PLUG OF WAR - Who would think a small plastic plug could be at the center of such a heated debate on child rearing? CNS Photo by K.C. Alfred.
Yes, even the cute ones adorned with Winnie the Pooh.
Just drop the topic into conversation at a social gathering of parents and watch battle lines be drawn. There will be the fans who can't imagine life without it, to fierce foes who think pacifiers are responsible for everything from crooked teeth to cigarette addiction.
Aside from breast-feeding and circumcision, few other topics can get parents, grandparents, pediatricians and child experts so stirred up that a timeout may be in order.
Few would argue that pacifiers - or, for the 2-year-olds reading this, "dummies, nuks, binkies" - help soothe overwhelmed, fussy infants. There are even studies that say pacifiers might prevent sudden infant death syndrome.
The rules for older children, however, are much more murky and confusing.
The American Academy of Pediatrics says not to worry about pacifier use until the child is 6 to 8 years old, while the American Academy of Pediatric Dentistry says not to worry about a pacifier habit until permanent teeth come in.
But many child-development experts and dentists take a much harder line, saying that pacifier use should stop as early as 6 months and no later than 3 years old. These experts believe that prolonged pacifier use can reform the jaw and cause problems such as overbites and cross-bites, delay speech and inhibit a child's evolving social skills.
Mark L. Brenner, a child therapist and author of "Pacifiers, Blankets, Bottles & Thumbs," said that toddlers should be weaned by 22 months at the latest.
"You have to prepare them for the next stage of development, and if they are still hung up on a pacifier, their social development is delayed," he said.
Want to potty train on schedule? Well, you might be looking at trouble if little Sally is still hooked on the nuk. That's because you are sending mixed messages, Brenner said. It's infantilizing her while asking the child to grow up and control its bodily functions.
Lonna Corder, who runs a Montessori preschool in philanthropist Ann Getty's home in San Francisco, argues that a pacifier should be taken away as soon a baby begins to get teeth, at around 6 months.
"Take it away when your child's brain can handle it," she said.
If you wait too long, getting rid of the pacifier becomes a struggle - one that could have been avoided, Corder said. And talk about a struggle. Your choice: Deal with an irate 2-year-old or, say, climb Mount Everest. Easy call, really. "The moment you have to negotiate with a toddler - you are done," she said. "You have to take a strong stand and say no." Jenny Thomas, who works as an occupational therapist at the Getty preschool, agreed that waiting can make it more difficult for the children and the parents, especially if the kids rely on the pacifier to go to sleep and then wake up when it falls out.
You then hear: "WWWWAHHHHHH!" or "I! WANT! MY! NUK!!!"
Either option is not pretty.
"I know 3-year-olds who are trying to fall asleep and who throw lots of tantrums, and the only way they can fall asleep is with a pacifier," Thomas said. "I say bite the bullet earlier and have a week of hell rather than months of hell when they are 3-years-old."
Sylvia Riggio of San Diego knows about that. Her son, A.J., is 27 months and is having a tough time giving it up. "They're good in the beginning, but they are bad because they are addicting," she said.
Aside from sleep concerns, some child-development experts say extended use may have other behavioral drawbacks.
Megan McClelland, an assistant professor in the Department of Human Development and Family Sciences at Oregon State University, said she recommends that pacifier use be discontinued around the age of 1 because it inhibits a child's ability to learn how to soothe himself.
"It's a way to calm themselves down, but it's an external tool," she said. "If they are using a pacifier, then it's not teaching them how to cope on their own."
Dr. Thomas Roberts, chair of child and family development at San Diego State University, said he sees no problem with children using pacifiers even until the age of 6. The way he sees it, all children need something to soothe them.
"Some children get attached to the bottle, some get attached to a pacifier," he said. "It all depends."
Jessica Browning of San Diego said her 18-month-old son, Mason, lost interest in the pacifier around 6 months.
"What he clings to is his blanket, so he might turn out to be like Linus," she said.
Brenner said pacifier use and objects like blankets and stuffed animals should be treated differently. While pacifiers are appropriate only for babies and young toddlers, keeping a well-loved blanket long into childhood is perfectly fine because even adults have objects that they use to make themselves feel more comfortable, from a favorite pillow to a prized pair of earrings.
Besides, Corder said, a prolonged pacifier habit could have long-term ramifications. And not healthy ones. Yearnings may come one day for, perhaps, Marlboros and Twinkies.
"The psychological problem becomes 'I need something in my mouth to calm me down,'" she said. "Don't tell me that it isn't going to be cigarettes or food when they get older, because it will."
Brenner said that extended use - past the age of 3 - can also have social consequences as children can be shunned by their peers.
Don't think kids first get into cliques in middle school. It can start early.
"Other kids look at it as kind of weird," he said.
Adults do as well. Patty Eshelman, director of the Unitarian Cooperative Preschool in San Diego, said it drives her crazy to see 4-and 5-year-old children being wheeled around the mall in a stroller sucking on a pacifier.
At her school, Eshelman said, children are able to keep their pacifiers in their storage cubbies and use them only at nap time. Limiting the time with the pacifier helps with their verbal and social skills and reduces the safety concerns, but still provides the comfort some children need.
"I see programs where they are walking around with it, and it's not appropriate or safe," she said.
Aside from concerns about social and language development, pacifiers can have real implications for children's teeth. John Warren, a professor of dentistry at the University of Iowa, has studied the impact for more than a decade, tracking the jaw development of some 700 kids from birth to their 13th birthday. He said the longer the pacifier use, the more likely it is that a child will need braces. Whereas a child who doesn't use a pacifier might have only a 10% to 20% chance of needing braces, a child who has sucked on a pacifier for several years will most likely need the service of an orthodontist.
"The risk goes up with usage," he said.
But there's a Catch-22. It's called the thumb.
While Warren recommended getting rid of a pacifier by a child's first birthday, he said that extended thumb sucking is much more detrimental than using a dummy.
Because of that, many parents stick with a pacifier. They figure it's easier to wean a child from that. The pacifier is disposable, after all. The thumb? It's kind of not.
Adam Goodman, an orthodontist in Manhattan, N.Y., said he sees the effect of thumb sucking and pacifier use in his practice daily. Of patients who came in for early treatment at age 7 or 8 suffering from cross-bites - when the lower and upper teeth don't line up - or overbites - when the upper teeth stick out over the bottom teeth - as many as 50% had long-term pacifier or thumb-sucking habits, Goodman estimated. Severe cross-bites and overbites can make eating difficult and can cause speech impediments such as lisping.
"Nobody would deny the negative effects," he said.
Dr. Mitchell B. Poiset, a pediatric dentist in San Diego, said despite the problems pacifier use can cause, he takes a "more touchy-feely" approach to the issue, saying some children require the comfort a pacifier can provide.
"Some kids are very hardy and durable," he said. "Some kids are more needy."
Cyndi Bramwell of San Jose, Calif., said her oldest child, Gracie, 5, had no interest in the pacifier and was a terrible sleeper. Her other daughter, Emma, is 2 and still uses one and sleeps much better.
"It helped her sleep," she said. "To have a baby sleep by any means, I was OK with that."
Still, Bramwell said that she sees 3 as the cutoff point for Emma.
Even if a parent misses the deadline of weaning a child by 3, Poiset said, the negative effects are minimal.
"It's all fixable with braces," he said.
That, and a loan.
TIPS ON HOW TO TOSS THE RING
Just as opinions vary on appropriate pacifier use, so does advice on how to help your child kick the binky habit. Here are some tips:
Just Say No. The tough-love approach says take it away and tough it out as your child whines, screams and freaks out. Show no weakness and don't give in or your child will learn that whining gets her what she wants.
Three-day plan. Mark L. Brenner, author of "Pacifiers, Blankets, Bottles & Thumbs," recommends giving your toddler repeated warnings over three days that he'll have to give up his precious pacifier. On the third day, put all the pacifiers in a plastic bag so the "recycling truck" can take them and make new toys or tires out of the discarded dummies. While your child initially might be upset, Brenner said, the pacifier pangs last no more than a couple of days.
Slow removal. Begin limiting usage. Start with the rule of no pacifiers outside the house, then only in the crib, then only at night, until you've finally weaned your child off the habit completely.
Barter. Take your kid to the local toy store and have them "trade in" their pacifier for a new toy. Of course, you'll have to have help from the store clerk to pull off this trick. Your child might think it's possible to have it both ways - the new toy and binky - so there still may be some withdrawal symptoms.
Fantasyland. Much like the tooth fairy, the Binky Fairy brings money or a toy to replace the pacifier. This tactic doesn't always prevent tantrums, but it does get the pacifiers out of the house.
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