Big Pacifiers, Big Problems

If you have a baby that uses a pacifier, you must read this.

Large pacifiers may be cute or seem like the right fit for your growing child, but did you know that they have been found to interfere with child development? These pacis are preventing the palate (roof of the mouth) from widening and cause incorrect sucking patterns. It’s an easy fix, so here’s what you need to know.

Beyond the aesthetics, choosing a pacifier for a child probably seems insignificant. All our children had them, we relied on them, and they turned out fine. 

This assumption can unfortunately be very damaging. 

Pediatric speech therapists have lately been reporting an alarmingly high number of children with tongue thrusts, open mouth posture, increase of ear infections, and the need for palate expanders.

Why the sudden rise?

Ironically, the culprit seems to be a popular trend. Large pacifier nipples. 

1. Round, vintage pacifiers, a seemingly fun and harmless fad, are actually affecting orofacial development. They are big and they are cute, but they are unwittingly creating a slew of preventable conditions in the children who use them. 
2. All pacifiers that are not geared for newborns (0-3/0-6 mos) are actually too large to accommodate integral orofacial development. Manufacturers market pacifiers to cater to incremental development, i.e. newborn, 6 mos, etc. Although it may seem natural to upgrade in size as your baby grows, it is essentially a downgrade for his or her health. 

This isn’t a bash on all pacifiers. They are actually great soothers and, in fact, some studies show that they may help prevent SIDS. It is, however, a plea for parents to avoid the categories listed above. Stick to the small, flat, paci nipples and steer clear of the large ones. 

A little explanation:

When a pacifier is too big, it fills the whole mouth, limiting the movement of the tongue and preventing the natural development of the hard palate. This causes a domino effect of other health issues. On the flipside, smaller, flat pacifiers require the mouth to work to keep it in place. This creates tension of the lips, teeth, cheeks, and tongue, creating a strong healthy suck and a broad palate. 

If you are reading this and are disappointed to have to settle for less than fashion-forward, you’re in luck! Many of the brands that have been selling the ‘long, round-vintage looking nipple’ now sell small, symmetrical options as well. See this post for a list of some recommended pacifiers!

Do You Want to Understand the Science of Why This is Harmful for Your Baby?

When a baby is born, there is a soft spot where the right and left sides of the palate meet. It’s tiny, high and narrow. This soft fibrous area in the center of the palate allows for growth (like the fontanelles on a baby’s skull). By puberty, the palate stops growing and that area solidifies into bone.

As the child matures in age, the bones of the face grow (nursing is the most natural way of widening the palate; clipping the frenum may be necessary as well). With a healthy sucking pattern, the tongue’s pressure on the roof of the mouth causes the palate to naturally widen, allowing the tongue to have a comfortable resting position in the mouth. 

Potential ramification of a narrow palate: 

• Orthodontics. Being that palate is small, there isn’t sufficient room to allow for all of the child’s dentition. The mouth becomes overcrowded and the teeth will likely be crooked. Visits to the endo and orthodontists may be necessary to correct the resultant crossbite (the upper teeth sit directly over the bottom teeth), and remove teeth. 

• Mouth breathing. The hard palate also acts as the floor of the nasal cavity. When the palate is narrow, the back of the throat remains narrow too. This makes it harder to breathe through the nose (frequent ear infections are common because of the poor drainage and narrow passages). Breathing through the nose is important because it filters the air, cleaning and warming it–preventing respiratory and other infections. Some mouth breathers also develop more cavities from the unfiltered air hitting their teeth. Habitually breathing through the mouth can also negatively affect sleep, often causing irritability and behavioral issues in response to lack of proper rest.  

• Deviated septum. This tends to happen later in life, where one nostril is getting more air than the other as a result of the narrow palate. As there isn’t sufficient room for the septum to support itself in the tiny space, it can buckle over time causing a deviated septum. This can cause chronic sinus infections, headaches, and breathing difficulties. 

• Articulation and tongue thrusts. When oral muscles are weak, and the mouth is too narrow for the tongue to rest comfortably, the child can develop a tongue thrust and have trouble swallowing properly. Many of these children have an open mouth posture as well as articulation issues.  

Yes! There’s Something You Can Do! How to Prevent & Treatment of the Narrow Palate

Ages 0-3

When purchasing pacifiers for your baby, start with a newborn size and stick with it. Don’t move up to larger ones as the child grows. The smaller the pacifier, the more the mouth works to keep it in place. Shape is important too. The right type of pacifiers will have the label “orthodontic,” “anatomical,” or “symmetrical.” The same goes with the bottle–stick with the newborn size. Let the mouth work up a healthy suck to broaden the palate. Aside from the therapeutic benefits, the larger nipples are not great for feeding either. The fast flow causes gulping and intake of too much air. 

If you want to set your baby on the right track, you can read about what type of products are healthy to use and why in this post.

Ages 3-6

If your child is ages 3-6, and already past pacifier use, but you’re worried that he’s suffering from the consequences of it, you can still help your child expand their palate naturally by encouraging healthy sucking patterns. The palate is not yet fused at this point and you can still try to help your child develop a healthy suck. Using cups with narrow straws where only a little bit of the straw fits in the mouth can help. Something as simple as drinking from a narrow straw is real oral motor therapy! See more info on what you can use in accompanying post.

Ages 6-8

As soon as your child’s 6 year molars are in–take them for a consultation at the orthodontist to see if they can benefit from a palate expander! A palate expander can give that bit of space for the teeth to grow in properly, possibly eliminating the need for braces altogether, and prevent all the other consequences of having a narrow palate! Although you would assume that the dentist would point out the narrow palate at your child’s cleaning, they often focus on dental hygiene alone-and rarely point out structural issues till the child is older, ready for braces. 

If you, as the parent, notice that your child frequently has an open mouth posture or cross-bite, ask your dentist: “Do you think my child needs a palate expander?” Waiting till the child is in 7th grade and going for a braces consult, may be too late.  Once a child hits puberty and the palate is hard bone, it will entail surgery as the bone needs to be broken to widen it.

I’m Not Good with Medical Things. How Do I Identify If My Child Has a Narrow Palate?

• Do you notice that your child has a cross-bite (upper teeth sit directly above or inside the lower teeth). A cross-bite can refer to a single tooth or a group of teeth in the back or front of the mouth. 
• Is your child a habitual thumb sucker? Though not discussed here, prolonged sucking of the thumb can have the same or worse effect as a large pacifier.
• Do you notice that your child has an open mouth posture or has trouble keeping his tongue in his mouth?
• Does your child present with articulation errors and/or a tongue thrust when swallowing
• Does your child have a history of ENT issues like enlarged adenoids, tonsils, ear infections, poor sleep (snoring) etc.
• If you don’t feel confident in your ability to pick up on these symptoms, ask your dentist at your regular visit, “Does my child have a narrow palate?”
• If you have any suspicion that your child might have a narrow palate, book a consult at an orthodontist as soon as ages 6-8. If your child does need a palate expander, you will potentially avoid so many more problems.

See the list of recommended pacifiers and sippy cups products here.