Dummy/pacifier use and speech development

Mon Oct 17 10:28:52 UTC 2005

Baker, E. (2002). The pros and cons of dummies: What a speech pathologist
should know. ACQuiring Knowledge in Speech, Language and Hearing, 4(3),
134-136.

Key points raised in the review were as follows.

THE PROS OF USING A DUMMY / PACIFIER / COMFORTER

1. They (dummies) MAY help settle agitated, fretting babies (evidence is
equivocal)

2. They are thought to facilitate sucking in premature infants (conflicting
evidence)

3. They are thought to help infants with GORD (research failed to support
this)

4. There is thought to be something "protective" about dummy sucking in
terms of preventing SIDS in babies 1 to 12 months (evidence is inconclusive)

THE CONS OF USING A DUMMY / PACIFIER / COMFORTER

1. Increased risk of GI infections.
2. Increased risk of Otitis Media (with all that that implies) in babies who
use a dummy >5 hours a day. (interesting studies cited research surrounding
the importance of this)
3. Increased incidence of dental caries and malocclusion.
4. Association with nipple confusion.
5. "Other" - latex allergy, choking (these are rare).

SPEECH DEVELOPMENT AND DUMMY / PACIFIER / COMFORTER USE

The speech-language pathologist can surmise that:

1. Certain sounds are difficult to produce with something in your mouth.
2. Dummy sucking reduces vocal play.
3. Dummy sucking reduces imitation of facial expressions and mouth movements
(interesting studies cited research surrounding the importance of this)

There is very little research into a possible DIRECT relationship between
dummy sucking and language delay.

There is a positive relationship between dummy sucking, dental malocclusion
and speech disorder.
There is a positive relationship between dummy sucking, otitis media and
speech disorder.

It is important for SLPs to be well-informed in order to advise caregivers
accurately.

================
RELATED ARTICLES
================

Pacifier pros and cons: is it good or bad to give your baby a binkie?
(Healthy Baby)
http://www.findarticles.com/cf_dls/m0KFZ/2_9/98576972/p1/article.jhtml

"Your baby is crying. She looks very unhappy: She has her mouth open, her
eyes squeezed shut, her fists clenched. You've tried everything you can
think of to calm her down--breastfeeding, walking her in the stroller,
gently rocking her and singing to her. In your palm you hold what you hope
will be the answer--a pacifier. But before you pop that binkie in her mouth,
consider the many ways using it could affect your baby's health.

THE PROS

A way to soothe > The amount of time an infant spends crying increases from
birth until about 6 weeks, when a baby cries for an average of three hours a
day.

"That's a lot of crying stress," says Cynthia R. Howard, M.D., M.P.H.,
associate professor of pediatrics at the University of Rochester School of
Medicine and Dentistry in New York. Sucking undoubtedly helps calm a baby,
she adds, which is why pacifiers are so popular. According to a 1999 study
by Howard published in Pediatrics, approximately 75 percent of babies are
given pacifiers to suck.

Health benefits > The only proven medical benefits linked to pacifiers have
been seen in preterm babies. Preemies who suck on binkies gain weight
faster, according to a 1992 study published in the Swedish journal Acta
Pediatrica. Other research has found that preemies who use pacifiers shortly
after birth show earlier sucking patterns and experience fewer health
complications. "Sucking promotes oral-muscle function and muscle
development," says Nina L. Shapiro, M.D., assistant professor of pediatric
otolaryngology at the University of California, Los Angeles, School of
Medicine.

Reduced risk of SIDS> Pacifiers are associated with a reduced risk of sudden
infant death syndrome (SIDS), according to four recent studies. But since a
cause-and-effect relationship has not been proven, researchers aren't sure
how, or even if, pacifiers prevent SIDS. In the meantime, the SIDS Alliance
refrains from recommending their use.

THE CONS

Ear infections > Pacifiers were found to he responsible for 25 percent of
ear infections in children under 3 attending day care, according to a study
published in Pediatrics in 1995. Restricting pacifier use to just before a
child fell asleep, though, returned the risk to almost normal, a follow-up
study in 2000 (also in Pediatrics) found. Why the link? Pacifier sucking
promotes fluid collection in the ears, which can lead to ear infections,
Shapiro says.

Early weaning from the breast > Offering a pacifier to a full-term baby may
keep her from what she really needs--food. Indeed, several studies have
linked pacifier use with early cessation of breastfeeding. However, a study
reported in the Journal vi the American Medical Association found that
pacifiers probably were not to blame for early weaning. The researchers
concluded that their use is a sign of breastfeeding difficulties or reduced
motivation to breastfeed.

While the pacifier-breastfeeding connection remains a question, if you do
give a binkie, it's best to wait. "If you want to offer a pacifier, wait
until four to six weeks, when your milk supply is established," Howard says.

Dental, problems> Children who suck anything--thumb, finger or pacifier--
past age 2 have a higher risk of developing protruding front teeth and/or a
crossbite in baby teeth, according to a study published last year in the
Journal v/the American Dental Association. In some cases, these problems
persist when permanent teeth come in.

So where does that leave you and your screaming baby? Prudent use of a
pacifier--occasionally and briefly, after breastfeeding is established and
before your child is 2--probably won't cause any harm. So if your baby is
soothed by using a pacifier for short intervals, give it to her guilt-free.
Or you could try another round of feeding, rocking or singing. Either way,
your baby eventually will settle down.

RELATED ARTICLE: * Do's and don'ts

If you do decide to offer your baby a pacifier, here are some caveats to
remember:

* Never give your baby a pacifier to delay a meal.

* Offer a binkie; don't force it.

* Boil the pacifier or run it through the dishwasher frequently for the
first six months; after six months, wash the pacifier regularly with hot,
soapy water.

* Never tie a pacifier around your baby's neck or hand, or to your child's
crib or bassinet.

Elizabeth Rusch, mother of 1-year-old Cobi, is the author of Generation Fix:
Young Ideas for a Better World [Beyond Words, 2002]."

COPYRIGHT 2002 Weider Publications
COPYRIGHT 2003 Gale Group

===========================================
Do Pacifiers Discourage Breastfeeding?
http://www.findarticles.com/cf_dls/m0867/1999_April/54450681/p1/article.jhtm
l

The majority of babies in the U.S., whether they are breastfed or not, are
given pacifiers. Some scientists have worried that if a baby gets used to an
artificial nipple such as a pacifier, she might have difficulty suckling at
the breast (something called "nipple confusion"). Indeed, a number of
studies have reported that infants who use pacifiers are less likely to be
breastfed as long as infants who don't. However, there is a lot of debate
over whether the pacifier actually causes the problem.

In a study of 265 breastfeeding infants from Rochester, NY, researchers
interviewed the mothers at delivery and at regular intervals until
breastfeeding ended. Two-thirds of mothers introduced a pacifier before
their baby was 6 weeks old, and as was found in other studies, infants who
used pacifiers didn't breastfeed for as many months as those who didn't use
a pacifier.

However, the authors of this study paid careful attention to which came
first--the pacifier or problems with breastfeeding--and they found that when
women gave their babies pacifiers, they already tended to breastfeed fewer
times per day and they were also more likely to report that breastfeeding
was inconvenient and that they had insufficient milk supplies.

These researchers conclude that it may be incorrect to blame pacifiers for
decreases in breastfeeding. Rather, they think that mothers who are having
problems breastfeeding are the most likely to give their infants pacifiers,
and because of their problems breastfeeding, these same mothers are more
likely than others to stop breastfeeding early. (Howard CR et al: Pediatrics
Mar 1999; e33 [electronic edition]

COMMENT: Many studies have found that pacifier use is to early stopping of
breast feeding, and most people feel that pacifiers must be the cause of
this problem. On that basis, some parents have been warned not to give their
infant a pacifier, for fear that it will interfere with successful
breastfeeding (however, that doesn't stop babies from sucking on their
fingers, thumbs, or toes!)

This carefully done study makes an important point about whether pacifiers
are the cause or the effect of this problem, and we agree with the authors
that pacifiers don't seem to be the cause.

Rather, moms who are having various difficulties in breastfeeding are more
likely to give their infants pacifiers because the infants cry more as a
result of breastfeeding not going well. Of course, when breastfeeding isn't
going well, there's an increased chance that mothers will stop early.

What this means, we think, is that parents should focus more attention on
how to breastfeed successfully and worry less about whether the baby uses a
pacifier."

========================================

Pacifier Use And Ear Infections
http://www.findarticles.com/cf_dls/m0867/2000_Oct/66304090/p1/article.jhtml

"It's known that pacifiers can affect the way a child's teeth come in, but
with that exception, they are generally considered harmless, and 75-85% of
children in western countries make a habit of using one. In the last few
years, some studies have raised the question of whether pacifier use might
be related to an increase in ear infections (otitis media), and researchers
from Finland have now tried to learn more about the relationship between
pacifier use and ear infections.

They enrolled 484 infants from 14 well-baby clinics; on average, the
children were 8 months old. The children under 18 months of age were divided
into two groups; in one group, parents were advised that pacifier use was OK
up until age 6 months, but between 6 and 10 months they were told to limit
use to the time just before their baby was falling asleep, and then to stop
all use after the infant was 10 months old. Parents in the other group were
given no advice about pacifier use. Parents kept daily symptom sheets for a
period of three to six months, and took their children to the doctor
whenever they felt it was necessary.

Overall, the authors found that about three-quarters of the infants in both
groups used a pacifier before the study began, and by the end of the study,
pacifier use had dropped to about two-thirds in both groups. Even though the
intervention didn't reduce the total number of children using pacifiers, it
did appear to reduce the amount of time infants spent using a
pacifier--among the 7-18 month olds, the intervention seemed to reduce heavy
pacifier use by 21%.

Along with that reduction in pacifier use was a 29% reduction in the number
of ear infections. The authors conclude that "pacifier use appeared to be a
preventable risk factor for acute otitis media in children." (Niemela M et
al: Pediatrics, September, 2000, pp. 483-488)

COMMENT: Pacifier use and ear infections are both common parts of an
infant's life, but there's been surprisingly few studies focused on whether
pacifier use actually increases the risk of ear infections. The current
study offers some additional evidence that frequent use of pacifiers might
be related to a child's risk of having ear infections, but it doesn't prove
that pacifiers actually cause ear infections.

Until we know for sure, it's hard to suggest that parents be advised to
"pull the plug". On the other hand, parents who choose to limit pacifier use
in an effort to limit their child's risk of ear infections are probably not
going to do their child much harm."

===========================

Counseling Parents About Pacifier Use in Infants
http://www.findarticles.com/cf_dls/m3225/5_63/71267999/p1/article.jhtml

"Pacifier use is associated with an increased risk of acute otitis media,
oral candidiasis and dental caries. Niemela and associates conducted a
randomized, controlled trial in 14 well-baby clinics in Finland to determine
if counseling parents about pacifier use was associated with a decrease in
episodes of acute otitis media in infants.

Nurses who staffed the well-baby clinics were instructed about the harmful
effects of pacifier use and asked to share this information with the parents
of children 18 months or younger (see the accompanying table on page 948).
Parents were also given a leaflet summarizing this information. The
counseling sessions occurred at each well-baby visit. Parents of children in
the control group (whose nurses received information about the epidemiology
of infectious diseases) did not receive counseling about pacifier use. All
parents were asked to complete a daily symptom sheet to record symptoms
consistent with acute otitis media.

The children enrolled in the trial were followed for three to six months,
depending on the date of recruitment. Information about previous episodes of
acute otitis media, type of day care and signs and symptoms of allergies was
also collected. Based on previous studies of the prevalence of pacifier use,
the authors surmised that one half of the children in the intervention
(counseling) group would develop acute otitis media; they hypothesized that
the counseling would decrease this occurrence by one quarter. The use of
pacifiers was classified as follows: none, only when falling asleep or
continuously.

There were 272 children in the counseling group and 212 in the control
group. The mean age of the children was eight months. About one third of the
children had a history of acute otitis media. Pacifier use occurred in 79.0
percent of the intervention group and in 74.7 percent of the control group.
At the end of the study, pacifiers were still being used by 68.0 percent of
children in the intervention group and 66.5 percent of children in the
control group. However, children in the intervention group were
significantly less likely to be using the pacifier continuously than were
those in the control group (35 percent versus 48 percent). Among children
seven to 18 months of age, this represented a 21 percent decrease in the
continuous use of a pacifier.

The incidence of acute otitis media was reduced by 29 percent in the group
that received counseling. Continuous use of the pacifier was associated with
a 33 percent higher rate of acute otitis media. Most of the parents seemed
to appreciate the counseling about pacifier use, although 11 percent felt
anxiety because they had not known of the adverse effects of pacifier use, 9
percent felt guilty and 7 percent were angry about the counseling.

The authors conclude that offering supportive and encouraging
recommendations about the use of pacifiers can reduce the occurrence of
acute otitis media. Pacifier use is one of the easily modifiable risk
factors for acute otitis media (as opposed to anatomic considerations or
mode of day care), and anticipatory guidance of parents about pacifier use
should occur."

GRACE BROOKE HUFFMAN, M.D.
Niemela M, et al. Pacifier as a risk factor for acute otitis media: a
randomized, controlled trial of parental counseling. Pediatrics
September 2000;106:483-8.

COPYRIGHT 2001 American Academy of Family Physicians
COPYRIGHT 2001 Gale Group

=================================

Caroline Bowen PhD
Speech Language Pathologist
9 Hillcrest Road
Wentworth Falls NSW 2782
Australia
e: cbowen at ihug.com.au
i: http://www.slpsite.com
t: 61 2 4757 1136

  _____  

From: info-childes at mail.talkbank.org [mailto:info-childes at mail.talkbank.org]
On Behalf Of Alcock, Katherine
Sent: Monday, 17 October 2005 7:20 PM
To: info-childes at mail.talkbank.org; dev-europe at lboro.ac.uk
Subject: Dummy/pacifier use and speech development

There has been a new recommendation out recently that infants be offered
pacifiers to put them to sleep, which is supposed to help prevent SIDS.
About the first thing mothers in the UK say to me when they hear I study
oral motor skills and speech is "oh, we never use a dummy" or "my sister
gave hers a dummy, it's very bad for their speech, isn't it?"  I expect this
to re-emerge with this new advice, and I've even heard from speech
therapists that they are supposed to be linked to lisps.  

I have heard this much less frequently from US parents than UK parents - I
think using a dummy is much more stigmatised over here, and this makes me
suspicious of un-referenced advice even from health professionals.  And I
have been able to find absolutely no evidence one way or the other - Medline
and Psycinfo searches bring up nothing (some work on dental problems - which
don't seem to be linked).

Does anyone know of any studies? 

thanks 

Katie Alcock 

Katie Alcock, DPhil 
Lecturer 
Department of Psychology 
Lancaster University 
Fylde College 
Lancaster LA1 4YF 

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