Observations Regarding Pacifiers and Oral Motor Development
Dr. Debra Beckman is a speech-language pathologist practicing in Maitland, FL. Dr. Beckman specializes in speech, language, and swallowing disorders in patients. As a speech-language pathologist, Dr. Beckman evaluates, diagnoses, and treats patients with communication and swallowing troubles. These conditions may be due... more
Are pacifiers good or bad? It depends on how the pacifier is used. From the first trimester in utero, until the end of our lives, each of us continues to seek oral stimulation – for comfort, for sustenance, or out of boredom. For babies who have reflux or GERD, sucking and swallowing can provide some relief when reflux occurs. The saliva combats the stomach acids, and the peristalsis combats the reflux. For these babies a pacifier is important.
Other babies may have a strong need for oral stimulation and crave constant input. Take away the pacifier, and a mighty outburst will follow. Still other babies have impaired oral skills, and cannot vary the movements they use. They use a pacifier because the skills needed for other activities with the mouth have not developed. As the baby matures, input to the mouth changes from the anterior, midline, to posterior, lateral, as the baby changes from sucking to chewing. The increase in jaw stability and strength is an important step toward increased food texture and toward the jaw stability necessary during speech. During non-nutritive sucking on a pacifier, the jaw shows minimal movement, and the tongue often protrudes over the lower lip, under the pacifier nipple during sucking.
If the pacifier fills the mouth the majority of waking and sleeping hours, there is reduced opportunity for the development of oral patterns that are more posterior and lateral. Some pacifiers are designed with a large rounded shape on the top and a wide flat surface on the bottom. This design further limits the variety of tongue movement possible during non-nutritive sucking, as compared to those pacifiers that have a shape that is rounded on all sides. The tongue is habitually positioned down and forward, extending out between the gums or teeth. The goal is to provide a variety of movement opportunities to build a variety of oral skills.
A variety of oral input is desirable. As the infant places different items in his or her mouth, including fingers, thumbs, toes, toys, clothing, etc., the variety of movements increases. This enhances improved control for oral structures so that the next level of skills can emerge and develop. So, if the pacifier is used minimally with ample opportunity for the baby to explore their world orally, then the use of a pacifier is no problem. However, if the pacifier is in the baby’s mouth the majority of all waking hours and for hours at night, then important opportunities for skill development are lost, and the use of the pacifier is a problem.