Thumbs, Fingers, and Pacifiers

What do I need to know before offering a pacifier?

If your baby wants to suck beyond what ­nursing or bottle-feeding provides, a pacifier may satisfy that need. Before offering a pacifier, keep the following tips in mind:

• Offer a pacifier at nap time and bedtime. This helps to reduce the risk of sudden infant death syndrome (SIDS). If you are breastfeeding, wait until breastfeeding is going well before offering a pacifier. This usually takes about 3 to 4 weeks.

• Do not use a pacifier to replace or delay meals. Only offer it when you are sure your baby is not hungry.

• Do not force your baby to take the pacifier if he doesn't want it.

• Never tie a pacifier to your child's crib or around your child's neck or hand. This is very dangerous and could cause serious ­injury or even death.

• Be prepared for night waking. If your child depends on a pacifier to fall asleep at night, he may wake up when the pacifier falls out. If your child is too young to put it back in his mouth or can't find or reach it if it has fallen out of the crib, you may need to wake up and get it for him.

What should I keep in mind when shopping for a pacifier?

• Pacifiers come in different sizes. You will also find a variety of nipple shapes, from squarish "orthodontic" versions to the standard bottle type. Try different kinds until you find the one your baby prefers.

• Look for a 1-piece model that has a soft nipple (some models can break into 2 pieces).

• The shield should be at least 1½ inches across so a baby cannot put the entire paci­fier into her mouth. Also, the shield should be made of firm plastic with airholes.

• Make sure the pacifier is dishwasher-safe. Follow the instructions on the pacifier and boil it or run it through the dishwasher before your baby uses it. Be sure to squeeze the water out of the nipple with clean hands; otherwise, the hot water inside might burn your baby's mouth. Clean it this way frequently until your baby is 6 months old so that your infant is not exposed to germs. After that you can just wash it with soap and rinse it in clear water.

• Buy some extras. Pacifiers have a way of getting lost or falling on the floor or street when you need them most.

• Do not use the nipple from a baby bottle as a pacifier. If the baby sucks hard, the nipple may pop out of the ring and choke her.

• Pacifiers fall apart over time. Some manu­facturers have expiration dates for pacifiers. Do not keep pacifiers past that time. Inspect them every once in a while to see whether the rubber has changed color or has torn. If so, replace them.

When do pacifier use and thumb and finger sucking become a problem?

If your child sucks strongly on a pacifier or his thumb or fingers beyond 2 to 4 years of age, this behavior may affect the shape of his mouth or how his teeth are lining up. If your child stops sucking on a pacifier or his thumb or ­fingers before his permanent front teeth come in, there's a good chance his bite will correct itself. However, if the bite does not correct itself and the upper adult teeth are sticking out, orthodontic treatment may be needed to realign the teeth and help prevent broken front teeth.

How can I help my child stop her pacifier use or thumb- or finger-sucking habit?

As a first step in dealing with your child's ­sucking habits, ignore them! Most often, they will stop on their own. Harsh words, teasing, or punishment may upset your child and is not an effective way to get rid of habits. Instead, try the following:

• Praise and reward your child when she does not suck her thumb or use the paci­fier. Star charts, daily rewards, and gentle reminders, especially during the day, are also very ­helpful.

• If your child uses sucking to relieve boredom, keep her hands busy or distract her with things she finds fun.

• If you see changes in the roof of your child's mouth (palate) or in the way the teeth are lining up, talk with your pediatrician or ­pediatric dentist. There are devices that can be put in the mouth that make it uncom­fortable to suck on a finger or thumb.

• No matter what method you try, be sure to explain it to your child. If it makes your child afraid or tense, stop it at once.

The good news is that most children stop their sucking habits before they get very far in school. This is because of peer pressure. While your child might still use sucking as a way of going to sleep or calming down when upset, this is usually done in private and is not harmful. Putting too much pressure on your child to stop may cause more harm than good. Be assured your child will eventually stop the habit on her own.