I attended an interesting CE presentation at the Children's Nutrition
Research Center in Houston sev. yrs ago organized by the local ILCA affiliate
(HALCEA).  Two speech pathologists presented on swallowing disorders of
newborns.  While they had almost no experience with breastfed infants (sad)
they gave me new insights on the management of preemies and other infants
with weak oral structures.  They pointed out that the soft palate is a muscle
and has low tone in preemies.  To 'exercise' this muscle they provide
non-nutritive experiences with pacifiers.This exercise improves babies
abilities to swallow without aspirations up into the nasal pasages which
frighten and choke infants-- often setting up oral aversiveness.  Babies with
elevated tongues are often defending their airways.  Sev. studies have ref.
this phenomenon ( including:  Widstom and Thingstrom-Paulsson:  The position
of the tongue during rooting reflexes elicited in newborn infants before the
first suckle.  Acta Paediatr Scan 1993; 82:281-83)  This is one reason why I
am cautious about methods of bringing the tongue down and forward.  I like to
look at baby's ability to handle flow rate to see if there is a reason that
tongue is elevated.  OTs PTs and Speech Path. have much to teach us as LCs
about the complicated oral mechanisms.  They all use the concept of exercise
to physically strengthen weak structures.  I think that neurological probs.
and symptoms of trauma in infants show up first as feeding dysfunction.
 Usually temporary, but not always.  We see them before others do.  I would
love to see a much closer alliance with PT including PTs with brfg. ed. and
LCs with PT awareness so there would be much better and earlier cross
referral.

 The pacifier should not be a dummy:  ie a substitute for nursing or mother's
attention (except for during traffic jams etc:))  It may provide a tool for
specific oral tasks, and I have used it successfully as such.  I like ones
shaped like a finger, slightly rounder at the tip and with the widest base I
can find. I find that NUK shaped pacis teach babies to pattern sucks with a
clench that causes mothers to have a flattened underside to their nipples
with creasing across the tip along which blisters open.  Babies do flatten
underside of mom's nipple with their tongue, but they have to push up against
it with the posterior tongue in the up and down piston rhythm seen in the
sonargraphic studies. That provides for some 'down time' during the release
cycle.  As the NUK already has that shape, my theory is that babies just
clench in a 'locked' position rather than pulse it in and out to form that
shape.  Since its already indented, the tongue doesnt have to push against
any resistance to  flatten it, so I would think this would decrease its
effectiveness  as an exerciser.  The NUKs also have such a narrow base that
they condition baby to slide out onto the nipple rather than stay on the
breast with a nice wide mouth.
Just MHO.
Barbara Wilson-Clay, BSE,IBCLC
priv. pract. Austin, Tx
PS my husbands grandmother who died at 94 always called pacifiers:  Storm
Plugs.