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When to pull the pacifier?

Dear SLP,

My child is quickly approaching his second birthday.  He really likes his pacifier and only uses it at night.  Is ok for him to continue using it?


Pacifier Mom


Dear Pacifier Mom,

There are advantages and disadvantages to pacifier use.  A review of research conducted at Eastern Illnois University determined that advantages to pacifier use include calming and soothing infants, stimulating sucking and aiding in the suck, swallow, breathe pattern in preterm infants, and potentially preventing SIDS.  Some of the disadvantages include a correlation between early pacifier use and a decline in breastfeeding, a correlation between pacifier use and occurrences of acute otitis media in infants, increased occurrences of dental abnormalities, dental abnormalities with possible links to speech articulation, and tongue thrust with subsequent distortions of /s/ and /z/. 


After reviewing current research the study focused on the impact of pacifier use on speech articulation, testing children who had been using a pacifier for an average of 2 years.  Children who used a pacifier had an average standard score of 106 when compared to the control group who had a standard score of 115.  Although both groups scored within a typically developing range for their age, the pacifier use is clearly impacting the correct production of sounds.


When babies are born and begin breastfeeding they have a forward tongue position which extends in a forward and backward position when sucking.  This facilitates the movement of milk from the front of the mouth to the back.  As babies develop and increase core strength to begin sitting, they also begin eating more solid foods and their feeding pattern changes to an up and down chewing movement.  The use of pacifiers, thumb sucking, and extended bottle and sippy cup use keeps the tongue moving forward in the mouth in a more infantile pattern.  Eventually, this can impact structures in the mouth including the development of the palate causing it to arch, the position of dentition, and tongue positioning.  The result can lead to sound production challenges.  As a Speech Language Pathologist, I frequently see the effects of pacifier use, thumb sucking, and extended bottle and sippy cup use.   Since these are preventable conditions, I recommend discontinuing the use them as early as possible and certainly not beyond the age of two.


View the full research study on the American Speech Language and Hearing Association website:

Email your speech and language questions to: Dear SLP



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