Pacifiers Versus Thumb Sucking: Two Pediatricians Sound Off on Which Is the Greater Evil

It’s a debate that’s been raging for generations: Which is worse, pacifiers or thumb sucking? (Or are they both fine?) That’s why we consulted a couple of pediatricians—Allison Laura Schuessler, D.O., board-certified, general pediatrician at Geisinger, and Dyan Hes, M.D., Medical Director of Gramercy Pediatrics—to get their medically-backed takes.

The #1 Reason You Should Lick (Not Sanitize) Your Kid’s Pacifiers

baby using pacifier
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The Pediatrician Who Is Pro Pacifier: Dr. Schuessler

The Pros: “The big advantage of the pacifier is this: You can take it away. Typically, kids who suck fingers or thumbs will bow to peer pressure as opposed to parental pressure at about school age.”

The Cons: “Both pacifier and thumb sucking are bad for your toddler’s teeth if these habits continue past age two or four. After that age, both habits become problematic. With pacifier use, there are times of day that are more teeth-friendly. If a pacifier is used at bedtime and for sleep, we see less of an impact on teeth until the two- to four-year mark. Where it’s a concern is with children who are using it throughout the day—e.g., they have a pacifier in their mouth constantly. At that point, it can start to impact more than just their teeth, but their speech development, too. (You might even notice that they’ll babble less.)”

Her Advice: “All babies are born with a need to suck—it’s how they obtain nutrition. Non-nutritive sucking also has a soothing and calming effect. I advise limiting pacifier use to sleep and waiting until three to four weeks of age to introduce it if an infant is breastfeeding. After the age of one, it’s suggested that you stop using a pacifier full-stop. The only exception? If you’re flying and your child is under the age of two. A pacifier can help equalize pressure in that case.”

How to Break the Habit: “It’s not impossible to break the use of a pacifier after age four, but it’s difficult. It’s tough to remove objects that children use to find comfort. If the child associates the object with sleep, it will be even more challenging. The best way to do it is to be consistent. It will result in rough nights, but kids will adapt within the first week or so.”

baby thumb sucking
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The Pediatrician Who Is Pro Thumb Sucking: Dr. Hes

The Pros: “In utero, a fetus can be seen sucking his thumb as early as 12 weeks. Thumb sucking is often seen in newborn babies, too. Usually, it’s not a problem because it is used for comfort at nap time and bedtime or during periods of stress. Most kids do not suck their thumbs all day. In most scenarios, when a child wants to play, he has to take his thumb out of his mouth to use his hand. A pacifier, on the other hand, is a problem because some kids can go around with it all day, dangling from their lips like a cigarette. They can also cause dental malocclusion (imperfect positioning when the jaw is closed), increased ear infections and sometimes interfere with speech development, depending on use.”

The Cons: “Thumb sucking becomes a problem when the child is older and always sucking a thumb in public or not speaking because of it. There’s also the possibility that, just like the pacifier, it can cause dental issues. Most dentists recommend that thumb sucking stop by age three at the latest. It also should be said that some babies are given pacifiers in the first few days of life in the NICU because it has been shown to be an analgesic and prevent or lessen pain in babies. Pacifiers have also been shown to reduce the risk of SIDS in infants and, therefore, many pediatricians recommend their use until six months of age.”

Her Advice: “I recommend eliminating the pacifier at around nine months of age—before your baby can walk and take another child’s pacifier! Usually, parents are very nervous to drop the pacifier because their child needs it to sleep. However, I have not found this to be true in practice. Most often, the difficulty falling asleep without one lasts three to four days max. Parents often ask about ear pain and flying. Babies are born with sinuses, but they are underdeveloped, which means they don’t really start feeling ear pain with flight until 1 to 2 years. By nine months, I recommend having your baby suck on a pacifier while flying or drinking from a bottle/nursing for takeoff and landing just to be sure their ears equalize.”

How to Break the Habit: “If thumb sucking goes on past three years, it can become tough to break. Positive reinforcement star charts sometimes help to modify a child’s behavior. For example, a parent should hang a calendar on the fridge. For every day that a child doesn’t suck his thumb, the child gets a sticker. If he gets three stars in a row, he gets a prize. Another option: Some parents resort to putting a soft sock on their child’s hand to prevent thumb sucking at night.”

mom and baby cuddling
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Our Take

Both are probably fine until age three when dental issues have the potential to kick in, but we’re partial to the pacifier because of the control factor. (As parents, you have a bit more power to regulate use, you know?) It’s also nice to have a way to help your child calm down in a pinch for the early days when they may or may not have found their thumb.

Still, setting limits is important—and striving to cut off (or reduce) use by age one is ideal. It’s not the end of the world if they continue, but the pressure to always have a clean one on hand gets real when you’ve got a toddler who can talk back…or, worse, throw a tantrum.


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