This topic was originally written at the end of another post, but the questions and comments I’ve received via -email warrant a more lengthy discussion. (By the way – If you’d rather send me an e-mail with a question or comment rather than post it on the site, the address is firstname.lastname@example.org.)
When I’m in a social setting and people find out that I’m a pediatric speech-language pathologist, I get lots of questions about using pacifiers, sippy cups, and if they affect speech development in babies and toddlers.
Let’s tackle the sippy cup?question first. “Sippy cup mouth,” or a huge open bite, is quite common. Don’t mistake the word “common” for “normal.” When children have an open bite they have a gap between their upper and lower teeth when closing the top and bottom teeth together. Many times this dental malocclusion can be linked to prolonged sippy cup use. By prolonged I mean carrying a cup around all day and sleeping with one at night, or using this kind of cup exclusively after age 2 or 3. It can be worse if your child is using a sippy cup AND taking a pacifier because there’s something in his mouth essentially all of the time.
If your child is using a lisp as a toddler or preschooler, it’s likely he has an open bite. An approximation for the sound /s/ is very common in this age group, with or without an open bite. As children get closer to age 5, their/s/ should sound adult-like. If this doesn’t occur by age 5, children may need speech therapy to help learn a more mature production pattern for /s/. This is usually the only negative effect on speech development.
Although it’s messier than a sippy cup, your child should learn to drink from a straw by age 2 and an “open cup”before age 2 1/2 to 3. This takes a commitment from parents because it requires more supervision and clean up than using a no-spill cup. Not too long ago, we didn’t even have sippy cups, besides the slotted top kind from Tupperware. Actually that cup could still be a nice transition between sippy cups and an open cup. The skills to drink from a slotted opening are more mature than the sucking pattern required for the no-spill sippy cups.
Moving to a more complex cup is a great way to work on oral motor coordination than any set of “oral motor exercises.” This drinking practice is very functional, meaning that your child would have built-in opportunities to “practice” many times a day, rather than setting aside time to do special oral motor tasks.
Introduce the new cups (straw, slotted, or open) when he’s seated at a table, outside, or on a tile kitchen floor. Save the sippy cups only for times when making a mess is a big deal such as in the car, when he’s on carpet, or in any other place that would be a major hassle to clean.
Your child should NEVER go to bed with a sippy cup or bottle, no matter how convenient it is to help him to sleep. Leaving the cup or bottle between your teeth while sleeping is what leads to the open space AND tooth decay, especially if you’re using milk or juice. I’ve known several two-year-olds who have had to see a dentist due to a mouth full of greying teeth. Not a pretty site. If you can’t kick this habit just yet, at least switch to water in the cup at bedtime.
Straw drinking is wonderful for oral motor coordination and sensory skill development. Drinking a cold, thick liquid from a crazy straw is just about the best way to improve tongue, lip, and cheek strength and coordination all in one! Look in the toddler dishes/utensils section of the major retailers for the many version of these cups, or save and use the plastic ones you get at sit-down restaurants. Sports water bottles are also a good option.
Now let’s tackle pacifiers. For some toddlers, pacifiers are not an issue since they never took one in the first place or easily gave it up as an infant. Sometimes not taking a pacifier hasn’t necessarily been a good thing either, since a child may not have found a successful way to self-soothe. Sucking is a very good way to regulate an out-of-control infant and toddler.
Many babies find their thumbs during this phase. While some parents and even experts prefer this habit, I think it’s a lot more difficult to kick, even for 6 and 7 year olds, because you can never truly get rid of it.
For some babies and toddlers (and their parents!), pacifiers are essential and even recommended. For babies with significant oral motor issues, learning to suck a pacifier and keep it in their mouths is a milestone. For cranky babies and toddlers with sensory integration differences, using a pacifier to soothe is the only thing that helps them calm.
Most children should be able to give up the pacifier between age 2 1/2 to 3, or at least relegate this for sleeping or calming only. Walking around all day with a pacifier in your mouth is not recommended as kids move closer to age 3, but not because it keeps you from talking. It makes you look like a big ol’ baby, but that’s another issue in and of itself, and one I’m not going to tackle today!
I think it’s a myth that pacifiers prevent children from talking. Most kids try to talk with it in their mouths and then take it out if their parents insist that they don’t understand them. If your toddler is not talking, is over age 2, and is addicted to his pacifier, try to limit the pacifier to naps, bedtime, and when he really needs it to calm down. You can monitor to see if having an open mouth during waking hours will help him vocalize more. In nearly every child I’ve seen in my whole career, the lack of language is the reason the kid isn’t talking, not because he takes a pacifier.
Some SLPs disagree with this and insist that a toddler be weaned as soon as they begin therapy. I usually advise parents to keep the pacifier until we find other ways to help a kid self-soothe. I think taking away the only method some kids have for calming down is too traumatic when they are also struggling to learn to communicate. I am not into torture, not for the kids I see, and especially not for their parents!
I will add that I don’t let children keep pacifiers in when I’m in their homes seeing them for therapy unless they are falling apart without it. Many children I see work so hard during treatment that they need it to calm down after we’re finished, and I think this is alright.
Parents of children with sensory issues tell me that they need the pacifier for times when no other option works to wind down a jacked-up toddler or end a tantrum. If your toddler, even at 3, still needs the pacifier to help calm his sensory system, keep it and don’t feel guilty. As a mom, I’m just fine with that. As a therapist, I’m fine with it too, but I’d like to see them learn to self-soothe in other more mature ways as they turn 3, and especially by 4, if at all possible.
Options that I’ve seen work are finding a special blanket, stuffed animal, or doll. You are still transferring dependence to an object, but usually one that won’t hurt your teeth, or cause grandma and the neighbors to raise an eyebrow or make those nasty, condescending comments that cause us all to cringe.
Kicking these habits aren’t easy, but it’s all part of growing up, for your baby and you!