Significance

of NonNutritive
Sucking on a
Pacifier for
Preterm
Infants
BY: TAYLOR JOHNSON

*Some information in this presentation comes from outside sources*

Introduction
Presented By: Taylor Johnson
Mentor: Angeline Chin
Mentor Site: Clear Lake Regional Medical Center
Career of Study: Neonatal Intensive Care Unit Occupational Therapist
Project topic: Significance of Non-nutritive Sucking on a Pacifier for Preterm
Infants

Independent Study Mentorship: Fall 2017

Teachers Name: Mrs. Click

About My Mentor
Attended University of Florida
Bachelor of Science
6 months close supervised training with an experienced OT mentor
must complete yearly competency for work and routine continuing education
for NICU

About My Mentor Site

Mentor-site: Clear Lake Regional Medical Center
Located in Webster on Medical Center Blvd

Clear Lake Regional Medical Center Image. Digital image. N.p., n.d. Web. 22 Nov. 2016.

What is ISM?
ISM stands for Independent Study Mentorship
ISM is a course designed for students wishing to mentor an adult professional in
a chosen career

Each student is required to have a minimum of 3 hours and keep up with an

ISM Professional Portfolio (online format)
Students are also to develop a final presentation at the end of the semester
Here is the link to my online portfolio: http://taylorjohnsonism.weebly.com/

Artifacts

My Project Topic
Non-nutritive sucking (NNS) on a pacifier plays a significant role in an infants
life, especially preterm babies
I will be discussing the importance of using pacifiers and other key factors
related to non-nutritive sucking
I believe that not a lot of people know how much pacifiers help preterm
infants with brain growth

Non-Nutritive Sucking on a Pacifier

Rhythmic movements of the infants mouth and tongue on the pacifier to
modulate state or explore the environment
Used as a self-calming, self-soothing, and self-regulating method

Non-nutritive because infants are not obtaining nourishment but maintaining

homeostasis
A baby born premature (before 37 weeks) lacks developmental and physical
skills to feed correctly

By 28 weeks gestation, infants should be able to suck and swallow

Last trimester: large amount of brain growth going on

Wolf, Lynn S., and Robin P. Glass. Feeding and Swallowing Disorders in Infancy: Assessment and Management. Tucson,
AZ: Therapy Skill Builders, 1992. Print.

Advantages
Soothing, calming, self regulating
Optimal brain development
Smoother transition to bottle or breast feeding

Better bottle feeding performance

Decreases hospital stay for preterm infants
Prevents SIDS (Sudden Infant Death Syndrome)
If baby is being fed through a tube, pacifier helps get them used to sucking

Improved state control

Decreases behavioral distress to (iatrogenic) medical examination stressors
Promotes return to sleep faster
Improves oxygenation

Advantages (continued)
Decrease intestinal transit time
Improve weight gain by reducing fussing/restless activity
No short term negative effects
Does not interfere with breast feeding

Sexton, Sumi, MD, and Ruby Natale, PhD, PsyD. "Risks and Benefits of Pacifiers." - American Family Physician. American
Academy of Family Physicians, 15 Apr. 2009. Web. 02 Oct. 2016.

Disadvantages
Increases the chance of dental issues, especially with prolonged
May cause suffocation if there is a string attached
The advantages out-weigh the disadvantages

My Research Study
I conducted a survey on parents with children in elementary school through high
school on their childs pacifier use
I found that of the 47 responses, 6 children had health problems

4 with breathing problems

2 with feeding issues
1 born premature
1 with other health problems

36.17% of parents said their baby did not use a pacifier at all
31.91% of parents only gave their child a pacifier to reduce crying
27.66% used a pacifier during sleep only or as much as possible
8.51% used a pacifier before or after feedings
23.4% stopped pacifier use between 19 months and 2 years of age

Overall almost 45% of parents noticed better sleep, about 60% notice crying time
was reduced, and only 25% noticed better bottle feeding

How do Occupational Therapists Help?

The OT is responsible for educating parents and NICU staff on

proper non-nutritive sucking care

brain development in the last trimester & first months after birth
importance of sleep protection
proper positioning
techniques to encourage safe & appropriate oral feedings
tummy time for when they discharge
always looking at the baby, not at the monitor

May work with baby on sucking by ensuring that each baby has a pacifier at
certain times
May help calm the baby during procedures such as baths or IV placements
Pay attention to the infants reflexes such as grasping and signs of stress
Make sure the baby is positioned properly for sleep and non-nutritive sucking
Pinelli, Janet, and Amanda J. Symington. "Non-nutritive Sucking for Promoting Physiologic Stability and Nutrition in Preterm
Infants." Cochrane. The Cochrane Collaboration, 19 Oct. 2005. Web. 02 Oct. 2016.

How do Occupational Therapist Help?

(continued)
If infants are older than 34 weeks OTs will feed them to assess how their
feeding skills are.
Perform feeding assessments on fragile feeders

Assess babys progress in brain growth and determine what infant needs
Depending on the hospital a Physical Therapist or Speech Therapist may work
on babys progress and assessment as well
Follow up and treatment of babies
Participation in committees to better NICU and babies
assisting and supporting in all aspects of helping NICU team run smoothly
Assess which infants will be feeding at what times
OTs make sure babys environment has low light, minimal noise, gentle
touches, keeping baby contained

How do Occupational Therapists Help?

(continued)
Decide which RNs are most overloaded and then take blood pressure,
temperature and change diaper of the baby while assessing how they are
responding to being handled
During times when the infants cannot be touched, OTs will review their charts,
complete documentation, and go to meetings

Non-Nutritive Sucking vs Nutritive Sucking

Non-Nutritive

Nutritive

Development (progression)
27-28 weeks: weak, single sucks with
long random pauses
30-33 weeks: short stable sucking
bursts (1-1.5 sucks per sec),
respiratory rate may increase,
sluggish esophageal peristalsis
34 weeks: longer sucking bursts,
regular pauses, sucking same as term
infants, intermittent swallowing after
less than 6-8 sucks, smooth
esophageal peristalsis

Development
Sucking and swallowing occur in
utero after the first trimester, suckswallow-breathe as early as 32 weeks

Rate
2 sucks per second

Stimulus
Liquid obtained from nipple

Rate
1 suck per second
Pattern
If mature, continuous stream of sucks
(10-30) then variable bursts and rest
periods towards end of feeding

Non-Nutritive Sucking vs Nutritive Sucking

(continued)
Non-Nutritive

Nutritive

Pattern
alternating sucking bursts (4-13 sucks)
rest periods (3-10 seconds)

Arousal Feeding
Occurs more efficiently in arousal
episodes
Suck elicits swallow
Maturation is more important than
age, weight, or practice in achieving
s-s-b coordination

Stimulus:
occurs in sleep as spontaneous
mouthing movements or in response
to dry stimulus (pacifier/finger)
Arousal feeding:
able to elicit in all states except
deep sleep and crying
Helps initiation of nutritive sucking
bursts
Rhythmical NNS does not guarantee
an effective nutritive suck

Suck-swallow-breathe ratio
1:1:1, may be higher if suck is
inefficient at end of feeding
Infant may have multiple swallows
without breathing

Non-Nutritive Sucking vs Nutritive Sucking

(continued)
Non-Nutritive

Nutritive

Suck-swallow-breath ratio
At least 6-8 non-nutritive sucks before
a swallow

Indicator of neurological impairment

Since nutritive sucking is sensitive to
arousal and environmental
distractions, it is not
interchangeable with NNS as an
early measurable index of
neurological function

Respiration
improved oxygenation in preterm
infants up to 35 weeks
Improved in non crying, breathing
frequency, tidal volume, minute
ventilation
Remain unchanged in term infants
Indicator of neurologic impairment
Suggested as a potential early sign in
infants with perinatal distress
Traditional neurologic evaluation

Ross, Erin Sundeth, PhD, CCC-SLP, and Kathleen Philbin, PhD, RN. Journal of
Perinatal & Neonatal Nursing. N.p.: n.p., n.d. Print.

Types of Pacifiers
Wee Thumbie Preemie Pacifier (white)

Least invasive
Allows room for feeding/breathing tube
For babies who tend to seek more medical attention
Typically used by infants under 30 weeks

Wee Soothie Preemie Pacifier (purple)

For babies who have matured a little more
Has the notch for feeding/breathing tubes
Typically for infants 30-34 weeks

Soothie Newborn Pacifier

Also called the term pacifier
For babies 0-3 months
Can be used by babies as early as 32 weeks

Product

Long Term Effects

Non-nutritive sucking promotes brain growth
Stimulates proper sucking techniques for nutritive sucking
May cause dental issues with prolonged pacifier use

Conclusion
Brain development occurs during the last trimester and the first months of birth
Pacifiers promote deep sleep, reduce fuss time, which results in weight gain
and shorter hospital stay

Acts as a self-soothing, self-calming, and self-regulating method

NICU OTs offer support for infants, parents, and other NICU staff by promoting
deep sleep, positioning, and educating
Pacifiers have so many advantages that they outweigh the few
disadvantages such as dental issues with prolonged use

Questions?
Feel free to ask any questions you may have

Thank You
I would like to thank my mentor, Angeline Chin, for taking time out of her
schedule and meeting with me in the mornings
I would like to thank Mrs. Brauer and Mrs. Jamie for taking time out of your day
to evaluate me
I would like to thank Mrs. Click for being an amazing ISM teacher and guiding
me through the semester
I would also like to thank my parents for being supporting me and taking my
brother to school on the days I met with my mentor

Works Cited
By Mayo Clinic Staff Print. "Infant Reflux." Overview - Infant Acid Reflux - Mayo Clinic. N.p., 18 Nov. 2015.
Web. 17 Nov. 2016.
Dubowitz, Lilly M. S., and Victor Dubowitz. The Neurological Assessment of the Preterm and Full-term
Newborn Infant. London: Spastics International Medical Publications Heinemann Medical,
1981. Print.
Clear Lake Regional Medical Center Image. Digital image. N.p., n.d. Web. 22 Nov. 2016.
@healthline. "Nasogastric Intubation and Feeding." Healthline. N.p., n.d. Web. 17 Nov. 2016.
Pinelli, Janet, and Amanda J. Symington. "Non-nutritive Sucking for Promoting Physiologic Stability and
Nutrition in Preterm Infants." Cochrane. The Cochrane Collaboration, 19 Oct. 2005. Web. 02
Oct. 2016.
Ponti, M. "Recommendations for the Use of Pacifiers." Protecting and Promoting the Health of Children.
Canadian Pediatric Society, 01 Oct. 2003. Web. 02 Oct. 2016.
"Role of the Modified Barium Swallow." National Center for Biotechnology Information. U.S. National
Library of Medicine, n.d. Web. 17 Nov. 2016.

Works Cited (cont.)

Ross, Erin Sundeth, PhD, CCC-SLP, and Kathleen Philbin, PhD, RN. Journal of Perinatal & Neonatal
Nursing. N.p.: n.p., n.d. Print.
Scheer, Peter. "Food Aversion: A Disease Or A Characteristic Of An Intelligent Child?" NoTube. N.p., 15
Sept. 2016. Web. 17 Nov. 2016.

Sexton, Sumi, MD, and Ruby Natale, PhD, PsyD. "Risks and Benefits of Pacifiers." - American Family
Physician. American Academy of Family Physicians, 15 Apr. 2009. Web. 02 Oct. 2016.
"Sudden Infant Death Syndrome (SIDS)." Sudden Infant Death Syndrome (SIDS) - Mayo Clinic. N.p., n.d.
Web. 17 Nov. 2016.
"The Power of a Pacifier." Thrive Occupational Therapy. N.p., 17 Apr. 2016. Web. 02 Oct. 2016.
Wolf, Lynn S., and Robin P. Glass. Feeding and Swallowing Disorders in Infancy: Assessment and
Management. Tucson, AZ: Therapy Skill Builders, 1992. Print.