Pacifier & Bottle Weaning for Children with Autism in 6 Easy Steps

Dr. Mary Barbera

When Lucas was a baby, he was addicted to his pacifier. Since becoming a behavior analyst in 2003 I’ve seen tons of kids who are equally addicted to pacifiers. I’ve also seen kids with trouble bottle weaning. When I see parents with toddlers who have pacifiers in their mouths or drinking out of a baby bottle, I want to yell, “get that pacifier out of their mouth.” It affects their teeth, their language, and their behavior! But I get it. I was that parent. And I didn’t know how to wean Lucas without it being traumatic for both of us.

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Many children, especially those with behavioral issues, use pacifiers well past infancy. Their parents struggle with what to do to keep them quiet and happy. So they usually give in and “plug the child up” with a pacifier.
Toddlers and even older children can also be addicted in the same way to a bottle. Both bottles and pacifiers are both really bad for toddlers and older children because they hamper talking, increase problem behaviors for items, and can be detrimental to normal teeth development (both baby and adult teeth).

How to Start Bottle Weaning and Pacifier Weaning

These steps should help you start the weaning process for a pacifier and/or bottle weaning if you are not willing or able to go the “cold turkey” route.
  1. Assess when your child (and you) needs the pacifier and/or bottle most (ie: at bedtime, church, in the car, etc.)
  2. Make a plan with boundaries to start weaning based on your assessment. (I will only feed via a bottle 4 times/day, she will only have a pacifier at nap/night time in the car and at church, I will only give morning bottles or bedtime bottles when I’m at home sitting in a certain rocking chair).
  3. If your child likes/has more than one bottle/pacifier, hide or dispose of all others (so they can’t stash them or accidentally find one during non-pacifier times). If you want to keep one pacifier in the bedroom and one in the glove compartment of the car, that is fine. You just need to have one or two and maintain control of them.
  4. If you are going to wean to just using the pacifier at nap/night time, for instance, create a “Binky Box” to be stored on the high shelf in the closet. Have the child put it in, in the morning or naptime after waking. Don’t take the pacifier and hide it or make it disappear. Instead, have the child put it in the “Binky Box” or “Paci Box.”
  5. Give a strongly preferred edible or toy for giving up the pacifier and putting it into the box.
  6. For bottles give the least preferred drink in the bottle and the most preferred drink in a cup.
Also, pair the cup with highly reinforcing toys and items during non-bottle times. While your child or client probably will not understand your complex plan, even infants will respond to reinforcement and other behavioral procedures.

How to Handle Problem Behaviors that Occur

If your child is ever crying while trying to access these items, do not give it to them. Also if they are crying or having problem behaviors while accessing any reinforcement (including blankets, pacifiers, or bottles) take the item away for at least a few seconds to show her/him that crying will not work!
At the very minimum, children should not have access to pacifiers, blankets, or bottles on demand at any time of the day or night. They need you to help them with boundaries!
Assessing, planning, and taking action may be emotionally taxing to you and your child. It’s OK to pick a less stressful time to implement all of this. Such as after the holidays, when the other siblings go back to school, after a vacation is over, etc. The important thing to remember is that with these 6 steps you can tackle the pacifier problem/bottle weaning struggles and help your child.
I’ll see you right here next week.

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