For my take on pacifiers and thumb-sucking, see the essay on thumbsucking on
my web page (http://www.prairienet.org/laleche/dettwyler.html) and also this
excerpt from my article on "Evolutionary Medicine and Breastfeeding"

From the section on implications for pediatric advice:

"For mothers who decide to wean prematurely, health care professionals must
provide education and support to help relieve the negative health
consequences.  This might include discussion of various types of formula,
and advising parents to avoid whole cows' milk until the child is at least
2.5 years old.  It might include making sure all immunizations are complete
and up-to-date, and that parents understand the necessity for prompt
treatment of all illnesses.  Dietary supplements of docosahexanoic acid and
arachidonic acid might be advised for optimal brain growth in the child who
has been weaned before brain growth has been completed.  Parents should also
be educated about the possibility that their child's instinctive need to
suck (which can be very strong in some children up to and beyond seven years
of age) should be respected and met in another way, if not at the breast.
Thus, pacifier use and thumb-sucking through age seven, at least, should be
considered normal behavior for prematurely weaned children.  While pacifiers
and thumb-sucking are less healthy alternatives for meeting a child's
sucking needs than at the breast, they must still be recognized as meeting
legitimate needs.  If thumb-sucking is leading to orthodontic problems, then
alternatives need to be found.  Never should the child, or the parents, be
criticized for behavior that is normal for the circumstances and meets real
needs."

From the section on implications for research needs:

"Research on how to best meet the sucking needs of children weaned
prematurely: There are many questions that could be asked on this topic:  Is
a pacifier preferable to the child's own thumb or fingers?  If so, what
shape, size, and type of pacifier would be best?  Is there a certain
technique of thumb- or finger-sucking that results in fewer orthodontic
problems?  Is orthodontic treatment during the teenage years a reasonable
trade-off for allowing the child to suck its thumb as long as it needs to
during childhood?"

Kathy Dettwyler

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