Pacifiers in babies and children: Encourage or discourage?

There’s a lot of debate about pacifiers and since it’s Children’s Dental Health Month I thought I’d tackle the issue. Many parents are apprehensive to start one with a baby, yet many babies need to suck. Sucking is a natural reflex. Sucking on thumbs, fingers, pacifiers or other objects may make babies feel secure and happy and help them learn about their world. They can even be sucking on a hand or arm when still in the womb. Many babies find their thumb or a finger to suck on and self-soothe if not offered a pacifier.

Baby friendly?

pacifiers, thumb suckingI personally was unhappy to hear of the “baby friendly” initiative at our local hospitals that discourages any pacifier use during hospitalization.  I think it makes parents fear the pacifier even more than they had before and they have benefits as well as cautions.

I’ve seen more mothers get frustrated with breastfeeding when they can’t use a pacifier. I have rarely seen a problem with breastfeeding when babies are allowed to use a pacifier.

Studies do not support the thought that pacifiers affect breastfeeding rates.

This Cochrane Review also failed to show problems.

Things to love about pacifiers:

Babies have a natural desire to suck.

Even in the womb we can see babies sucking. A pacifier allows them to fill this need, which allows parents to have a much needed break.

Pacifiers can help with pain relief.

There’s a natural pain relieving property to sucking. Think about how addicted older kids are to sucking on a thumb or pacifier. It is soothing. Adding sugar to the pacifier for painful procedures helps pain even more.

Don’t give your baby sugar at home. It’s not good for them and can lead to cavities once they have teeth.

Pacifiers help prevent Sudden Infant Death Syndrome (SIDS).

We don’t know why they help, but studies show that pacifier use decreases the risk, along with sleeping alone on a firm, flat surface, on the back, without soft bedding.

Parents can control use.

Pacifiers can be weaned gradually and kids tend to outgrow them earlier than thumb-sucking.

Infants over about 4 months of age can develop other self-soothing abilities, so you can use them just for sleep in older infants and toddlers.

Keep them in the crib to decrease the risk of germ spreading from displaced/replaced pacifiers.

 

I like pacifiers better than thumbs

If a baby wants to suck, he will find his hand if something else isn’t offered. Babies eventually find thumbs or fingers if they want to suck on something.

Thumbs are always with a baby and child, so they can suck on them whenever they want, not just in the crib when a parent gives it.

Thumbs can get red, dry, and cracked with sucking behaviors – especially in dry weather. This can be painful to the child. The drive to suck is so strong they continue to do it despite pain. It can also lead to infections of the thumb.

Most kids will stop a pacifier habit by 3 years of age. If a pacifier is limited to sleep time only, kids are already not in the habit of sucking on something all day long. They only have to learn to fall asleep without sucking.

Thumbsuckers continue their habit more often and much longer. Often it’s not until they’re teased at school that they decide they want to quit. Until they make the decision to quit it’s hard to make it happen.

Thumbs are never clean. At least you can wash the pacifier and keep it in the crib. Kids play with their hands and you can’t keep the thumb out easily after they’ve touched everything.

a few cautions to pacifier use:

 

Don’t use them instead of feedings

Don’t use a pacifier to try to limit the number of breast feedings in a day, especially early on. Newborns need to eat quite a bit. Trying to “hold them off” with a pacifier will only limit your milk supply and could cause them to not gain sufficient weight.

Work with your pediatrician or a lactation consultant to be sure your baby is feeding enough if you’re feeling a need to breastfeed less.

Latch problems

I find that most babies can go back and forth from breast to pacifiers easily.

Most isn’t all.

If your baby seems to have trouble latching on the breast after using an artificial nipple (either a pacifier or a bottle) then stop the artificial nipples and focus on breastfeeding. (If you need to supplement, you can use a syringe, a supplementing system, a spoon, or other methods.) Continue avoiding artificial nipples until breastfeeding is going well.

Work with a lactation consultant if you have continued problems.

Pacifiers can spread infections.

Ear infections and other illnesses can spread easily from pacifier use.

Wash them regularly.

Keep them in the crib for babies over 6 months of age to avoid exposing it to germs from other kids.

Choking risks.

Pacifiers can crack and come apart as they age. Be sure to check it regularly to make sure it’s not damaged. You don’t want it to become a choking risk.

What about teeth?

After permanent teeth come in, sucking can cause problems with the proper alignment of the teeth. It can also cause changes in the shape of the mouth.

Both finger or thumb-sucking and pacifiers can affect the teeth in the same ways, but pacifier use is often an easier habit to break.

General recommendations about stopping the sucking habit

Be careful how you approach stopping a thumb-sucking habit or pacifier use. If you are too harsh or negative it will probably make the habit worse.

Use positive rewards.

Have your child come up with goal ideas and things to earn. Rewards don’t have to be expensive. It can be a trip to a special park or the ability to pick dinner or what book to read. You can also get stickers, trinket toys, an

Sticker charts are a great way to keep track of times that there was no sucking!

For thumb-sucking

Think about making it more difficult for your child to suck his thumb. Keep the hands busy with crafts, toys, etc.

For the older child, talk about germs and how important it is to keep the thumb out of the mouth unless she just washed her hands.

Consider sewing socks or mittens onto long sleeve pajama tops. This will keep the thumb out of reach. (Unless your Houdini takes the PJs off.)

Using a “bad” tasting polish or tabasco doesn’t really keep kids from not sucking their thumbs unless it’s only a reminder to stop. If they really want to suck, they don’t care about the taste. But if they do want to stop and need reminders throughout the day to keep it out of their mouth, the bad tasting nail polishes can help.

For pacifiers
Plan a countdown to not using the pacifier any longer.

Make getting rid of the pacifier a big deal, like any other special event. Find a fun name for the day, like “Big Kid Day” or “Give to baby day”.

Put the chosen date on the calendar and do a count down every day by crossing off dates. Or make a paper chain and tear off one chain daily until the big day.

Find a replacement for the pacifier, such as a new stuffed animal or blanket. The stuffed animal can even be from Build-A-Bear. Put the pacifier inside so the child knows it’s there when he hugs his bear. Whatever you choose, be sure it can be snuggled or used to replace the pacifier for comfort.

Fill a box with all the pacifiers on the big day and leave it out for the “binky fairy” to take to new babies. The fairy can leave the new comfort item. Or you can just have your child put all the binkies in the box and seal it shut with tape when he’s ready to earn the new comfort item.

The big thing is you need to get rid of all the pacifiers. If your child finds one hiding somewhere, he will sneak it and return to the habit quickly.

Books that might be helpful

Note: These are Amazon Affiliate links and I do get paid a small amount for the referral.

In this book for toddlers,Little Brown Bear finds some tricks to help him stop sucking his thumb. It can help put the idea into your child’s head.

This is not specific to thumb-sucking, but the Berenstain Bears always teach kids in a fun way. Sister bear has trouble biting her nails in this story.

Thumb Love is appropriate for the older child who wants to stop sucking his or her thumb. If your school aged child has been the object of teasing due to thumb-sucking, he or she will relate.



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Sleep Tricks

I preach about sleep to kids all the time, both at the office and at home. It’s one of my three most important things for overall health along with eating nutritious foods and daily exercise. Most of us don’t get enough sleep. Here are some tricks to get in a few extra minutes each day… they all add up!

Most of these tips are appropriate not only for kids and teens, but also for their parents! In November I wrote about the problems I often see with teen sleep deprivation specifically.

Know how much sleep is typical for every age group.

A great infographic of this is found at the Sleep Foundation.

Warning: It shows generalizations. For example, when tweens and teens go through a growth spurt many need 10-11 hours of sleep per night, which is more than the graph shows.

Just remember that individuals are just that: individual.

Think of sleep as a currency.

We can go into sleep debt when we don’t get enough. If it’s just a little loss of sleep, it’s easy to catch up and pay back the debt. The further into debt you go, the harder it is to get out of debt.

Don’t let the bank come after you in terms of health problems!


Listen to your body and teach kids to listen to their needs.

If you’re tired, you need more sleep. It’s sometimes easy to recognize but not always. Some kids are notoriously not able to do this well.

The longer you stay up, the harder it will be to fall asleep. It’s ironic, but sleep deprivation leads to insomnia. If you suffer, try to allow extra zzz’s on a weekend to fill the deficit. But don’t let the sleep deprived person sleep in so late that he can’t go to bed on time that night.

Many parents have realized that the later the kids stay up, the earlier they wake. Despite waking early, they didn’t get enough sleep. Behavior shows that they’re tired when they don’t sleep enough – you might see whining, tears, frustration, and irritability when this happens.

Many kids get hyper when they’re tired, so don’t be fooled if they have lots of energy in the evening. If they don’t wake easily in the morning or are whiney during the day, they are tired!

Routines.

Go to bed and get up at the same times every night and morning. If you let your kids stay up later on a weekend, be sure it isn’t more than 2 hours past their ideal bedtime.

Remember that going to bed just 15 minutes late each weeknight gives over an hour less sleep during the week – it all adds up!

Resetting the internal clock.

If someone has a hard time getting up, have them get natural sunlight as soon as possible in the morning. It helps set the circadian rhythm. If you can’t get natural sunlight, turn on lights in your home.

Conversely, start turning down lights a few hours before bedtime. Avoid screens (tv, computers, smart phones). Lights keep you from feeling tired. Don’t let them keep you up!

Use a night mode on a screen if you must work online prior to bed – a common problem for teens who have homework these days. I have used a free app called f.lux with great success. I can tell the difference in tiredness and ability to fall asleep when I have this active on my computer.

Winding down.

There are many ways to wind down before climbing into bed.

  • Journal before bed if thoughts keep you awake. People who spend bedtime thinking about everything can’t sleep. Jot a few things down to give yourself permission to not think anymore. Sounds weird, but this “worry list” works for many people!
  • Coloring is another way to relax. It’s not just for kids anymore!
  • Learn meditation. There are many apps available for smartphones and tablets, just do a search in your store. I refer kids to Stop, Think, & Breathe often. There’s also an adult version. I have many of these apps (mostly free) on my Mindfulness Pinterest Page.
  • Belly Breathing is very effective and can be taught to kids. Some kids will put a stuffed animal on their tummy and try to raise the animal with a slow, deep breath.
  • Set the mood in the room: darken the room, get the temperature “just right”, and find the number of blankets that helps you sleep. Setting up a fan or other white noise maker helps many people sleep. For more tips on setting up the perfect room for sleeping, see Bedroom.
  • Weighted blankets have been shown to help many people, especially those with anxiety fall asleep faster but there is a concern about safety when used by kids.
  • Listen to Weightless – music that’s been shown to help initiate sleep.
  • Reading at bedtime can be a great relaxing thing, but if you have a page turner, be careful to not get caught up in the book for hours. I find that stopping at a lull mid-chapter is better than waiting until the end of a chapter. A good author leaves you hanging at the end of a chapter and begging for more! Set a time limit and stop reading when time’s up! That’s what bookmarks are for.
  • Take a warm bath. This can help relax you for a good night’s rest.
  • Ask a family member to give you a massage or back rub. Again, a great way to relax!
  • Warm milk or herbal teas might help some sleep.
Be active during the day.

Lounging around makes you feel more tired during the day, but it’s then harder to fall to sleep at night.

Experts recommend avoiding exercise for a few hours before bedtime, but I know that is really hard for kids in sports. I don’t have a great fix for that, unfortunately.

Skip the snooze.

Kids and their parents who hit snooze several times miss out on all that sleep that they are in a half awake zone. If you really don’t need to get up until the 3rd snooze time, set the alarm for that time. You will be more well rested so it will be easier to get up immediately. Train your body (or your kids) to get up at that time. After several days of an extra few minutes of sleep, you’ll notice the difference!

Kids sleep alone.

Keep kids out of the parent bed so everyone gets the best sleep. Snoring, different bedtime, and other body movements makes it hard to sleep together. No one sleeps well, which makes everyone grumpy the next day.

If kids are anxious about sleeping in their own room, see The Most Common Reasons Why Kids Are Afraid To Sleep.

Pets

Pets can either help an anxious child calm down and sleep or can keep kids awake. Know the situation and act accordingly.

If pets make noise or try to wake their person, they should not be in the bedroom at night.

If the pet is quiet and lets kids sleep, they can provide reassurance to a child who doesn’t like being alone. But be sure they don’t wake the child!

Melatonin

Melatonin is a hormone that’s made in our body and helps us feel tired. It’s also available as a supplement. I think that if other sleep techniques fail it can be a great sleep aid, but I also think that if you’re going to give it to your child you should talk to his physician first.

Dr. Craig Canapari is a pediatric sleep expert who has written a great deal on how melatonin works, when it would be appropriate to try it, what concerns there are regarding melatonin, and more. Check out his Melatonin Guide for Parents.

Avoid Caffeine

Most of us know that caffeine will help wake us up, but many think they can drink it later in the day and it doesn’t affect their sleep. Dr. Melissa Welby has a great blog on how caffeine works and what it does to our sleep cycle.

Don’t be fooled with hidden sources of caffeine. I have occasionally gotten ice cream with coffee for a family bedtime treat, only to find out upon tasting it that it had coffee. Caffeine is often added to drinks, so read labels. But be careful! It might not say caffeine directly. Some are labeled as “guarana” — a plant with caffeine. Pretty much anything that is labeled as an energy drink (or food) is a likely culprit. Even decaf coffee has a small amount. Chocolate naturally has caffeine… the darker the chocolate the higher the caffeine content. Some pain relievers and other medicines have caffeine.

Especially for those not accustomed to caffeine, it will disrupt sleep even if taken several hours before bedtime.


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Sleep Deprived Teens: Health, Safety, & Mental Well Being Are At Significant Risk

Teens do not get enough sleep. Most teens need 8.5-10 hours of sleep each night. Not 6 hours. Not even 8 hours. Most don’t get even close to meeting their needs and that’s a bigger deal than many realize. Sleep is very undervalued, but we need to prioritize it.

Why don’t teens get enough sleep?

One of the most common reasons is that their biological clock (AKA circadian rhythm) makes it hard to fall asleep before 11 pm and school starts too early to allow them to sleep until 8 am, which would allow for 9 hours.

In addition to their circadian rhythm, some of their habits and activities can interfere with a healthy bedtime.

Screens are a big problem.

The light interferes with our natural melatonin rising. I regularly ask teens (and parents) to limit screen use for at least an hour before bedtime, but most teens say that’s impossible because they have to finish their homework at that time and they need their computer or tablet to do homework. If you can’t turn off the screen, at least use a program that limits the blue light that prevents the rise of melatonin. I personally use f.lux. (It’s free and works on PC, Mac, ipad, android, and Linux). I find that it really helps. (This is not a paid endorsement, just a personal statement.)

Phones.

On a similar note, phones distract kids from what they’re doing, delaying falling asleep. It takes longer to finish homework when there are distractions from the phone. Kids often are tempted to check in one more time on all their social channels, which delays sleep time. And then friends who are still up will text to see who’s up (or who they can wake up).

Activities are too late. 

I’m not talking about kids just out and about on a school night. I’m talking about regularly scheduled activities that otherwise help build a well rounded person. It’s not uncommon for activities to be scheduled to run until 9:30 or 10 on school nights for middle and high school aged kids. They get home and are hungry, need a shower, and are ramped up so not ready for sleep.

Activities start too early.

I know many kids who must be at school before school actually starts. Whether it’s band practice, church study groups, sports, or taking a missed test before school, they all interfere with sleeping in, which is what teens need.

School starts too early.

Most school districts around the country start school well before the recommended 8:30 earliest start time. School districts that have initiated later start times have shown improved test scores, fewer absences and tardies, less depression, improved athletic performance, and better graduation rates. Unfortunately, those schools are still in the minority.

Medical causes of sleep deprivation and fatigue can also occur. 

If you suspect any of these, you should schedule a visit with your doctor.

  1. Anxiety
  2. Restless leg syndrome
  3. Sleep apnea – pausing of breath, often associated with snoring
  4. Medications that affect sleep cycles
  5. Heartburn or acid reflux
  6. Hormone imbalances, such as thyroid problems
  7. Anemia, or low red blood cell counts
  8. Depression
  9. Nutrition: not eating enough, or eating foods that are not nutritious. If you eat foods that cause spikes in your blood sugar, as those sugars drop you feel fatigued.
  10. Infections
  11. Celiac disease
  12. Chronic pain conditions
  13. Chronic sleep deprivation – I know this is counter-intuitive, but being tired can make it harder to sleep.

 What happens with too little sleep?

sleep is needed
Teens who are sleep deprived suffer in many ways. Make sleep a priority!

Sleep deprivation can lead to many problems that are often not attributed to poor sleep, such as irritability, poor academic performance, accidents, obesity and more.

Moodiness.

We all associate the teen years with angst, so we can easily attribute a teen’s moodiness to just being a teen. But being chronically tired can lead to emotional dysregulation. This will look like irritability, frustration and anger.

School problems. 

It has been well established that getting proper amounts of sleep can help with focus and learning. When our teens fail to get enough sleep, they often report problems with attention, memory, decision making, reaction time, and creativity. It’s no surprise that teens report problems paying attention to a lecture or trouble completing homework in a reasonable time with full accuracy. Grades can easily fall, which leads to anxiety and depression, which in turn leads to more moodiness and trouble sleeping.

Sleep deprivation mimics ADHD. Whenever I see a teen who wants to be evaluated for ADHD because of new loss of focus, falling grades, problems with behavior, or similar issues, I always look at sleep. Most often they don’t have ADHD if this is a new problem. They need more sleep, not a stimulant medication. You can’t put a band aide on a broken bone. Fix the problem, not the symptoms! (The same goes for a teen with ADHD who thinks the medicine that’s worked for years suddenly isn’t sufficient. Unless the medicine recently changed, they need sleep.)

Injuries.

Teens with chronic sleep deprivation are more likely to be accidentally injured.

Drowsy driving is comparable to drunk driving. Teens are at the highest risk for falling asleep at the wheel. Drowsy driving is the most likely to occur in the middle of the night (2-4 am), but also in mid-afternoon (3- 4pm) as teens drive home from school.

Athletes are more likely to be injured while playing their sport, so it is in the best interest of the team to let players sleep.

Risky behaviors. 

Teens with chronic sleep deprivation have been shown to participate in more risk taking behaviors, such as driving without a seatbelt, drinking alcohol, skipping the bike helmet and tobacco use.

Pros and Cons of later school start times for our economy

There are many temporary issues with changing school start times. Parents might have to find solutions to child care of younger kids if they rely on teens babysitting after school. New bus schedules need to be started. Sports programs will need to change practice times. After school job availabilities will change.
Despite these common arguments, economic analysis from the Brookings Institution shows that a one hour delay of school start times could lead to a $17,500 earnings gain for students, compared to a cost of $1,950 during the student’s school days.
Another study that presumed all students start school at 8:30, with a year-by-year economic effect. The study did not take into account other potential benefits of later school start times, such as decreased depression and obesity rates. They found an average annual gain of about $9.3 billion due to fewer automotive accidents, improved graduation rates, and other factors.

What can teens do to get more zzzz’s?

Go to bed when tired at night.

Fighting sleep initially will make it harder to go to sleep when you finally go to bed.

Attempt to follow a regular sleep schedule.

Going to bed and getting up at about the same time every day helps. While sleeping in on weekends can help repair a sleep deficit, it can make it harder to get to sleep Sunday night and getting sufficient sleep every night is better than just getting more sleep a few days/week. Try to sleep in no more than 2 hours past your school day wake up time.

Follow the same routine each night at bedtime.

Brush teeth, read a book or color, take a bath or shower — do whatever helps you wind down and relax. Repeating this every night can help your brain get ready for bed.

Nap to help make up missed sleep.

A short 15-20 minute nap after school can help revitalize the brain to get homework done. Just don’t sleep too long or it can interfere with bedtime.

Turn off the screens an hour before bedtime.

This includes tv, computer games, computer/tablet use for homework, and smartphones for socializing. Use night mode screen lighting and apps that dim the screen (like the f.lux app I mentioned above).

Avoid caffeine in the later afternoon.

The time it takes half of the caffeine to be removed from your body is 5-6 hours. Ideally teens would sleep and never drink caffeine, but I know that isn’t reality. Any caffeine in the later afternoon can make it harder to fall to sleep. Don’t forget “hidden” sources of caffeine, such as chocolate, energy bars, and workout supplements.

One interesting concept that has scientific backing (but goes against the “no caffeine after 3 pm” rule) is the coffee nap. Basically, you drink coffee then quickly nap for 15-20 minutes. Sodas and teas don’t work as well as coffee due to too much sugar and too little caffeine. The coffee nap has been shown to be more effective than either a nap or caffeine alone. Don’t do this often — use it at times you really need it. Don’t do this too late in the day or the caffeine will inhibit your regular night’s sleep.

Skip the snooze button.

Set your alarm for the last possible moment you can, which allows your body to get those extra minutes of sleep. If you need to get out of bed by 6:45, but set your alarm for 6:15 and hit snooze several times, you aren’t sleeping those 30 minutes. Set your alarm for 6:45!

Skip the late night studying.

Studying too late is ineffective. When the brain’s tired it won’t learn as well and you will make mistakes more readily. It takes a lot longer to get anything done when you’re tired. Go to bed and get up a little earlier to get the work finished if needed. Of course you should also look at your time management if this happens too often. Are you involved in too many activities? Do you work or volunteer too many hours? Did you waste too much time on tv, games, or socializing? Do you put off big projects until the last minute? Homework needs to take priority when you’re more alert in the afternoon and evening. If you have problems with this, talk to parents and teachers about what you can do.

If you lay awake for hours or wake frequently, try these techniques to help fall asleep: 

If these fail, talk to your parents and doctor to help find a solution.

Charge your phone in another room. 

Friends who decide to text in the middle of the night keep you from sleeping. Even phones on silent have blinking lights that can spark your curiosity. It’s too tempting to look at your social media apps one more time.

Don’t use the excuse that you need your phone as an alarm. Alarm clocks are cheap. Get one and put your phone elsewhere!

Use your bed for sleep only.

Stop doing homework in bed. Stop watching YouTube and Netflix in bed. Train your brain that your bed is where you sleep.

Exercise.

Exercise helps our bodies sleep better, but it should ideally be earlier in the day. Too close to bedtime (which is common with athletes and dancers) wires us up.

Get natural sunlight in the morning. 

This helps to set your circadian rhythm.

Keep the bedroom cool and dark.

It is harder to sleep if the room is too warm or too bright. A fan can be used to circulate air.

Use blackout shades if needed.

Keep pets out of the bedroom. 

Your animals might love you and you love them, but if they keep you up, it’s just not worth having them around at night.

Nicotine and alcohol affect sleep.

These should not be used by teens in an ideal world, but I know teens will not always follow the rules. Teens should know that if they are using nicotine or alcohol, their quality of sleep will be affected.

Nicotine is a stimulant (like caffeine), which leads to more time sleeping lightly and less time in deep sleep. And yes, vaping and chewing lead to this problem too, since it’s the nicotine that causes the problem.

Alcohol reduces the time it takes to fall asleep but it increases sleep disturbances in the second half of the night, often leading to early wakening. Alcohol relaxes muscles, which can lead to sleep apnea (often noted as snoring). Sleep apnea does not allow the body to have restful sleep. Alcohol is also a diuretic, which might increase the need to wake to go to the bathroom during the night.

We all need to prioritize sleep: for our kids and for ourselves. Our bodies and minds will thank us.

Resources:

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Lead by Example

We’ve all heard the saying: kids will do what they’re shown, not as they’re told.

It’s so true. Think about all the times your kids are watching you. They are learning from you.

What can you do to help them have healthy habits?
  • Eat your vegetables.
  • Get daily exercise.
  • Wear your seatbelt.
  • Stop at stop signs.
  • Don’t use your phone while driving.
  • Wear a life vest near a lake or river.
  • Maintain your composure during times of stress.
  • No phones at the dinner table.
  • Don’t tell lies- even little ones.
  • Get enough sleep.
  • Be kind to others.
  • Call home- your parents and siblings would love to hear from you.
  • Don’t permit violence in your presence.
  • Give your time and talents to others.
  • Take care of your things.
  • Limit screen time.
  • Brush your teeth at least twice a day and floss daily.
  • Wear a helmet when on a bike.
  • Don’t mow the lawn without proper shoes.
  • Make time for family.

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helmets, exercise
Exercising together safely as a family sets great lifelong habits!