As the trusted expert in your client’s treatment, you will get a variety of questions from parents regarding sippy cup use, pacifiers and nuks, straw cups, no spill cups, and metal cups.There may be questions about the appropriate age to transition from the bottle to the sippy cup if your client is young enough.
 A large number of children can use a pacifier and sippy cup without it negatively impacting speech and oral motor development. You probably used one and have given them to your kids. But for our clients exhibiting tonal differences, sippy cups and passy’s can be bad news. Daily  use of them can lead to an inappropriate lingual resting posture, swallowing and chewing differences,  speech disorders, and dental problems.
The problem with both beloved items is that they reinforce an immature back and forth suckle pattern in the lingual musculature. Around the age of two we expect a mature swallow to have developed. I see plenty of three and four year old cruise through my door with a nuk in their mouth. Is their swallow pattern matured? No. Do they have the beginnings of a lisp? Yes.  Are most of them drooling? Yes. Did the parents deliberately give the nuk to their child knowing it would cause such problems? Of course not. They followed the advice of their mom, their friends, and the magazines touting passy use for psychological reasons.Â
From a cleaning perspective I can fully appreciate a no spill sippy cup. But as a therapist, I would love to start a “no sippy cup” campaign. Getting your parents to throw out those cleaning friendly cups can be tough. I tell parents to opt for straw cups. The trouble is that straws can be pulled out of the cups and liquid dumped..fun game! Big headache for mom! Be patient and supportive. I will often recommend straw use only at the home and will “o.k.” no spill cups for travel / outings.  There are also several brands available that have “built in” straws. Some are good but beware of the straws that a child has to bite on prior to sucking. They may be less messy but the oral motor implications are negative.
Discontinuing pacifier use can be challenging for both the child and the parent. I recommend giving the child a passy and a new item the child really likes together for two weeks. Following the two week period, I tell my parents to pick a night when no one has to work the next day, have a “bye bye passy” party, throw out every nuk in the house (and have the courage to throw the bag in the trash), and present the second item only to the child that night. There will be tears from both the kid and the parent. The parent will probably curse you under her breath. And then one of two things will happen. The child will self soothe with the other item the parent presented and fall asleep, or no one will sleep that night.
If the child cannot get to sleep without a nuk after several trial nights without it, there may be an underlying need for oral motor stimulation. There are a multitude of items that can be used in place of a passy without concern to lingual and dental impact.Â
Some of your chronic passy users may also be thumbsuckers. Thumbsucking is another “ball of wax.”  Before you can expect your client to have improved articulation skills you have to get the parents on board with limited or ideally no use of pacifiers, sippy cups, or thumbsucking.
