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No. 3

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by Dr. Rodger Sayre
- disclaimer -
On Binkies, Blankies, and Bellybuttons

When our eighth child was about 3 years old, he had a penchant for sucking his right index finger, with his left index finger inserted in his bellybutton. One day, when our son struck this characteristic pose in the church foyer, his uncle knelt down on one knee, coming eye to eye with his adoring nephew. “William,” he said seriously, “Don’t take your finger out of your bellybutton . . . your rear end might fall off!”

I think all my children sucked either a finger or a thumb till they were at least a year old, and some a lot longer! We didn’t teach them to do that; it just came naturally. There were times when we tried to introduce a Binky® to a screaming infant in the back seat of the car for the sake of our sanity, but we were never very successful. Our kids just seemed to prefer a thumb or finger, always linked with some other object of inestimable value, such as a beat-up blanket, teddy bear, or bellybutton!


Honestly, in my earlier years of parenting, I wondered if I should be doing something to discourage my toddlers from sucking their thumbs. Some pediatricians had suggested that “non-nutritive sucking” beyond the age of 2 caused a variety of dental problems. Many recommended that parents diminish the probability of thumb-sucking by offering pacifiers to their newborns, citing the fact that at the appropriate time, pacifiers are more easily removed from a child’s environment than their fingers (no kidding, really?). But 20 years ago, there was a lack of good data regarding this age-old debate.

Well, it’s the 21st century, and while we are still awaiting a good study specifically addressing the thumb-sucking-versus-pacifier issue, there are at least a few decent studies dealing specifically with pacifiers. These studies have shown some benefits of pacifier use including:

  • Pacifiers have been found to be effective in soothing babies that are undergoing painful procedures.
  • The risk of sudden infant death syndrome (aka SIDS) is lower in newborns that are given a pacifier at bedtime, with one study estimating 1 death is prevented for every 2733 infants “treated.” Why? No one knows for sure, though a variety of postulates have been offered. Fact is, it helps.

But there are also some studies showing potential disadvantages of pacifiers:

  • When offered to breastfed children (particularly during the first several weeks of life) there may be an increased incidence of early weaning. It is postulated, however, that “confounding variables” (such as the fact that mothers offer pacifiers more frequently to children who are having a hard time nursing in the first place) may be responsible for this conclusion. Still, the American Academy of Pediatrics recommends that pacifier use be withheld until “breastfeeding is well established.”
  • Confirming earlier suspicions, pacifiers used after 24 months of age are shown to increase the incidence of dental malocclusion; the longer the use, the greater the likelihood. Fortunately, most malocclusions resulting from pacifier usage (or thumb-sucking for that matter) resolve spontaneously with the cessation of the habit, particularly if the habit is broken before the permanent teeth arrive.
  • Some very recent studies have made a connection between speech impediments and pacifier use beyond the age of 3.
  • Pacifiers are well known to harbor some potentially infectious organisms, particularly Candida (yeast) and S. aureus bacteria. It is not clear if this propensity translates to increased infections, however.
  • Pacifier usage after 6 months of age is linked to a higher incidence of ear infections (otitis media).

On the issue of pacifiers harboring infection, I am compelled to comment on a practice I witness frequently in my office. When a child drops his pacifier on the floor, the parent will respond by picking up the pacifier, placing it in his or her own mouth, then replacing it in the child’s mouth. For the life of me, I have no idea why parents do this! For those of you who have fallen into this cultural idiosyncrasy, I have but two words for you: Stop it! You are placing both you and your child at increased risk for infectious diseases with this practice.

Now on to thumb-sucking. The pros and cons of thumb-sucking are fairly obvious, though not objectively documented. Here are some advantages:

  • Thumbs are cheap!

Cultures of thumbs generally yield just normal skin flora. Thumb-sucking has never been linked to an increased incidence of ear infections, or any other infection for that matter.

Thumbs don’t get lost. This is particularly important at 3:00 a.m.!

As intimated above, the biggest drawback of thumb-sucking is:

  • Breaking the habit!

The good news regarding the thumb-sucking habit is that the vast majority of children (in excess of 85 percent) quit spontaneously by age 4. If your child is a thumb-sucker and you are looking for tips in breaking the habit, you may wish to visit the official website of the American Dental Association, selecting “Oral Health Topics A-Z,” and scrolling to “thumb-sucking.” In our family, a simple Band-Aid on the thumb for those who persisted in their thumb-sucking past the age of 4 was all that was needed. For William, two Band-Aids were required: one on his finger and one overlying his bellybutton!

Whatever you decide to do, don’t lose sleep over this issue! Thumb-sucking has never been linked to moral debauchery! Pacifier usage is not prohibited in the Ten Commandments! There are advantages and disadvantages to both, but it is not an issue over which we should go to war with our neighbors. As someone once said, “It behooves one to major on the majors, and minor on the minors.” This issue unquestionably falls into the latter category.

About the author

Rodger Sayre, MD, FAAFP, has been an HSLDA board member since 1997. He and his wife, Mary, have graduated 6 of their 11 children and continue to teach the rest at home in Pennsylvania. Dr. Sayre is certified as a Diplomat of the American Board of Family Medicine and is a Geisinger Medical Group associate with a busy practice in Tunkhannock.