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Prolonged pacifier use and speech development.

History of the Pacifier

Infants are born with a natural biological drive to suck. Sucking is a reflexive behavior that is instinctive. This reflex is vital for newborns because it facilitates nourishment. Breastfeeding and bottle feeding are considered a form of nutritive sucking (NS) because the purpose of NS is to obtain nutrition in the form of breast milk or formula. Sucking on a pacifier and finger sucking are common methods of nonnutritive sucking (NNS). NNS is a normal behavior in infants and used for the purpose of calming and pacifying the child. The use of a NNS device, such as a pacifier, dates back to the 15th century. In Western countries, it is estimated that 75 to 85 percent of children have used a pacifier. A review of the literature reports both advantages and disadvantages of pacifier use.

Advantages of Pacifier Use

Calms Infants

One prominent and oft-cited advantage of pacifier use in the current literature is that pacifiers facilitate calming and soothing in young infants. The act of NNS, in particular with pacifiers, is one of an infant's first methods of self-organization and self-soothing that is repetitive and rhythmic in nature. A pacifier can provide comfort in times of stress, promote sleep, decrease pain associated with teething, and may decrease the likelihood of finger-sucking.

Helps Preterm Infants

Research has shown positive outcomes with preterm (i.e., premature) infants and the use of pacifiers. In preterm infants, the sucking reflex is often not present at birth and an infant's ability to suck may not be sufficient to sustain adequate nutrition through feeding by mouth. These ineffective sucking patterns may lead to the need for temporary tube feedings. In the neonatal intensive care unit, pacifier use is considered a routine practice for preterm infants. Pacifiers are beneficial for stimulating the sucking reflex and in facilitating a preterm infant's ability to coordinate the process of sucking, swallowing and breathing to feed orally. Past research has noted that preterm infants who used pacifiers demonstrated more rapid weight gain and increased growth than infants who did not use pacifiers.

May Help Prevent SIDS

Past research stated that pacifier use in young infants can potentially be a preventive measure in Sudden Infant Death Syndrome (SIDS). SIDS is defined as the sudden death of an infant less than one year of age which remains unexplained after a thorough case investigation. It has been suggested that pacifiers prevent the infant's tongue from falling back into the pharynx and blocking the airway. Also, pacifiers may reduce the tendency for infants to "spit up," which could possibly block the airway and contribute to SIDS. The American Academy of Pediatrics (AAP) Task Force on SIDS recommended pacifier use as protection against SIDS in infants younger than one year of age while falling asleep.

Disadvantages of Pacifier Use

Reduces Breastfeeding

One concern of pacifier use is that it may be related to a decrease in breastfeeding duration. Several studies have found a correlation between early pacifier use and decline of breastfeeding. However, the AAP recommends breastfeeding over formula for the health, nutritional, immunologic and developmental advantages of breast milk consumption.

More Middle Ear Infections

Researchers have investigated the impact of pacifier use on the occurrence of middle ear infection. Study results have indicated that children who used pacifiers had an increased annual occurrence of middle ear infections as compared with non-pacifier users.

Creates Dental Anomalies

Numerous studies have investigated the correlation between pacifier use and the occurrence of dental anomalies such as crossbites, open bites, and abnormal dental arches.

When the pacifier is in the child's mouth, the pacifier teat occupies the upper part of the front portion of the mouth, which forces the tongue to a lower position. The lower tongue position widens the lower jaw, thus enhancing the probability of dental irregularities. Past research concluded that prolonged pacifier habits resulted in changes to the dental arches and other dental abnormalities. In addition, some dental characteristics extended well beyond the termination of the pacifier habit.

A study from The Journal of the American Dental Association found that children who continue to use a pacifier past age two increased their risk of developing protruding front teeth and improper bite, which may affect speech production.

Our Research

We suspected that prolonged pacifier use may interfere with the development of the tongue tip movement needed for the production of certain speech sounds and wanted to explore children's speech production further. The hypothesis of our research study was that children past the age of 2 who used pacifiers frequently would display more articulation errors than children with limited or no pacifier use.

Seven children ages two to four with at least two years of extended pacifier use were matched with seven children with no history of or limited pacifier use. Word-imitating tasks for the speech sounds /s/, /z/, /d/, /t/ and /I/ were tested to explore whether these tongue-tip sounds would be affected. These specific speech sounds were evaluated because of the age when these sounds begin to emerge in the speech of children and because the presence of a pacifier in the mouth may interfere with the development of the tongue-tip movement needed for the production of these sounds.

The results of our study showed that the pacifier and non-pacifier users' average scores on the speech articulation tests were within the average range for both groups; however, the pacifier group scored more than 10 percentage points lower on the production of the sounds /s/, /z/, /d/, and /t/ than the group of children who did not use pacifiers. The non-pacifier users as a group consistently obtained greater percent accuracies on all of the speech articulation tasks used in the study.

Although this was a limited sample, the data seems to indicate that pacifier use may have negatively affected the speech skills of children who used a pacifier regularly and for a longer time period than is typical. Additional studies with a larger number of children are needed to confirm the link between the use of pacifiers and their impact on speech development. Our study highlights the importance of continued research regarding pacifier use and its possible effect on speech development.

Danielle LaPrairie is a speech-language pathologist at Edward Hospital located in Naperville, Illinois. She works with both pediatric & adult populations in an outpatient setting and adult populations in an inpatient setting. Goldacker, Throneburg and Calvert are licensed speech-language pathologists and university faculty members in the Department of Communication Disorders and Sciences at Eastern Illinois University with years of clinical experience in both educational and medical settings.
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Author:LaPrairie, Danielle R.; Goldacker, Frank E.; Throneburg, Rebecca M.; Calvert, Lynn K.
Publication:Pediatrics for Parents
Geographic Code:1USA
Date:Mar 1, 2011
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