and bedtime. Let me say it loudly for the people in the back: this is me, a board certified pediatric dentist, telling you to please CONTINUE a pacifier “habit” (I hesitate to even call it that at this age) at naps and bedtime if your child is less than one year old! My three children never took to a pacifier, but in those desperate so-late-it’s-early hours I spent trying to get my fussy babies to sleep, you can bet I tried repeatedly. The only indication for delaying pacifier introduction is if you are breastfeeding. The AAP recommends waiting until nursing is well established, or around one month of age, before offering the pacifier. Once nursing is going well, then offer the pacifier with sleep and satisfy that oh-so-natural and healthy sucking reflex!
Please CONTINUE a pacifier “habit” at naps and bedtime if your child is less than one year old!
When the pacifier is utilized in that first year, it should be used when placing the infant to sleep for naps or at bedtime. It does not need to be reinserted in order to have the SIDS protective effect. Between 6 months and 12 months you’re balancing the SIDS protective benefit against the increase in risk for otitis media (ear infections) that is associated with pacifier use beyond 6 months. If your child is prone to recurrent ear infections, be sure to clean pacifiers often and your doctor may recommend weaning before 12 months.
Do not use a pacifier that’s been dipped in a sweet liquid, particularly honey, because honey has been linked to botulism in infants. For sleep, do not use a pacifier that’s attached in any way to the child’s clothing or other objects because it can be a choking hazard.
What about that in-between stage, after age one and before three years?
Beyond age one, pacifier use has been linked to more frequent ear infections. If your child is repeatedly coming down with them and is an ardent pacifier user, talk to your pediatrician because this may be an instance in which working to stop the habit before the “age three” threshold may be warranted. You could also try a more frequent cleaning regimen to see if that helps. Other reasons to work to stop the habit before age three might be hygienic, personal preference, or speech development (many SLPs recommend trying to wean by around 18 months, especially if the child is using the pacifier outside of sleep times). The tips here and in the next post should still prove helpful regardless of the child’s age.
One final word of caution, though, before you dive into weaning your “tweener” off the pacifier. I’ve seen many an 18-month-old pacifier sucker morph into a digit sucker with cessation of the pacifier habit. It is then that, in my opinion, your job becomes all the more challenging later because a digit habit is harder to break than a pacifier habit simply because you can’t remove the digit (unless you want jail time).
If your 12-35-month-old child is really loving that pacifier, my advice is to wean pacifier use to only naptime and bedtime by age 12 months, gradually dropping it for naps thereafter, and ultimately only using it at bedtime. This brief period of time of use (while falling asleep) is least likely to produce extensive jaw and tooth position changes and can be weaned quite easily when communication skills improve and you work as a team.
If nothing else is amiss such as a high ear infection rate then find something else to focus on for the time being. Maybe learn some baby sign language together so you can begin to talk about the pacifier in greater depth sooner with your child. Rest in the fact that research shows that the changes in the bite and teeth positions largely correct themselves with normal growth and development as long as the habit is stopped by 36 months of age. So give yourself a break, and let baby keep the binky a little longer!
Part 2: Coming soon!
Part 2 will dive deeper into the psychological considerations for a persistent NNS habit and provide specific tips for helping a child stop a digit sucking habit.
