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Thumb-Sucking & Pacifiers, Ages 1 to 3

Should I be worried that my toddler sucks his pacifier all the time?

No. For children between the ages of 1 and 3, sucking on a thumb or pacifier is natural. It can help your child with new challenges, such as sleeping through the night, eating with the family, and going on a long car ride. Sucking is a life skill that your child began in the womb and perfected as an infant. As he becomes a toddler, you may worry that sucking his thumb or pacifier will impair your child's developmental growth by making it harder for him to talk or play. That's a legitimate concern after age 4, but there's no cause for alarm now.

Will sucking a thumb or pacifier hurt my child's teeth?

It's unlikely. According to the American Dental Association, children can safely suck their thumbs or a pacifier until age 4 or 5 without damaging teeth or jawlines. But you'll probably want to encourage your child to stop by age 5 or 6, when permanent teeth begin to appear.

It's not the pacifier or thumb per se that can harm your child's teeth over time, experts say; it's the intensity of the sucking. Children who rest their thumbs or pacifiers passively in their mouths are less likely to have a problem than children who suck aggressively. So now is a good time to watch your child's behavior: If he sucks hard, you may want to begin curbing his habit a bit earlier, say at age 4.

Which is better: pacifier or thumb?

Neither is clearly preferable, though each has pros and cons. A pacifier can free your toddler's hands and fingers, letting him explore his world. It can also reduce the likelihood that he'll suck his thumb, a habit that's generally harder to control and stop. And you can always take away the pacifier if it begins to interfere with meals or talking (though your child may protest). Another plus is that children often naturally abandon their pacifiers between the ages of 1 and 3, while thumb-sucking, particularly at night, may persist until age 4 and beyond.

But you have to pay for pacifiers, and you'll spend a lot of time picking them up and washing them. You'll also need to choose pacifiers carefully, buying a nipple with a shield that's at least 1 1/2 inches across so that your child doesn't swallow or choke on it. Also, never attach a pacifier to his shirt with any kind of string, ribbon, or cord; he might wind this around his neck or wrist and harm himself.

Unlike a thumb, a pacifier is easily lost or dropped on the floor; your child may wake up more often at night and cry when he can't find his "binky." And it's temptingly easy to pop a "plug" into your child's mouth instead of solving the real problem when he's hungry, tired, or bored. Finally, pacifiers can wrongly provoke critical remarks from grandparents and others who may see their use as a sign that your child is emotionally frail or needy. (Experts say there's no correlation between emotional health and pacifier use or thumb-sucking.)

The choice between pacifier and thumb is really up to you and your child. Which one does he naturally prefer? And what would you rather deal with: the hassle of buying, cleaning, and packing pacifiers now, or the challenge of stopping thumb-sucking later?

Why does my toddler suck his thumb mostly at night or when he's upset?

Fatigue, fear, boredom, and illness are among the major reasons toddlers seek the security of a thumb or pacifier. Sucking can help your child get to sleep and comfort him if he wakes. A thumb or pacifier may sometimes prevent your child from crying, giving him a chance to calm down and catch his breath when he's upset. Of course, nothing -- not even a thumb or a "binky" -- is better for your child than you are. If you notice that he's sucking more than usual, take it as a signal that he may need extra cuddling -- or a snack.

What can I do now to prevent sucking from becoming a bad habit?

While sucking at this age is normal and healthy, you may want to help your child reduce his dependence on his thumb or pacifier, so that he can give it up at an appropriate time. The key is to notice when and where sucking occurs. If you see your child sucking his thumb and you know he's hungry, suggest a snack. If he tends to suck his pacifier when he's tired, work more naps into his day. Or if frustration is the problem, encourage him to express his feelings. Together, you and your child can find solutions.

Further Resources

National Institute of Child Health & Human Development
http://www.ncbi.nlm.nih.gov/pubmed/2676311

References

American Dental Association. Thumbsucking. http://www.ada.org/2977.aspx?currentTab=1

Frances L. Ilg, M.D., Louise Bates Ames, Ph.D, and Sidney M. Baker, M.D. Child Behavior: The classic child care manual from the Gesell Institute of Human Development. Harper Paperbacks. 1992.

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