Thumb Sucking Versus Pacifier Use

Little girl asleep, portrait
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Parenting experts have long known that nonnutritive sucking, such as sucking on a finger, thumb, or pacifier, is normal behavior for most infants and young children. According to the American Academy of Pediatric Dentistry (AAPD), it is associated with their need to satisfy the urge for contact and security.

It used to be that parents were discouraged from letting their babies use pacifiers. The concern was that that they would interfere with breastfeeding and that prolonged use could cause speech delays and dental problems.

But the current American Academy of Pediatrics recommendations states that using a pacifier might be protective against sudden infant death syndrome (SIDS). As a result, more parents are letting their babies use them.

The Pacifier-SIDS Connection

A study published in a 2005 issue of the British Medical Journal found that babies who used pacifiers while sleeping were significantly less likely to die of SIDS than those who did not use them, regardless of whether the infants slept on their backs or their stomachs.

The researchers speculated that the pacifier may have kept the airways open and also that the handle of the pacifier may have prevented the baby from burying its head in the bedding.

The AAP recommends parents of babies 1 month or older consider offering the child a pacifier at bedtime to reduce the risk of SIDS. They recommend weaning the baby from the pacifier after age 6 months to reduce the risk of otitis media (inner ear infection).

Other Pacifier Pros (and Cons)

One argument for preferring pacifiers over thumbs and fingers is you can simply take away a pacifier if a child develops a prolonged pacifier habit. On the other hand, your child's fingers and thumb are right there if she wants to suck on them.

Some experts also argue that so-called "orthodontic" pacifiers are less likely to cause dental problems. However, the AAPD states that thumb, finger, and pacifier sucking all affect the teeth essentially the same way and that most children stop before the permanent teeth come in and any harm is done to their teeth or jaws.

On the downside, some studies have suggested that using a pacifier (or bottle) can increase the risk of ear infections, possibly because the sucking motion may block proper airflow through the eustachian tubes, which normally keep the middle ear open and clean.

Using a pacifier is no guarantee that your child won't become a thumb sucker. One survey found that 34% of prolonged thumb suckers originally sucked on a pacifier.

Thumb-Sucking Pros and Cons

The main reason to prefer finger and thumb-sucking over a pacifier is that your infant doesn't need you to continuously put her pacifier in her mouth whenever she needs it to soothe herself. (This can have you getting up several times during the night if your baby cries each time it falls out.)

Once your baby learns to find them, her fingers or thumb will always be available, so she can reliably use them for self-soothing. Still, many experts report that thumb-sucking habits are harder to break, and thumb suckers are more likely to develop prolonged sucking habits.

Most importantly, there haven't been any studies to show that sucking on fingers and thumbs offers the same benefit in reducing the risk of SIDS, which would be a big reason to prefer pacifier use.

  • Studies say use at bedtime may reduce risk of SIDS

  • May have negative effect on breastfeeding

  • May increase risk of otitis media after age 6 months

  • May have adverse dental effects if continued past age 2 years

Thumb Sucking
  • No evidence it may reduce risk of SIDS

  • Always available

  • May be a harder habit to break than pacifier use

  • May expose child to more germs

  • May have adverse dental effects if continued past age 2

Pacifier Tips

Things to keep in mind about pacifiers:

  • Keep extras: Choose silicone one-piece, dishwasher-safe pacifiers and keep a few backups on hand in case you lose one.
  • Maintain: Replace pacifiers often and use the appropriate size for your baby's age. Watch for loose parts or signs of deterioration. Never attach a pacifier to a string or strap long enough to get caught around your baby's neck.
  • Sanitize: Keep pacifiers clean (especially before he or she is six months old and the immune system has matured) You can wash them with soap and water or in the dishwasher. Resist the temptation to put the pacifier in your own mouth to clean it; you'll only spread more germs to your baby. (Keep fingers clean as well if your child prefers them.)
  • Wait: If you're breastfeeding, wait until you've established an effective routine before offering a pacifier. (Typically, this takes three to four weeks.) If your baby's not interested in the pacifier, don't force it.

A Word From Verywell

The fact that both thumb sucking and pacifier use can turn into prolonged habits, sometimes into first grade or beyond, may lead you to think that you should avoid both—but remember that sucking either one is normal in a baby's first year and the majority of kids give it up easily.

Finally, while it is nice to think you can choose whether your baby will use a pacifier or suck her thumb, in reality, you can't usually make that choice; many babies may simply prefer one or the other. In fact, some parents can't get their babies to take either.

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  3. Schmid KM, Kugler R, Nalabothu P, Bosch C, Verna C. The effect of pacifier sucking on orofacial structures: a systematic literature review. Prog Orthod. 2018;19(1):8. doi:10.1186/s40510-018-0206-4

  4. Hanafin S, Griffiths P. Does pacifier use cause ear infections in young children?. Br J Community Nurs. 2002;7(4):206, 208-11. doi:10.12968/bjcn.2002.7.4.10227

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