When to Take the Pacifier Away

From the first trimester in utero, each of us seeks oral stimulation for comfort. Babies seek pacifiers often for comfort. Pacifiers are a personal choice for self soothing, therefore I will not provide a definitive age as to when the use of pacifiers should discontinue but provide insight on limitations pacifiers may have on oral development and some suggestions to reduce potential speech and feeding difficulties.pacifier

Pacifiers become problematic for two reasons. The first being the amount of time the pacifier is used, second the size and shape of the pacifier. As the baby matures, the input to the mouth changes. This especially happens during the transition to chewing. During this time the increase in jaw stability is important. Sucking on a pacifier shows minimal jaw movement, reducing opportunities for development of oral patters towards sides and back portions of the mouth causing weakness in those muscles this could potentially cause future speech and feeding complications. Second the shape of the pacifier is important to consider. The pacifiers with the large rounded shape on the top and flat surface on the bottom limits the variety of tongue movement.

2 Pacifier Tips:

1. Limit the amount of time the pacifier is used. The goal is to provide a variety of movement opportunities to build a variety of oral skills. If the pacifier is used the majority of the day and night, important opportunities for oral development are lost.
2. Use the pacifiers that have the shape that is rounded on all sides. This allows for a more natural positioning of the tongue during no nutritive sucking.

Watch this webisode of Pediatric Therapy Tv about taking away a pacifier


Feeding Difficulty in Children- How Common Is It?

It is often assumed that eating is a natural instinct children are born with and that difficulties in this area are rare. Not so. Various studies into boy wont eat his vegetablesfeeding disorders have identified a wide variety of prevalence statistics. It is known that some children are at an increased risk for feeding difficulty; those who are born prematurely, experience early medical complications, or children with neurological disorders. But even for children without any medical or developmental diagnoses, feeding may be a very tricky skill to acquire.

Currently available data suggests the incidence of children who experience feeding difficulty is as follows:

  • Manikam & Perman, 2000: Pediatric feeding disorders are common. 25% of children are reported to present with some form of feeding disorder. This number increases to 80% in developmentally delayed children.
  • Lewinsohn et al 2005: up to 45% of children at 36 months of age exhibit some “picky eating” as defined by food refusal, or accepting food one day and denying it another.
  • Emond, Emmett, Steer, & Golding, 2010: This study compared the eating habits of children diagnosed with Autism to a sample of typically developing children at multiple ages. Children with ASD experienced feeding difficulty much more frequently and to a greater degree. Using a parent-completed questionnaire, typically developing children were identified as “very choosy” eaters as follows:
    • o 15 months: 5.4%
    • 24 months: 9.5%
    • 38 months: 15.5%
    • 54 months: 13.9%

Parents of picky eaters, the underlying message here is: you are not alone. If your child is experiencing feeding difficulty, seek out the advice of a professional- your pediatrician, an occupational therapist, speech-language pathologist, and nutritionist are among the qualified individuals who can help you to better understand and navigate the factors that impact your child’s feeding abilities.


Emond, A., Emmett, P., Steer, C., & Golding, J. (2010). Feeding symptoms, dietary patterns, and growth in young children with autism spectrum disorders. Pediatrics, 26, 337-342.

Lewinsohn et al. (2005). Prblematic eating and feeding behaviors of 36-month-old children. International Journal of Eating Disorders, 38, 208-219.

Manikam, R., & Perman, J. (2000). Pediatric feeding disorders. Journal of Clinical Gastroenterology, 30, 34-46.

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Positioning for Infants 101

Recent statistics show that 1 in 10 babies have plagiocephaly, or flatness to one side of their head. Since 1992 when the American Academy of baby on tummyPediatrics launched the “back to sleep” campaign, cases of SIDS have dramatically decreased. However, cases of plagiocephaly, or flat head, have increased. With babies spending so much of their day on their backs, in swings, car seats and bouncy chairs, babies aren’t given the proper tummy time to let their head naturally round out.

Positioning your infant to switch the direction that they are laying is recommended to prevent flatness to one side of their head. Simple positioning things that parents of little ones can do at home are:

Ways To position Your Infant:

  • Providing ample tummy time daily: start with just a few minutes and work your way up from there. By 5-6 months, aim for ½ of play time to be on the tummy.
  • Alternate the hip or arm where you carry your baby. This way, they have equal opportunity to look both ways and keep their neck muscles flexible.
  • Alternate the end of the crib each night where you place your baby to sleep. This way, if they are always looking at one part of the room, ie a nightlight, window or door, they will have a different part of their head that they are sleeping on each night.
  • Alternate the end of the changing table where you change your baby.
  • Limit use of carseats, swings, bouncy seats or any device where a child is “contained.” Excessive time in these “containers” can cause a flat head on one side and limit gross motor development.
  • When your child is in a car seat, a cushioned head support will help keep some pressure off the back of their head.

It is normal for your babies’ head shape to not be completely round following a vaginal delivery; however, head shapes usually round out from the pressures of delivery within the first 6 weeks of life. It is important to use the positioning techniques above to ensure that your baby has a nice round head shape as they continue to develop.

If you are concerned about your babies’ head shape, talk to a physical therapist or your pediatrician. Physical therapy can help round out your child’s skull and help with gross motor development.

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Navigating Early Speech & Language Milestones: What to expect between birth and 1 year

Parents often wonder if their child’s skills are developing typically. Between gross motor skills, fine motor skills, speech-language skills, social-emotional functioning, and overall growth, there’s a lot to keep track of! In fact, it mother and infantmight feel overwhelming. It’s important for parents to remember that every child develops at their own rate, with some skills emerging faster, and other skills taking more time. When considering your child’s development, referring to developmental milestones can be an excellent guide. If you begin to feel concerned regarding your child’s development, seek help from a licensed professional right away. A trained therapist will give you accurate information, ease your worries, and if needed, give your child any help they might need.

Speech & Language Skills Emerging Between Birth and 1 Year

0 – 3 Months

Your child might:

  • react to the presences of familiar people or objects
  • smile or coo in response to their caregiver’s voice or facial expressions
  • calm or feel soothed when they are held
  • begin to move their eyes toward sounds
  • produce different vowel sounds (example: “ahh”)
  • cry differently based on their need (i.e. hunger or pain)

3 – 6 Months

Your child might:

  • begin to babble (example: “bababa” or “dadada”)
  • be feeling happy or unhappy based on their laughter or use of facial expressions
  • be babbling or making sounds to themselves or others
  • become excited in anticipation of feeding
  • smile when they see a familiar face
  • turn their head toward a sound
  • fix their gaze on others’ faces
  • be playing when supported in a designated play area

6 – 9 Months

Your child might:

  • make a sound of babbling with a sing-song pattern
  • use inflection while they vocalize
  • be using a variety of consonants when babbling (example: m, b, p, n, t, d, z)
  • try imitate your gestures (example: bye-bye)
  • begin to comprehend words such as “no”
  • initiate interactions with others by vocalizing

9 – 12 Months

Your child might:

  • show more interest in Imitating sounds and actions
  • be vocalizing during play
  • begin to imitate various animal sounds (example: roar, ruff-ruff, bah-hah)
  • begin to understand and follow simple directions
  • look for toys out of sight
  • gesture or vocalize to let you know what they want or need
  • shake their head to tell you “no”
  • begin to wave “bye-bye”
  • begin to say their first true words

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Gross Motor Milestones for your Babies’ First Year

The first year of a child’s life is full of learning and excitement. Every month brings new milestones, both for fine motor, gross motor and speech production. Knowing what is expected in each month can help you prepare as a parent, and even help you facilitate your baby standingbabies’ milestones. Below is a list of gross motor milestones to help your baby through the first year of life. Keep in mind that each milestone has a window that the milestone is expected to occur.

Gross Motor Milestones in the First Year:

1-2 months: Baby will bend and straighten legs alternately or together

2-3 months: While on their tummy, the baby will hold their head up at a 45 degree angle between their chin and chest

4.5-6 months: Baby will sit with arm support with their arms in front of them

5.5-9 months: Rolling from tummy to/from back to both right and left sides independently

6-8 months: Independent sitting without arm or trunk support

7-9 months: Kneeling on hands and knees (quadruped position)

9-10 months: Pulling to stand at a surface supported with arms.

8-13 months: Creeping on hands and knees with belly off the ground

9-13 months: Cruising along a surface

10.5-13 months: Independent standing

12-14 months: Independent walking

Growth and development occurs differently in every child and there is a window where milestones traditionally occur. If you are concerned about your child’s development, speak with your pediatrician or schedule a physical therapy evaluation.

References: Piper MC and Darrah J. Motor Assessment of the Developing Infant. W.B. Saunders Co. Philadelphia. 1994

Peabody Developmental Motor Scales, second edition. PRO-ED, Inc. 2000

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