The Pacifier Question: Why Not to Make Your Toddler Go Cold Turkey

Robby was two years old when his dentist told his parents that it was time to lose the pacifier. Concerned at the professional’s warning that using it was causing misalignment of the boy’s jaw, they took heed and soon made it disappear.

That’s when the trouble began. Before long Robby had difficulty falling asleep. Within a week, he began striking out at classmates at his daycare center.

Over the years I have seen this pattern over and over. A well -meaning dentist or pediatrician warns that a pacifier or thumb sucking might lead to oral-health problems. Loving parents, eager to avoid expensive orthodontia or worse, take heed. And before long behavior issues arise.

The problem is that pacifier use and thumb sucking aren’t just bad habits. They are often ways children calm themselves. As such, they can also be part of a child’s strategy for achieving emotional regulation, an important building block for social and emotional development.

When a child like Robby suddenly loses the use of a pacifier (or thumb sucking) it can send the child’s developing emotional system into a stress response. Depending on how each child’s mind and body interpret this loss, it can cause the child’s body to register what we call faulty “neuroception,” a sense of threat rather than safety. To be sure, some children manage this shift with ease, but many others don’t, and unusual or challenging behaviors soon appear.

That is not to say that the dentist’s advice is wrong. It may properly address the child’s physical development, but miss the child’s mental health and psychological development.

This dichotomy is a stark illustration of how the various pediatric fields often address their own specialties without acknowledging or integrating other aspects of a child’s health and development.

Dental professionals receive little or inconsistent cross-training in mental health, the “home” of social-emotional development. And the opposite is also true: programs training mental-health professionals do not typically emphasize how a child’s physical body contributes to social and emotional development. It’s as if emotions and relationships were somehow detached from the physical body and brain.

A better approach is for parents and professionals to collaborate in determining whether withdrawing something that soothes the child—using a pacifier, thumb sucking or holding a blanket, for example—will cause unnecessary stress. If it will, it’s best to wean the child away from the object sensitively and slowly rather than suddenly taking it away.

When we’re doing something for a child’s benefit, the best approach is to explain the change to the child himself. Of course, toddlers aren’t sufficiently developed in social problem-solving (putting many ideas together and understanding the impact on a future event) to understand such an explanation.

And the thought that something a child loves (a pacifier) is bad for her can itself cause stress. And euphemistically telling a child a pacifier is “missing” often doesn’t lessen the ensuing stress the child feels as a result of losing that calming tool.

These positive strategies can help ease children into changes that may affect emotional regulation:

—Determine whether it’s truly necessary to take away objects or activities that help soothe a child’s body and mind.

—Make sure the child is developmentally ready before taking away an object that is soothing to the child.

—Identify a replacement object or activity that will provide the child with emotional security before the change happens.

—Try to wean a child from a soothing tool slowly rather than going “cold turkey.”

—Avoid making a shift during a time of transition or stress (such as moving or changing schools). Instead, opt for a time when you are available to engage in relaxed play with the child. Joyful engagement eases stress.

Ultimately, it’s healthy and beneficial for children to develop alternative or additional ways of soothing themselves. With the proper approach, helping a child discover these options can improve social and emotional development. The key is not to avoid necessary changes for the child, but to make sure they are undertaken with a deep respect for the child’s individual differences and nervous system.

*Update May 2019*  My new book explains how parents and childhood providers can support children’s social and emotional development.

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