Pacifiers don’t suck!

It is common practice to hold off on the introduction of a pacifier until breast feeding is well established, typically 2 to 4 weeks.  From 27 weeks gestation sucking calms the parasympathetic nervous sytem by reducing stress hormones that facilitate an infant’s capacity for early self regulation.  Sucking on a pacifier after feeding can help soothe the tummy as gastrin and cholecystokinin are stimulated that support increased digestion.  In some cases, pacifiers are used therapeutically to help an infant improve their sucking skills, particularly those who need to learn how to better cup and elevate the posterior tongue that can help with both breast and bottle feeding.

soothie II

 

I typically prefer the Phillps Avent green smoothie or Dr. Brown’s one piece silcone (Butterfly shaped) pacifier. The rounded edge promotes tongue cupping and midline groove, the flair at the base guide a nice gape and lip flange while proprioceptive input is provided along the lips/chin.  They have a nice balance between adequate firmness to facilitate mildline tongue groove and cupping while the pliability allows posterior tongue retraction and elevation during the suck.

I often use these pacifier shapes to help infants with recessed jaw or after tongue tie release (frenectomy) learn a new suck pattern.  I believe  it is important to refrain from sticking your finger in the nipple of the pacifier; “keep your pinky out of the binky”, because the  pliability is what is needed for infants to learn to simultaneously cup the lateral edges of the tongue while they elevate the posterior tongue to create inner oral pressure/suction.  If a little stability is needed I suggest using your thumb and index finger along the outer edge of the pacifier at the corner of the mouth.

There is a spot directly behind the upper gumline in infants at the level of the incisive foramen that, when touched in most infants, stimulates their suck.  However, there are others who; when this spot is touched, stimulates a gag.  This is why some infants have an aversive response/gag when the or bottle or pacifier nipple is directly up toward the roof of their mouth as is commonly suggested.  When an infant has this response it can typically be mitigated by bringing the bottle or pacifier nipple straight into the mouth along the tongue and allowing the infant to compress the nipple along the palate.  There is an alternative latch maneaver for breast I’ve found effective in these little ones as well….but that will need to be a different article.

The wider base of these pacifiers is preferred to those with very narrow bases that are easily maintained in the mouth by narrowing the jaw and lips as opposed to relying on more active tongue movement.   In fact, when infants are dependent on narrow base nipples we need to carefully assess if the infant is struggling with low tone, teethered oral tissues, poor tongue grooving/cupping etc.

Dr. Browns pacifier

Some infants just need a little prop that can help them return to the pacifier with a little rooting when it ventures from their mouth.  The WubbaNub, pictured below, is an adorable option.  Just remember, they should not be used in the crib.

wubbaNub

Pacifier use needs to decrease with age.  By 10-11 months a pacifier should be used nearly exclusively at night only with gentle fading until the babe can transition to sleep without it.   Use of a pacifier during the day beginning at 10-12 months can inhibit speech and expressive language development, at which point, I refer to them as “speech plugs”.

Allyson Goodwyn-Craine, M.S., CCC-SLP, BCS-S, CLC is a Pediatric Speech-Language Pathologist, Board Certified Specialist in Swallowing eand Swallowing Disorders, Certified Lactation Consultant

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