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Thumbs Up for Pacifiers?

I hope that I promote strong, responsible parenting through this blog, so putting the responsibility of the decision on chance or the child’s so-called choice is not an option.

It seems to me that the role of a skeptical parent is often defined by a collection of little decisions that seem much more important than they really are. Case in point, my wife and I were very recently discussing the choice to be made between fostering a child who uses a pacifier versus a child who sucks her thumb. This is — in that ‘big picture’ — a seemingly minor topic, but one that has amounted to more than one conversation and a number of hours researching to decide on the ultimate course of action. Fools wisdom points with hearsay and warnings in either direction, but the skeptical parent knows to ask the right questions rather than jump to the easy conclusions.

What is the Question

Babies suck. And before you pounce on that assertion, rest easy in the knowledge that I mean this literally. But, while some infants come into the world with a paw in their jaw, others (like our daughter) have earned their titles gradually. In fact, with our little one it was months before she habitually put objects in her mouth, a source of (so I’ve read) comfort, entertainment, and exploration:

This spectacle has left us, as a society and parents, with a dichotomy of sorts; Since babies are probably going to suck something, do we as parents allow our kids to go natural and gnaw their fingers (the thumb sucking camp) or do we invest in (and promote the use of) an array of manufactured soothers and pacifiers, designed honed by years of research to be an improvement to the convenient, fleshy variety provided to nearly every child upon birth.

The Argument

Having been the beneficiary of all kinds of unsolicited advice on the topic, one would think I’d hardly need to do the reading myself. But I thought (if for no other reason than an exercise in critical thinking and thoroughness) I would compile a short list of the negatives connected to each side of the debate as derived from reading a score of the top sites in Google. I chose randomly from a search for the words “pacifier versus thumb.” Such a search generated a fairly consistent set of ‘wisdom’ from both camps, occasionally promoting or discouraging. The list is not long (and I doubt it is complete), but should provide readers of this blog a basic understanding of the pros and cons of the decision to be made. That said please don’t assume that a negative for one side means a ‘positive’ for the other side. As will become clear, not much of this advice seems to be research-based, and is rather purely observational or anecdotal. And much of the reading suggests that those observations, and the “cons” are simply positive or negative to a greater (or lesser as the case may be) extent.

Skeptical Parents Ask Critical Questions

Of course, this winding path to understanding a seemingly minor topic has brought us back to the question faced by parents around the world: The kid is going to suck something, so what route should we be encouraging?

I’m not going to provide an answer to that question. The more I write in this blog, the more I become a firm believer in making decisions that are right for the individual situation based on sound evidence and critical reasoning.

Also, I am not going to back out of this problem by claiming that ‘babies will make up their own minds.’ True, some argue that parents don’t get much of a choice. Much of the information I read suggested that the kid will ultimately decide, pacifier or thumb. There are plenty of stubborn kids out there, but I tend to believe that parents are the ones who should ultimately make those decisions, even if it means more work. I hope that I promote strong, responsible parenting through this blog, so putting the responsibility of the decision on chance or the child’s so-called choice is not an option.

What I am hoping is that parents start thinking about the factors that come into play around why choices exist. I also hope there is understanding about issues (this one and others) involving mounds of conflicting observations, evidence, and (occasionally) formal research — and particularly why this means that we as parents need to take a step back from the claims and think clearly about what we are trying to accomplish.

So, as a skeptical parent, where does one start? My advice is understanding; That is to say, parents should know their child-rearing goals, and should balance their values with the evidence — and the source of the evidence. Ask three questions: where is this information coming from, what is this information promoting, and does this information support my goals as a parent? If the information is reliable, unbiased, and in-line with personal parenting objectives then its credibility is worth much more. Some of the the ‘evidence’ I was able to collect follows below, and skeptical parents should turn on their critical minds as well.

The Stated Cons of the Artificial Pacifier

Various websites suggest that kids who use pacifiers:

- are more likely to get ear infections. The reason was unexplained in the list I discovered, but I suppose would have something to do with plastic as a ready vector for bacteria. A little more digging confirmed this, as well as some correlative data. In general, I weigh this bit of evidence on what it’s promoting. I’d still like to see more information and a source of the claim, but it seems to be looking out for my daughter’s health — though to be honest, I don’t know yet if she’s at risk for ear infections.

Verdict: Claim is vague, but tempting to believe because of the health claim. I ask myself is someone preying on my emotion here and overstating the actual risk — or is this real? For those reasons alone I probably should not let it influence my decision too much, if at all.

- are prone to nipple confusion, in that they tend to breastfeed shorter or have general trouble breastfeeding. The source of this kind of ‘evidence’ tends to be motherly observations and personal perceptions. There may be peer reviewed clinical research to back this up, but my limited search didn’t turn it up. That said, one statement from a medical doctor cited this as correlation over causation: “An excellent randomized, controlled clinical trial, published in the July 18, 2001 issue of the Journal of the American Medical Association, concluded that pacifier use does not cause early weaning, it merely becomes more common among babies who are already weaning.”[2]

Verdict: It’s in line with personal parenting goals, but the claim is rife with logical fallacy, likely arguing a correlation as a causation. Scrap it.

- have lower independence as they rely on an object to sooth and entertain that can be lost or become otherwise inaccessible. To clarify, I don’t think this is claiming that babies are less “independent” as adults because of this. I think it means that they are presently dependent on a physical object (whereas a hand would be readily available and tougher to lose track of.) While all sorts of gadgets have been invented to prevent the loss, there is no perfect solution. And, really, this is arguing from common sense. I’m always losing things, and I doubt this would be an exception.

Verdict: Not really so much as a claim as a practicality, this would be a real consideration for absent minded parents — or a consideration to the goals of parents with a goal of limiting clutter and physical dependence on stuff. Not much to refute here, and any parent should know how much to factor this into their own decision.

- can ultimately become dependent on both the pacifier and the thumb, or develop a dependence on the thumb despite parents efforts to eventually remove the pacifier. Before I had even started my own investigations I had asked this exact question to my wife: “What’s to say she won’t end up sucking both?”

Verdict: Another not-so-much-a-claim as a practicality. I highly doubt there is much research about dual dependence — and I didn’t find any. But, I would argue this comes down to parenting responsibility and control and should only factor into a decision of a parent who has neither.

- have parents who come to rely on the pacifier as parenting aid. That is to say, parents can more easily become the kinds of parents who just ’stick it in’ as a way to quiet a screaming kid. My own objections to this aside, I might add that as the list goes on it seems we are getting further from claims and practicalities and deeper into conveniences.

Verdict: Yet one more (loose) practicality, and an active decision to be made as a parent. Mind, if a parent is the kind of person who would find themselves doing exactly that, it is definitely worth considering as part of the decision.

The Stated Cons of the Thumb (or fingers, theirs or mine)

Various websites suggest that kids who suck fingers and thumbs:

- are more likely to have dental problems later in life. This assertion is based on the apparent uncontrollable way that kids suck their thumbs, resulting in odd angles, peculiar positioning, and “unhealthy” pressure on young, developing gums. Shying away from the idea of some vast dental industry conspiracy theory (*shudder*), I would simply remind readers that careful consumers will think twice before reading the claims on any packages, including those which contain ‘orthodontic pacifiers.’ Additionally, some sage medical wisdom reminds us to put this claim into context: “According to the American Dental Association, thumb sucking does not cause permanent problems with the teeth or jaw line unless it is continued beyond 4 to 5 years of age. As it turns out, somewhere between 85% and 99% of children have finished thumb sucking spontaneously before this period.” [3]

Verdict: This seems like a claim with a bit of clever marketing behind it, and put it into the context of absolute risk and available research, it should barely register in the decision.

- tend to breastfeed longer, which can be a pro or a con depending on the parent’s goals. That is to say, parents hoping to wean, apparently aren’t doing themselves favors by avoiding a pacifier, and vice versa. Again, this is related to an earlier claim from the other side of the argument, debunked as correlation rather than causation.

Verdict: Again, it may be in line with personal parenting goals, but the claim is rife with logical fallacy, more likely arguing a correlation as a causation. This is not a relevant consideration in my books.

- cannot be easily controlled through the removal of the object of attention, without somehow removing the availability of the thumb. This is to say that parents don’t have much control over when and where a thumb goes into the mouth, short of restraint. (And, please, I would NEVER advocate that as an option.) But active discouragement of this kind of fixation does require a certain quantity of patience. And this is the practical argument from the thumb-sucking side — and like the other ‘practicalities’ of the debate, rests more on parenting skills and choices than, uncontrolled variables.

Verdict: This is not a claim, but a practicality that can be addressed through good parenting and should not be factored into the decision.

Conclusions and Such

Likely you’ve come to the end of this article with your head spinning and without the answers you were initially seeking. My goal here was not to provide a solution to the problem, but rather to point out a few of my own observations about skeptical parenting:

1. Those so-called ‘little decisions’ may seem trivial, but the advice surrounding them are often peppered with anecdotal evidence and claims. A simple Google search will result with heaps of advice pointing in numerous directions;

2. It’s very easy to let emotion become part of the decision, but not entirely possible to make the decision without it;

3. When parents are able to ’step back’ and examine those claims, they often find the clearest arguments are not so much claims as they are practicalities around goals and values, roles and responsibilities as parents, and;

4. The only good ‘evidence’ for this kind of decision is whatever is compatible with the parent’s style of parenting.

In other words, in this example, skeptical parenting is about wading through the bunk claims. And I’ve tried to (in roundabout sort of way) examine the way that a decision like this can be dissected to reveal what is really important: So, how did our decision get made? Breaking down the so-called evidence it became clear quite quickly that the most reliable source of information for decision-making was through sweeping away the list unreliable claims, and instead weighing the practical advice against our parenting style. Correlation observations and health-haunts pushed aside, we were left with the practical question of reliance on a convenient object versus more active work as parents. We chose…

[1] Rebecca Geiger, http://www.parenthood.com/articles.html?article_id=6091
[2] Alan Greene, MD, FAAP, http://www.parents.com/parents/
[3] Alan Greene MD FAAP, http://www.drgreene.org/

The skep/dad blog is meant to casually reflect on questions surrounding parenting and raising kids to become critical thinkers by asking questions and examining parenting ideas with a skeptical eye for facts and science. Each article is one dad's personal opinion, backed where relevant by literature and published research. skep/dad welcomes balanced discussion, comments, and ideas.

January 14, 2008 by Brad
Filed as: Encounters of the Mind

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