Just a quick welcome to our new dentist on Lactnet.  It is great to have new
members and the perspectives of different professions, as well as lively
discussion on dynamics of the process.

While I am hardly an apologist for the witless use of pacifiers as storm
plugs, much preferring the child to pacify at breast, I have watched speech
pathologists trained by Debra Beckman work with dysfunctionally sucking
children using pacifiers.  They play tug-a-war so infant will pull back on
the paci to exercise weak lip, cheek and tongue muscles. They move fingers
or pacifiers or teething toys around in the child's mouth so the flaccid
tongue will "chase" the stimulus.  They place the finger or item between the
posterior jaws to elicit reflexive jaw closure (a chewing type movement) in
order to exercise weak jaws.  I recommend such therapies all the time to
help tone up babies with low oral facial tone.  The speech pathologists at
Tx. Children's Hospt. use pacifiers with preemies so they exercise their
tongue and soft palate with non-nutritive suck.

The Japanese pediatric ENT reseach declares that thumb sucking (and prob. by
extrapolation we could include pacifiers) is not habituated activity, but a
survival stategy employed by babies who have compromised arousal in their
primary respiratory control centers and who depend upon the secondary (back
up respiratory center) typically used to control respiration during feeding.

 There is, perhaps, negative causality at play in babies who are attracted
to thumb sucking and pacifiers.  Perhaps these are subtly syndromic infants
or infants with tongue-tie or tucked, wedged head positions in utero who
couldn't keep their tongues up to spread the palate during formation.
Perhaps those babies with mid-line defects that occur out of sight in the
throat as deviations of the larynx, etc. have mis-shapen palates as well,
and breathing problems that attract them to pacifiers.  Perhaps the pacifier
is the marker for the symptom, not the cause of the problem.

The work of Smith, et al clearly documents with ultrasound that both
positive and negative pressure creation are involved in breastfeeding.  I.E.
both sucking and stripping in a dynamic interplay.


Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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