PACIFIERS: What's The Big Deal?
Did you know that the pacifier was invented by Christian Meinecke, a Manhattan druggist, in 1901? Before this modern pacifier was created, babies would suck on knotted rags dipped in water or honey or wooden beads or 'gum sticks' made of stone, bone or coral. As the mothers quickly adopted the use of this new pacifier, it had it's critics. An outraged 1909 letter to the editor of the New York Times railed against the 'villainous contrivance' which was said to 'thicken the tongue and deform the mouth' (New York Times, June 22, 2014). Despite these warnings, the use of the pacifier has grown; and still experts continue to object. Pediatricians, speech and language pathologists, dental hygienists, dentists, orthodontist and orofacial myologists all recognize that prolonged use can negatively impact upon good facial, dental and articulation development.
Here's why: when the pacifier is inserted in the mouth, the jaw opens beyond its normal position, increasing the vertical dimension. This increased vertical dimension can cause the face to grow long and narrow (Long Face Syndrome). As the face develops and grows, the bottom jaw grows down and back creating a retruded lower jaw.
With continued sucking, the mouth is opened for a prolonged period of time. The cheek muscles create tension and help to pull the hard palate downwards. The tongue drops down and under the pacifier which then pushes the pacifier up against the roof of the mouth. This light continuous pressure of the pacifier, along with the added tension of the cheek muscles, can help change the palate from wide and rounded into a high and narrow shape.
This is alarming as the roof of the mouth is the floor of the nasal cavity. As the child grows, this upwards pressure against the hard palate can buckle the nasal septum, causing a deviated septum; in turn, causing difficulty with consistent nasal breathing. Mouth breathing ensues.
Extensive pacifier use can also alter dental eruption. The pacifier can create an anterior open bite as it blocks the front teeth from coming in. Once the sucking habit is eliminated and the obstruction is removed, the teeth will be allowed to erupt and drift together. Its imperative that a prolonged sucking habit never start but more importantly, it doesn't persist beyond 4 years of age. Many of my adult patients with a history of Temporal Mandibular Joint Disorders (TMD) reported they were pacifier/digit suckers for years.
In addition, with the tongue resting low in the mouth, the jaw hinged open with lips parted causes the muscles to be underused, underdeveloped and weak. The tongue isn't placed properly in the oral cavity. This can lead to a frontal or lateral lisp, imprecise speech or multiple misarticulations.
Developmentally, babies don't need the pacifier to self-soothe after six months of age. Persistent, vigorous sucking beyond the age of four creates those negative changes just described.
This is compared to typical or preferred oral rest postures. The lips are closed with the tongue placed up against the roof of the mouth. The correct tongue position acts as scaffolding to ensure development of wide rounded dental arches. A slight space between the teeth, known as the dental freeway space, should occur. Nasal breathing is observed at rest.
The best way to avoid orthodontic, TMD or speech issues is to break the pacifier habit early. Start weaning your child from sucking as early as you can. An orofacial myofunctional therapist can help your child break the habit. Children 3 years of age or older can follow a positive behavior program!
If your child is still using the pacifier, remove it nightly once your child falls asleep; using your fingers, gently place their lips together. This approach should be used during nap time too.
Another approach to help your child break the pacifier sucking habit is to cut a hole in the nipple of the pacifier. This makes it difficult to suck the pacifier and your child will loose interest.