Q&a With Dr. Jason Wanuck: Settling the Debate Between Thumbsucking and Pacifiers
Sara Connolly, MD, FAAP, Board Certified Pediatrician • January 2, 2019 • 5 min read
1. Dr. Sara: Dr. Wanuck, I’d love to hear what a pediatric dentist would recommend if a parent of a young infant asks, “Which is the lesser of two evils, thumb or paci?”
Answer : Dr. Wanuck: The American Academy of Pediatric Dentistry recommends pacifier over thumb, if you have a choice. I say that because some babies begin thumbsucking in utero and really prefer the thumb over the pacifier. For babies who need non-nutritive sucking, which is what we call sucking outside of feeding times, a pacifier is an easier habit to break in the long term. In terms of tooth development, both the pacifier and the thumb affect the teeth and jaw in the same way.
2. For those infants who take a pacifier, are there safety tips parents should keep in mind?
Answer : Yes, absolutely! Never dip the pacifier in anything sweet before giving it to the baby because it promotes tooth decay. Never use a pacifier cord or string to attach a pacifier to the baby or the bed because it can be a strangulation risk. Inspect and clean pacifiers frequently, and throw them away if the nipple is broken, loose, or torn. Never substitute a bottle nipple for a pacifier: it’s a choking hazard. The pacifier shield should be wider than the child’s mouth, and the entire object should not be able to fit into the mouth — if it does, it’s far too small.
3. For those infants who take a pacifier, when is the “right” time to wean them off?
Answer : The earlier the pacifier is stopped the better, but certainly by age three. As you know, pacifiers become transitional objects for young children, meaning that they are part of self-soothing. So, it’s important that you help your child learn other methods of self soothing beyond the pacifier so that its absence is not quite so traumatic. Some children do well with a gradual wean, meaning limiting the pacifier to very specific times of the day, at first, and then stopping all together. Some stop very suddenly and yet do very well. Working together with your child’s pediatric dentist can help you develop a plan for weaning.
4. How about loyal thumbsuckers? Can a pediatric dentist help them quit?
Answer : Absolutely! Part of the twice-yearly visit to the pediatric dentist is spent discussing sucking habits and coming up with a strategy on how to eliminate them when needed. Children are smart, so when they hear that their dentist needs them to stop and then learn why, they often surprise us in their willingness to try. In some cases, we use a mouth appliance to help break the habit, but often this is not necessary.
5. Can you describe how teeth change when exposed to prolonged thumb or paci sucking?
Answer : The prolonged use of a finger or pacifier habit may affect both the growth and development of the teeth and jaws. Upper anterior teeth are often flared forward and more at risk for dental traumas. Upper posterior teeth often end up positioned inside the lower teeth leading to a significant bite interference or malocclusion. The upper arch is often constricted, which also promotes an improper bite and potentially dental crowding. Changes in dental alignment and malocclusion may lead to potential difficulties with mastication and speech, as well as an increased likelihood for orthodontic intervention.
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