Is David Beckham right to let his four-year-old daughter use a dummy?

Another storm in a teacup has been brewing, this time over a picture published of David Beckham’s four-year-old daughter Harper using a pacifier. After a critical article appeared in the Daily Mail about the risk of stunted “speech or dental issues”, the former footballer took to Instagram:

Screen Shot atInstagram

Pacifiers, also known as dummies, have been around for centuries and their first recorded use in the medical literature was 1473. Sucking is an inherent behaviour in babies, and has been observed that a foetus will begin to suck his or her thumb as early as 12 weeks. Together with some respiratory-like movements, this is thought to prepare the foetus for respiratory and swallowing functions. Babies are also thought to have the sucking tendency as a part of two reflexes that exist only in early life: the rooting reflex – where a child reaches out to suck on something like the breast or a finger – which remains until seven months of age and the sucking reflex, which remains until 12 months.

After this, dummies are often used as a comforter or out of habit. This is controversial because studies have identified some benefits – including pain relief in babies and in one review as reducing the incidence of sudden infant death syndrome – as well as risks. So what are the risks and are they really dangerous?

Effect of prolonged pacifier sucking in creating an open front bite. Child also has decay in back teeth and defects in the crowns.Gederi/Coomaraswamy/Turner/Dental Update, Author provided

Dummy sucking is associated with a number of oral health issues and one of the main worries is the risk of malocclusion, a misalignment between the top and bottom row of teeth when the jaws close. Facial growth is partly influenced by environmental factors, for example the pressure exerted by soft tissues of the lips, cheek and the tongue has a big influence in determining the shape of the dental arch and tooth position. Repeated sucking of a dummy over long periods of time can negatively affect mouth growth and the way the teeth of the upper and lower jaws interrelate, which may be cause for future corrective treatment. Another common worry is the risk of tooth decay and cavities caused by bacteria that have entered the mouth and have been found to colonise not only the tooth surfaces but the pacifier teat.

The British Dental Association (BDA) recommends “that the habit is curtailed by the age of 12 months in order to reduce the chance of associated oral health problems.” So, ideally the use of pacifiers should stop when bottles have also stopped being used – which is around 12 months age.

In the UK there are currently no specific British guidelines that recommend a specific age at which pacifier use should or should not be discouraged. In the US, weaning off pacifiers is encouraged after six months of age. However, for most children who continue to use pacifiers sometimes or on occasion there is no reason for over concern, unless the habit is prolonged or inappropriate. According to the British Orthodontic Society, as long as a sucking habit is stopped by the age of seven, teeth can often correct their alignment/position spontaneously with normal growth.

It’s hard to understand the fuss around David Beckham’s daughter. Yes, she’s still using the pacifier and as Beckham put it: “Everybody who has children knows that when they aren’t feeling well or have a fever you do what comforts them best and most of the time it’s a pacifier”. However, she is likely to outgrow it and if there is any damage, it should self-correct. At this stage I would say that it is not a danger to her and she will grow out of the habit when she is ready. Most children stop using pacifiers by the time they reach primary school, especially when under the influence of school friends and peer pressure.

Another reported issue associated with dummies is the potential for them to transfer pathogens into the mouth and latex (rather than silicone) dummies appear to be more receptive to the formation of bacterial biofilm. It is thus essential for parents to ensure their child’s pacifier is disinfected on a regular (daily) basis and replaced often and at the first sign of damage. And as the BDA also advises when it comes to tooth decay: “Dummies should always be used in an appropriate manner and never be dipped into, or coated with, anything containing sugars.”

So as long as dummies are used sometimes, are kept clean and eventually their use stops I don’t think the Beckhams have too much to worry about.

Kristian Coomaraswamy provides advice to the British Dental Association