Gradual Weaning of the Pacifier vs. A Cold Turkey Approach
If you know me, you are already aware I do not sleep train or use any form of behavioral sleep training with children. This includes any form of “Cry It Out”, extinction, premature withdrawal of comfort or separation-based techniques. So this post is about approaching the use of a pacifier without a “Cold Turkey” approach that is often recommended in the sleep training world.
Often when we think of changing habits, many of us have been conditioned to believe that it is an “all or nothing” approach. Gradual weaning can seem scary, especially when there is a return to the previous habit one is wishing to change, however “falling off the wagon” can be quite normal for the habit changing journey and is a real risk whether you do a cold turkey or gradual weaning approach. Often, it has to do with extent of external support as well as fear of a lack of control.
When it comes to the pacifier, the most common advice is to go cold turkey and deal with a “few rough nights”. However, for many parents, they cannot tolerate those few rough nights and end up giving the pacifier back to the child. This all or nothing approach to the pacifier, this “either it is in their mouth or not” is a common sleep training concept where often the recommendation is to take it away and deal with a few rough nights. This is not to say, all sleep trainers work this way rather, that it is common among those sleep training methods to read such recommendations.
Now, this may work for some families, but what about those who it does not work for? Where do they land? Are they just to accept that if they do not pull the pacifier cold turkey, their child will use it for years to come? This can be scary to new and tired parents who then may feel forced to those extremes.
Interestingly, a child can fully fall asleep nursing, suck for comfort during the day and the weaning approach is accepted. How is pacifier usage different in this regard? When I present gradual weaning about nursing, it is easily accepted but when I present the same approach to pacifier usage: I tend to get these questions: How will that work? Won’t that teach the child that if they cry, we will give it back? How can we progress to no pacifier if they are still allowed to have it? We heard that it is like teasing, to give it and then take it away (by the way teasing is actively provoking the child with something they want but not giving it to them. This is not the same as weaning which is supporting the process until the child is ready to go without. The fact that this causes confusion is likely why this approach to pacifier weaning is concerning to parents and professionals).
Yes, the concerns are real because if you do an internet search these are the messages you will likely see:
“Take it away cold turkey or it will never work.”
“You can’t gradually wean a pacifier, it is either in or out.”
“If you give it back when they cry, then they will learn crying will get them what they want.”
“You are drawing out the process longer instead of just cutting the cord.”
“You are making this harder on everyone.”
In an article written by Wendy Wood and David T. Neal, (https://behavioralpolicy.org/wp-content/uploads/2017/05/BSP_vol1is1_Wood.pdf) called “Healthy through Habit: Interventions for initiating and Maintaining health behavior change” they discuss how breaking the association to an existing habit while promoting another habit at the same time is best for long term beneficial results. Granted, they are talking about adults and public health, but the core concept is the same. If we gradually wean the use of the pacifier while introducing another helpful habit, we are setting the child up for long term success. Not only is this beneficial for the child, but also for the parents who have another comfort tool to offer in place of the pacifier, which often feels like their only option to calm their crying child. This empowers the parents and the child and contributes to the success of a gradual weaning approach.
The authors continue by discussing 3 central components of habit formation being: Behavioral Repetition, Associate Context Cues, and Rewards. For the purpose of this blog post and its length, I will focus on the first two.
Behavioral Repetition
In one study, participants chose a new behaviour to perform once a day in the same context and for some of those people, only 18 days of repetition were needed for that behaviour to become sufficiently automatic (Lally, P., van Jaarsveld, C. H. M., Potts, H. W. W., & Wardle, J. (2010). How are habits formed: Modelling habit formation in the real world. European Journal of Social Psychology, 40, 998–1009. http://dx.doi.org/10.1002/ejsp.674). This would suggest that introducing no pacifier once a day could lead to habit change in at least 18 days.
Sleep training, though, is often marketed as a 10-15 day plan and so the time required for this approach may not be feasible in terms of success vs. a cold turkey approach and the distress that is promised to dissipate after a “few rough nights”.
Why this is feasible option for a holistic sleep consultant who does not sleep train ( because sleep trainers can also be holistic in their approach and use sleep training) is because their support packages tend to average 3-5 weeks in length which would allow more time for such an approach.
Associate Context Cues
The authors point out that context matters when changing and creating habits. It depends not only on repetition but also the presence of stable cues. One way this can work with pacifier weaning, is to only offer the pacifier at sleep time.
There is also the concept of “piggybacking” which is tying a new habit to an existing habit. During the gradual weaning of a pacifier the parents can offer soothing in another form. So that when the pacifier is gone, the child still has a means of comfort available to them. In some forms of sleep training, a child would have the pacifier taken away and the parent would be directed to withdraw their comfort at certain intervals despite the crying of the child.
This would pose a challenge if the pacifier is taken away and no other option is available to the child during the transitional period because the child is expected to “learn to self soothe”(which infants cannot do, they cannot self regulate. They self regulate through co-regulation with a trusted caregiver. What the child ultimately learns with such methods is to no longer cry out or call for the parent. This is not “self soothing” and there is numerous information to support this).
So, what does this all really mean?
Well, you always have the option of trying to take away the pacifier cold turkey. The internet is full of strategies and creative ways of presenting this to a child. Often the parents are riddled with guilt and return the pacifier, which ultimately means did not reach their goal. Sucking is a strong comfort mechanism for an infant and child. They will suck a pacifier, their thumb, or a breast for comfort. Many, if not all, suck their thumbs in utero. You cannot teach a child to suck (no more than you can teach them to sleep). For many families, the pacifier it is a nonissue and for others, it needs to go. Do what is right, and safe for your family - just know you do not have to go cold turkey.
How would gradual weaning work?
Before I share some thoughts, I want to share that I am not purposely being evasive. I do not follow any predetermined steps or methods. My work is so individualized, and change is based on the child. Due to this I also tend to not offer blanket recommendations, which is why you may find the following thoughts to be evasive.
I would first set up the sleep stage, look at several factors and set up the sleep science. I would want many other pieces in place before attempting the weaning. At a certain point in the process, I would encourage the parents to begin weakening the pacifier association (this can include only offering it at sleep ( context cue from earlier in the post) and removing it right before the child falls asleep while offering another form of comfort simultaneously (this depends on what is age appropriate and safe).
From there we would be working on continuing to weaken the association by having more time without the pacifier in the crib while continuing to offer the other form of comfort. Notice, the child is never without comfort ( the concept of “piggybacking” from earlier in the post). This does not mean “not at all” – it means less time and that could be 1 minute and working up from there.
The repetition of this approach which is supported by other facets of holistic sleep work (and no sleep training) with time should yield results. Of course, this will take more time than a “few rough nights” but what it does is allow an opportunity for sustainable change while honoring the emotional wellbeing of the entire family unit. Habit changing is not just about taking something away – for sustainability we need to replace and introduce something new. Telling a family to remove the pacifier and then to let the child “cry it out” can be devastating to parents and many will give back the pacifier and not tell the sleep trainer.
Not everything has to come down to “all or nothing”, I acknowledge it can certainly feel that way when the sleep deprivation is so severe that the parents cannot fathom a longer process. One way to work with this is to seek help earlier to set up the stage for the sleep habits you can sustain. A sleep consultant does not just have to be sought out when things have become unbearable. We can help before that point and many families actually prefer this choice.
Source:Wendy Wood and David T. Neal. “Healthy through Habit: Interventions for initiating and Maintaining health behavior change.”(https://behavioralpolicy.org/wpcontent/uploads/2017/05/BSP_vol1is1_Wood.pdf)
In Wellness,