By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My nearly 3-year-old daughter still uses a pacifier to fall asleep for her naps and at night. Otherwise she doesn’t use it. I’ve gotten conflicting advice about whether this will cause orthodontic problems in the future. I’m loath to take the pacifier away from her since it’s such a limited use and it really does soothe her and help her fall asleep.

A. Many orthodontic problems are genetic, and the development of a child’s teeth, bite and facial bone structure changes over time. It may be impossible to know whether a misaligned bite would have emerged even if a child hadn’t used a pacifier.

Sometimes, stopping pacifier use appears to correct bite problems. You can have your child’s pediatric dentist take a look, but it may be tough to predict the future of problems identified now unless they’re severe.

Researchers compare groups of children who use pacifiers to those who don’t. Studies rely on parents’ reports and must track the children over years. Results may be complicated by habits that aren’t always reported – for example, children’s finger- and thumb-sucking.

Many studies report that bite misalignments are more common in children who use pacifiers, and that some problems (particularly posterior cross bites) are likelier with longer duration of pacifier use, markedly so after age 4.

Along with research limitations, deep-seated prejudices also come into play. Sometimes pacifiers seem to be misused as “plugs” to keep a child quiet.

When the pacifier becomes a kind of panacea for a child’s distress, there is cause for concern. The pacifier may keep parents from learning to offer a broader range of responses. It may interfere with the child’s learning other ways to soothe herself and even to understand and express her own discomfort.

Some adults may be troubled to see young children soothe themselves. Sucking a pacifier may seem “babyish” and lead to fears that the child will never stop. It is reassuring to see a child move ahead on her developmental pathway and discouraging to watch her hold onto or even revert to an old behavior.

Adults may worry that pacifiers, thumbs, bedraggled blankets and beloved stuffed animals are “crutches.” Children are often pushed to give up such habits before they’re ready – before they’ve mastered other ways of handling feelings of distress.

One simple guideline: If you try to take away a pacifier, or stop a child from sucking her thumb or fingers, you are likelier to reinforce the behavior. Instead, you can make the pacifier available as little as possible, and only for those very specific and common times when a child needs a self-soothing measure to settle down for sleep.

Once your 3-year-old is sound asleep, you may be able to ease the pacifier out of her mouth.

Occasionally we hear about a parent who gets away with “just losing” the pacifier, and who sympathizes with the child’s sense of loss while taking as much time as possible to replace it.

But we wouldn’t recommend this ploy. Instead, introduce a “lovey,” a soft bit of cloth or favorite doll that she can hold and stroke as she goes to sleep – while she sucks on her pacifier. This will help her learn to rely less on the pacifier, and may help her give up the pacifier sooner.

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.