Pacifier: One that Pacifies

The pacifier is one of the greatest misunderstanding of our time. Should baby use one? What shape should it be? When to use one? When to stop using one?

I have heard parents say "We don't belive in pacifiers". When asked why, the response includes the general idea that they want their infant to be able to soothe themselves and not rely on a crutch to help them cope. I understand the intent, but newborn use is typically acceptable based on baby brain development and innate regulating nervous system.

A newborn infant has very few coping skills or self-regulation skills. In fact the first three months after biirth (in a full term infant) is called The Forth Trimester. Indicating that, just like the first three trimesters, the forth is dependent care for the infant. But because the infant is not protected in the womb with all the needs of nutrition, elimination and homeostasis being provided for them. Now you, the parent or caregiver, are providing 100% of the homeostatic support. You supply the food, you take care of elimination, you manage supporting temperature, your provide the sensory input, you protect the infant. 24 hours a day, every single day.

The infant brings a few key skills to the game: crying, sucking, co-regulation

Crying is good. Really, it is. Crying is a baby's innate ability to say "I have a need! I don't know what it is, I can not tell you want it is, but I am relying on you to respond in a timely and predictable manner, to the best of your ability to meet my need!" A crying baby is a baby who has hope. Hope that you, will reliably come to the rescue, a crying baby believes in you. (Some times in institutional care the "baby rooms" are the quietest rooms in the facility. the workers will describe them as 'good babies" because they don't fuss or cry. They wait for a bottle to be given, they let their diapers get changed. I wonder if these babies have given up hope that their individual voice matters? Do they already anticipate their individual specific needs are not accounted for and simply 'learn' to accept the care they are given at it is provided? )

Sucking. A newborn infant will suck to soothe themself. Even preterm infants will suck to soothe. In fact, one of the most common things I see in the NICU is the use of pacifiers during care times (diaper changes, temperature, blood pressure and other procedures) use to help the baby soothe and remain calm during these tasks. It is part of neuroprotective care 101. However sometimes, we confuse sucking on the pacifier as a cue for hunger. Research has demonstrated that infants between 32 and 34 weeks gestation actually suck vigorously during cares in an effort to self soothe/regulate during stressful experiences and not actually as a sign of hunger or readiness to feed. (There is a whole tangent here but I will resist the impulse😂😂😂its a therapist thing)

Pacifiers- A newborn infant NEEDS to suck as one of their primary ways to assist in self-regulation a.k.a. self soothing. An infant can suck on their own hands (note from previous blogs, to NOT put mittens on hands as a baseline behavior), they can suck on a breast (breastfeeding is in fact only ONE part for nutrition and many parts attachment and soothing) , bottle feeding and yes, a pacifier. Sucking is a central nervous system generated pattern, it is reflexive, it is rhythmic, it is flexion and it is midline. It can help regulate breathing, it can promote digestion, and with peristaltic stimulation assist with reduced reflux.

What type of pacifier:

Breastfeeding: If you want to breastfeed your infant is it useful to use a long cylindrical shaped pacifier. The pacifier needs to reach to were the hard and soft palate come together allowing the tongue to elongate and cup around the barrel. To get an idea of where this is internally, use one of your fingers trace your finger from the corner of your infants eye and take another finger and trace from the corner of the nose: the point where those two lines intersect is about were the SV juncture or the sphenoid-velar juncture/hard and soft palate coming together place is.

Bottle feeding: You want the pacifier to MATCH the shape of the bottle nipple shape-this is actually where the REAL NIPPLE CONFUSION happens! Think of it as sports specific training- you are practicing the specific task you are trying to increase your skill in like you run more to become a better running, lift weights to get stronger. A baby who sucks on a pacifier is getting some reps using the tongue in a similar shape (although non-nutritive sucking is VERY DIFFERENT from nutritive sucking and being great at your paci does NOT mean you will be a great eater!)

Also remember this: the tongue actually shapes your palate. Therefore we do not want prolonged use of the pacifier. AAAANNNNDDD an infant will start to lose reflexive sucking at about three months of age.

A typical time line for pacifier use may look like this:

-Unlimited use for the first three months of life

-At around six months, start thinking about using a pacifier only when infant is needing support to transition to sleep or needing extra help to regulate

-The next step is only using it for sleeping...But think about all the other things an infant is starting to use their mouth for: social reciprocity (smiling, laughing), oral motor exploration: mouthing every toy and what ever they get their hands on, making a variety of sounds and early speech, eating food, beginning cup drinking, and teeth are coming in!!!

And the gold star would be to be done with it by 12 months. Prolonged use of the pacifier impacts tongue movements, and palate shape. This will impact how teeth come in, how words are formed and how foods are handled. It can impact the airway by keeping the tongue at lower position which increases open mouth posture leading to open mouth breathing, snoring and may impact airway safety.

Co-regulation: This is you and your baby's super power. The use of one body against another to help create homeostasis, hormone regulation, parasympathetic nervous system activation. So much more to say about this! So I will save it for next time! STAY TUNED!!!!!