Q&A: How do I take away the pacifier?

And what's the deal with the "Paci Fairy"?

My toddler is approaching her third birthday, and LOVES her pacifier. She mostly just uses it for sleep (naps, overnight), and occasionally during the day for comfort. Our pediatrician is saying we need to take it away, but I am dreading it! Do I really need to do this? And is there any research on the best way to break the paci habit?

As a fellow mom of a pacifier-lover, I, too, have been anxiously anticipating the dreaded paci farewell. My toddler is incredibly attached to “Cow Paci” (i.e., a small cow stuffie attached to a pacifier)...and I am incredibly attached to the reliable sleep it provides. 

As a result, I’ve spent many hours digging through the research on this topic. I’ve also spent many hours soliciting other parents’ suggestions, reading the Internet’s various conflicting advice and warnings, and spending too much money on solutions Instagram has thrust upon me (a Bye Bye Paci book,¹ a special bag in which to lay the pacis to their final rest…please don’t judge me).

So, let’s get to it! 

Before we get to the how question, let’s talk about the why. In other words: Do we have to?! The short answer is: yes, probably, but the research is not as strong as one might think.

In the research literature, repetitive pacifier use is described as a “Non-Nutritive Sucking Habit” (NNSH), or sucking that occurs without nutritional value (i.e., not on a bottle or breast).² There is good evidence that non-nutritive sucking, typically on a pacifier or finger, has a soothing effect on babies and young children. These “habits” (pacifier or finger-sucking) are incredibly common, estimated to occur in as many as 73% of U.S. children ages 2-5, and decreasing with age (48% of four-year-olds, 12.1% of seven-year-olds).

So what’s the problem? 

There are many claims about the potential health effects of prolonged pacifier use: ear infections, speech problems, malformed teeth, etc. The research isn’t great (i.e., not a lot of randomized evidence), but here’s the short answer on each:

• Ear infections: potential small association with frequent pacifier use, but likely only in kids who are already at-risk. If your child is getting lots of ear infections, it might make sense to discuss with your doctor whether to try reducing pacifier use.

• Speech problems: no great evidence here of a direct effect of pacifier use, but if the teeth are severely misaligned, this can affect speech (see below).

• Teeth: moderate evidence that prolonged pacifier use increases risk for “anterior open bite” and “posterior crossbite” (i.e., upper and lower teeth do not bite properly). This is not guaranteed, and we have little evidence telling us how much pacifier use (i.e., through the day, or only for sleep) is problematic. Research varies on the exact age to be concerned about this. Many studies recommend limiting or stopping pacifier use around age 2 or 3, though some set age 4 as the cutoff, and some even cite age 6 (when adult teeth can start to come in).³

Okay, so now to your other question. How do we stop it?