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Ask the Pediatrician: Balancing independence, safety — and COVID

Also, pacifiers and thumb-sucking: What's OK, what's cause for concern.

Answers to parent questions on pacifiers, thumb-sucking and giving kids more freedom.

The magnolias are blooming, the weather is tiptoeing into the 70s (on some days) and by and large, kids are returning to in-person learning. (Here’s last month’s discussion on that topic.) It feels like we are heading in the right direction, especially as more and more of us are getting vaccinated. This is a great time to remind ourselves that we still need to maintain COVID safety precautions: wear a mask, practice social distancing, and regularly wash our hands. While we have made great strides, we just have to keep on being thoughtful, careful and safe.

Thank you for your questions, and thank you for staying strong this year.


Giving kids more freedom — safely

My 12-year-old is asking for more independence while at the same time feels nervous after a COVID year. What should I do?
Great question! This is something we all struggle with as our children grow. It seems especially complex this year as we are emerging from COVID and a year of little independence. It helps to remember that the goal of adolescence is to gain confidence and develop the skills needed to navigate the world. As parents, we walk a fine line between helping our kids make good choices and getting out of their way so they can grow. We have to do this all while letting them know they are loved unconditionally. Yikes! Parenting can truly be like balancing on a tightrope.
giving kids more freedom

So, how do we do this?

Step by step approach: Preteens and teens rebel when we try to hold them back. This is a normal developmental step. The goal is to create an environment where your child will be successful. Taking a step-by-step approach with increasing levels of responsibility can help you and your child build confidence and trust. Let your child know that new privileges do not depend on age but rather on their ability to make wise choices. Start gradually. If your child is successful with initial independent tasks and activities, you can start allowing more.
Mistakes are normal, as long as you learn from them: Adolescents learn through trial and error. Even though it can be hard to watch as a parent, making mistakes and learning from them is a big part of growing up. Teaching our children (and ourselves) to view mistakes through the lens of opportunity is a great lifelong skill.
Keeping kids safe: One of my favorite analogies for helping adolescents stay safe is childproofing. Remember when you childproofed your house for the first time? You crawled around the floor, read some books and talked to friends. Then you sat back and watched your toddler do something you never imagined. This prompted you to make some adjustments. Childproofing is a continuous improvement process. Adolescent safety is the same, albeit more complicated this year because of the addition of COVID safety rules.
Communication, flexibility and giving yourself and your kids the grace to make mistakes are keys to success. Adolescence is a complicated time for everyone, but a foundation of a love makes it all much easier.

Pacifiers and thumb-sucking

How should I think about pacifiers and thumb sucking? Are pacifiers OK? Is thumb-sucking OK? 

Some babies love sucking from the beginning, others don’t. Here are few tips about pacifiers and thumb-sucking from the American Academy of Pediatrics:

As a rule of thumb (no pun intended), it is best to avoid introducing pacifiers until you have established breastfeeding or bottle feeding. This generally occurs around 4 weeks of age. Of course, some babies find their fingers or thumbs to suck on before that. For babies who want to suck beyond nursing or bottle feeding, limited pacifier use can be soothing. Be sure to only offer a pacifier when your baby is not hungry — a pacifier should never be used to replace meals. It is also important to never tie a pacifier around a baby’s neck because that can be a choking hazard.

How to choose a pacifier: Be careful to purchase only pacifiers that are in a single piece. Pacifiers that break into two pieces risk becoming choking hazards. It is also important for pacifiers to have a shield that is at least 1.5 inches across. This ensures your baby cannot jam the entire thing in their mouth. Finally, avoid using a bottle nipple as a pacifier as these can break and become a hazard.

How to keep a pacifier clean: Pacifiers can get goopy pretty quickly. It is a good idea to purchase pacifiers that are dishwasher safe. When you are done washing it, be sure to squeeze any hot water out of the nipple tip before offering it to baby to avoid burns.

Pacifiers and thumb-sucking: When is it a problem? Using a pacifier or frequent thumb-sucking becomes a problem for children who are around 2 to 3 years old. At this age, frequent sucking can affect the shape of the mouth and how teeth line up. Persistent thumb-sucking or pacifier use after adult teeth come in can lead to permanent dental changes that require correction with orthodontics.

How to help kids “break the habit”: The good news is this habit will go away on its own for most children. This means that, for the most part, you can ignore the issue and kids will outgrow the need. Some children, however, love sucking and are reluctant to leave this habit behind. Gentle reminders and praise when they are not sucking is a good first next step. Often children suck out of boredom. If you suspect this, try offering a distraction. Teasing or punishment is not a helpful way to help kids break the habit.

A few kids really are attached to sucking. If you start to see changes to the roof of your child’s mouth or teeth, it is time to discuss this with a dentist. There are devices that can be used to make sucking uncomfortable as a way to “break the habit.” The goal is to not be punitive or do anything that is scary. As always, keep the conversation open and explain why it is time to break the habit.


More health advice for tricky times:

Dr. Block: Keeping kids healthy during online (or hybrid) learning

Tips for supporting young kids during coronavirus pandemic

Tips for supporting teens during coronavirus pandemic




About the Author

Susanna Block

Dr. Susanna Block, MD, MPH, is a pediatrician with Kaiser Permanente in Seattle and lives with her family in Queen Anne.