Pacifiers and thumb sucking provide immediate stress reduction and promote relaxation, there’s never been any doubt about that. For the kids doing it, too, not just for their parents! That’s undoubtedly one reason babies and toddlers go for it when life throws some novelty at them, or it’s sleepy time. Recent research has suggested another reason this reflex is so common and ingrained. Babies put to bed with pacifiers have a lower rate of Sudden Infant Death Syndrome (SIDS). There’s no data yet on thumb sucking and SIDS, but there may be a similar effect.

So there’s that. The rest of the story is that this apparently instinctive and more or less universal behavior is nothing to worry about unless it goes out of bounds. It begins in the womb.  If it goes on too long or is too vigorous, if it’s just too much, then it can cause problems.  

The main oral health issues related to pacifiers and thumb sucking arise from the growth and development of the jaw in infancy and early childhood, and with the eruption of teeth. Teeth aligned to “fit” around a thumb or pacifier nipple are not normally aligned teeth, they are misaligned. Misaligned baby teeth are a kickoff to a chain reaction of problems including malformation of the jaw, speech issues, misalignment of the permanent teeth, and increased risk of tooth decay. Development of the roof of a child’s mouth can also be altered, or it may become hypersensitive.  

A medical issue was discovered by researchers in 1994, a connection between pacifier use and middle ear infections (otitis media). It is thought that sufficiently vigorous sucking action opens the eustachian tube, connecting the throat and the middle ear. This is the tube that we try to open during takeoff and landing in an airplane, to relieve the ear pressure. It’s supposed to stay closed until an air pressure change requires “clearing” of the ears. Sucking on a pacifier may be allowing liquids, and the bacteria they carry, to seep up from the throat into the ear, causing infection.  No connection has been observed between thumb sucking and ear infections.

Kids should start to abandon their “non-nutritive” sucking habits at around two years old, and be done with it by age four. When the behavior persists after that, or issues arise earlier due to over-vigorous or too much sucking, parents and pediatric dentists need to work together to change the child’s behavior. Home interventions are often effective, and when they’re not, dentists can provide oral appliances,  and also paint-on medications for the thumb, both of which discourage sucking.

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