I think that one of the best books to examine with regard to the issue of
understanding infant suck is the book Feeding and Swallowing Disorders by
two Occupational Therapists from the US, Lynn Wolf and Robin Glass.  The
book is available from Therapy Skill Builders, Tucson. (I have no financial
interest in promoting this book.)

Many things can impact oral motor behavior, and sometimes graded "exercise"
is useful.  In otherwords, starting baby on a series of movements or
activities that gradually progress in intensity.  Using a pacifier to play
"tug of war" can strengthen suck and improve lip and tongue tone.  Using an
airfilled pacifier gives the baby something to suck on that encourages the
tongue to do "push-ups".  This can help strengthen a weak tongue and help
the baby more vigorously use the tongue while breastfeeding.

Use of a pacifier remains controversial in breastfeeding circles, where
there is a belief that it is unlike breastfeeding.  While it is different in
some regards, pacifiers (or sucking on a finger) do encourage the tongue to
shape to a central groove -- the shape the tongue forms during
breastfeeding.  Pacifiers, like fingers, have narrow bases, so they
encourage more active lip seal.  Sometimes a baby with weak lip tone can
seal well with a narrow based item (like finger or narrow base pacifier or
bottle teat.)  They have more trouble sealing to a wider base -- such as a
round breast.  By gradually increasing the size of the base, the lip tone
can be exercised.  Because pacifiers come in so many designs, it is impt. to
think about what you want to accomplish.  Wolf and Glass even suggest that
it may be impt. to vary pacifiers so babies don't get too hooked on one size
or shape.

There are many interesting discussions about pacifiers in the Archives of
Lactnet, and interesting articles in the literature.  Many claims and
pronouncements have been made about pacifiers that are poorly substantiated
or perhaps reflect reverse causality.  I am careful to avoid making
statements about tools such as pacifiers that lack good investigation.  They
appear (from my careful reading) to have a role in the management of some
situations, and while they have some risks, they also have some benefits.


Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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