Babies are born with the need to suck. There are two types of sucking patterns. The nutritive suck, which allows the baby to feed properly, and the non-nutritive suck, which can comfort the baby. Babies often suck on their hands, thumb or pacifier for comfort and this often helps soothe them to sleep. However, at what point is prolonged thumb or pacifier sucking a problem, and is one option better than the other?

Sucking on a thumb or a pacifier are both fine ways for your baby to soothe themselves to sleep, but there are some things to know specifically about pacifier use. The pacifier should not be offered as a replacement for meals and it should only be offered when you are sure your baby is not hungry. Never tie the pacifier to your baby as this can cause serious injury or even death via accidental suffocation. If you are breastfeeding, it is recommended to wait 3 to 4 weeks before offering a pacifier to promote successful breastfeeding.

There is no current data that suggest a pacifier or thumb is better than the other, but there are pros and cons to each.

• Pacifier pros: Sucking a pacifier while sleeping can lower the chance of sudden infant death syndrome (SIDS).
• Pacifier cons: Continuous sucking on a pacifier can cause the auditory tubes in the ear to become abnormally open. This can allow secretions from the throat to get into the ear, which can lead to an increased frequency of ear infections.
• Thumb pros: Unlike pacifiers, your baby will always be able to find their thumb or fingers, so it is lower maintenance than a pacifier.
• Thumb cons: Children who suck their thumbs have a higher incidence of irritant eczema and callouses. Children can also transfer viruses and bacteria from the environment to their body from thumb sucking.

The most important thing to keep in mind, whether your baby is a thumb sucker or pacifier user, is they should give it up before their permanent teeth start developing. The American Academy of Pediatrics states that children who continue to suck strongly on their thumb or pacifier past 2 to 4 years of age may experience issues with the development of the shape of their mouth or how their teeth may line up. If your child is still sucking on their thumb or pacifier past four years of age, consider these tips:

• Positive reinforcement works best – Instead of scolding them when they suck on their thumb or pacifier, praise them when they don’t use it. Create a chart system where stars are added for good behavior or consider offering daily rewards. Provider your child with gentle reminders throughout the day is also helpful.
• Keep them busy – Often, children will suck on their thumb or a pacifier when they are bored. Keep their hands busy with activities to distract them
• Identify possible triggers – Often children will suck on their thumb or pacifier when they are feeling insecure. Identify when this happens so you can help console them in other ways, such as hugging them, offering reassuring words or providing them with another comfort such as a stuffed animal.

It is rarely recommended to use techniques that may be unpleasant, such as putting something on their thumb or pacifier that tastes bad. If your child continues to suck their thumb or pacifier and you are concerned about how it may affect their teeth or mouth, consider bringing them to a dentist for an evaluation. The dentist may also explain to them why it is important to stop.

Keep in mind that thumb or pacifier sucking rarely continues long-term. Most children stop their sucking habits when they start school, due to exploring their surroundings or peer pressure when they see other children are not doing it. Putting too much pressure on your child to stop their sucking habits may do more harm than good. Instead, take comfort in knowing that most children stop their sucking habits on their own.