I have a 4-year-old who unfortunately has demonstrated significantly violent behavior with parents’ attempts to wean him. He has been significantly impacted on a structural level by prolonged use, negatively impacting both speech and feeding. My gut tells me it needs to be addressed by pediatric psychology.
There are likely multiple factors contributing as this is atypical for an otherwise normally- developing four-year-old. What else do you know about his history and co-morbidities? That gestalt will likely offer some key insights that may be relevant.
It is possible the structural differences you observe are a consequence of prolonged pacifier use, but the structural differences may also be co-occurring. Meaning that the structural differences may be separate from the impact of a pacifier and unrelated in their etiology. Or they may indeed be solely due to prolonged pacifier use or exacerbated by it. Understanding any history or co-morbidities that are a part of his “bigger picture” would help peel that apart. As Barb so thoughtfully suggested, there may be reasons from a sensory motor perspective that pacifier use serves “a purpose” for him, meets a “need’ on a sensory level, as our kids at all ages do things for a reason. That may provoke the unbridled response reported when the “answer” to his “need” is taken away. Or it may be a learned behavioral response established in the child-parent relationship.
Without knowing his history and co-morbidities, it is challenging to problem-solve but with what I understand, there is a need for the expertise of pediatric SLP related to feeding and speech. Prolonged pacifier use can alter the oral-motor synergies/components that underpin chewing, swallowing and speech production. I’d suggest a consult by a pediatric OT skilled in sensory integration. The OT will also assess overall sensory motor control/processing, which may be the part of the underlying need that pacifier use is serving and determine if a PT consult is warranted.
At his age there may be a learned behavior and interaction pattern with parents, both related to pacifier use and beyond, that would benefit from the additional expertise of a pediatric psychologist.
Then the three professionals can together problem-solve and develop a plan of care with family involvement that addresses the “why” (postural, sensory-motor, oral-motor, “behavioral”) and a systematic approach to providing, in other ways, what his sensory system needs or “is craving” That may include SLP support for oral-sensory-motor treatment to normalize his oral-sensory system, and promote carryover of that intervention in ways that are more socially acceptable (and more developmentally supportive) than a pacifier, and OT for sensory integration that is perhaps more of a global need for this child than apparent on first glance.
I hope this is helpful.