We are born with an instinctive sucking reflex on which we are dependent for our early survival.  Sucking is essential for nourishment of the newborn and also provides physical and psychological comfort.  By seven months the need for sucking decreases as the developing musculature prepares us for eating, drinking, and chewing.  Non-nutritive (pacifier, thumb) sucking beyond the second or third year can lead to an imbalance in muscular activity and potential malocclusion (crooked teeth).  Prolonged pacifier use can result in crossbite-- a reversed relationship of the upper and lower back teeth.  Prolonged thumb sucking can result in an open bite (front teeth fail to meet), a high, narrow palate, and increased overjet (buck teeth).  There appears to be no benefit to physiologic vs. conventional pacifier designs despite manufacturers' claims. 

Babies who are bottle fed for their first six months are more likely to develop pacifier habits than breast fed babies.  There is no known association between bottle feeding and thumb sucking.  Pacifier use during the first week of life has been shown to reduce overall time spent breast feeding.

Pacifier use has been associated with an increase in inner ear infections.  All pacifiers should have air holes and large flanges to protect against asphyxiation.  Long cords should be avoided to reduce the risk of strangulation.

Babies who sleep in their parents' bedroom (not in their parents' bed) and are offered a pacifier do not sleep as deeply as those who sleep in a separated bedroom without a pacifier.  A pacifier at bedtime may reduce the likelihood of SIDS (sudden infant death syndrome).  A pacifier dipped in a sugar solution can help relieve minor pain in the first few months of life.  Once the first teeth have erupted, however, the use of a sugar solution will significantly increase the likelihood of tooth decay and should be avoided.

Pacifier habits persist longer today than in the past.  The appropriate time to discontinue pacifier use depends on the developemental stage of the child, the harm or potential harm to the oral structures, the availability of methods to stop the habit, and the perceived medical and social needs.  The best time to discontinue is at two years of age.  Half of all children will discontinue on their own at approximately this age.

Thumb and finger sucking tend to persist longer than pacifier sucking and may be more of a challenge to overcome.

Suggested methods for ending a pacifier habit are dipping in white vinegar, cutting the nipple shorter, or abrupt permanent removal.  Thumbs cannot be abruptly removed, but there are over the counter products that create a bad taste when painted on your child's thumb.  Wearing a mitten to bed is another potential aid.

THINGS TO CONSIDER

• Do not scold your child for thumb sucking or pacifier use, offer praise for not doing so.
• Children often suck their fingers when feeling insecure. Focus on correcting the cause of the anxiety and comfort yourchild.
•  Reward your child when he or she avoids thumb sucking or pacifier use during a difficult period.