Significance

of NonNutritive
Sucking on a
Pacifier for
Preterm
Infants
BY: TAYLOR JOHNSON

Introduction
Presented By: Taylor Johnson
Mentor: Angeline Chin
Mentor Site: Clear Lake Regional Medical Center
Career of Study: Neonatal Intensive Care Unit Occupational Therapist
Project topic: Significance of Non-nutritive Sucking on a Pacifier for
Preterm Infants
Independent Study Mentorship: Fall 2017
Teachers Name: Mrs. Click
*Some information in this presentation comes from outside sources*

What is ISM?
ISM stands for Independent Study Mentorship
ISM is a course designed for students wishing to mentor an
adult professional in a chosen career
Each student is required to have a minimum of 3 hours and
keep up with an ISM Professional Portfolio (online format)
Students are also to develop a final presentation at the
end of the semester

My Project Topic
Non-nutritive sucking (NNS) on a pacifier plays a significant
role in an infants life, especially preterm babies
I will be discussing the importance of using pacifiers and
other key factors related to non-nutritive sucking
I believe that not a lot of people know how much pacifiers
help preterm infants with brain growth

Non-Nutritive Sucking on a Pacifier

Rhythmic movements of the infants mouth and tongue on
the pacifier to modulate state or explore the environment
Used as a self-calming, self-soothing, and self-regulating
method
Non-nutritive because infants are not obtaining
nourishment but maintaining homeostasis

A baby born premature (before 37 weeks) lacks

developmental and physical skills to feed correctly
By 28 weeks gestation, infants should be able to suck and
swallow
Wolf, Lynn S., and Robin P. Glass. Feeding and Swallowing Disorders in Infancy: Assessment
and Management. Tucson, AZ: Therapy Skill Builders, 1992. Print.

Non-Nutritive Sucking on a Pacifier

(continued)
Last trimester: large amount of brain growth going on

Advantages
Soothing, calming, self regulating
Optimal brain development

Smoother transition to bottle or breast feeding

Better bottle feeding performance
Decreases hospital stay for preterm infants

Prevents SIDS (Sudden Infant Death Syndrome)

If baby is being fed through a tube, pacifier helps get
them used to sucking

Improved state control

Advantages (continued)
Decreases behavioral distress to (iatrogenic) medical
examination stressors
Promotes return to sleep faster
Improves oxygenation
Decrease intestinal transit time
Improve weight gain by reducing fussing/restless activity
No short term negative effects
Does not interfere with breast feeding
Sexton, Sumi, MD, and Ruby Natale, PhD, PsyD. "Risks and Benefits of Pacifiers." - American
Family Physician. American Academy of Family Physicians, 15 Apr. 2009. Web. 02 Oct. 2016.

Disadvantages
Increases the chance of dental issues, especially with
prolonged
May cause suffocation if there is a string attached
The advantages out-weigh the disadvantages

How do Occupational Therapists Help?

The OT is responsible for educating parents on proper nonnutritive sucking care
May work with baby on sucking by ensuring that each
baby has a pacifier at certain times
May help calm the baby during bathing, feeding,
procedures, and assessments
Pay attention to the infants reflexes such as grasping and
signs of stress
Make sure the baby is positioned properly for sleep and
non-nutritive sucking
Pinelli, Janet, and Amanda J. Symington. "Non-nutritive Sucking for Promoting
Physiologic Stability and Nutrition in Preterm Infants." Cochrane. The Cochrane
Collaboration, 19 Oct. 2005. Web. 02 Oct. 2016.

How do Occupational Therapists Help?

(continued)
Assess babys progress in brain growth and determine
what infant needs
Depending on the hospital a Physical Therapist or Speech
Therapist may work on babys progress and assessment as
well

Non-Nutritive Sucking vs Nutritive Sucking

Non-Nutritive

Nutritive

Development (progression)
27-28 weeks: weak, single sucks with
long random pauses
30-33 weeks: short stable sucking
bursts (1-1.5 sucks per sec),
respiratory rate may increase,
sluggish esophageal peristalsis
34 weeks: longer sucking bursts,
regular pauses, sucking same as term
infants, intermittent swallowing after
less than 6-8 sucks, smooth
esophageal peristalsis

Development
Sucking and swallowing occur in
utero after the first trimester, suckswallow-breathe as early as 32 weeks

Rate
2 sucks per second

Stimulus
Liquid obtained from nipple

Rate
1 suck per second
Pattern
If mature, continuous stream of sucks
(10-30) then variable bursts and rest
periods towards end of feeding

Non-Nutritive Sucking vs Nutritive Sucking

(continued)
Non-Nutritive

Nutritive

Pattern
alternating sucking bursts (4-13 sucks)
rest periods (3-10 seconds)

Arousal Feeding
Occurs more efficiently in arousal
episodes
Suck elicits swallow
Maturation is more important than
age, weight, or practice in achieving
s-s-b coordination

Stimulus:
occurs in sleep as spontaneous
mouthing movements or in response
to dry stimulus (pacifier/finger)
Arousal feeding:
able to elicit in all states except
deep sleep and crying
Helps initiation of nutritive sucking
bursts
Rhythmical NNS does not guarantee
an effective nutritive suck

Suck-swallow-breathe ratio
1:1:1, may be higher if suck is
inefficient at end of feeding
Infant may have multiple swallows
without breathing

Non-Nutritive Sucking vs Nutritive Sucking

(continued)
Non-Nutritive

Nutritive

Suck-swallow-breath ratio
At least 6-8 non-nutritive sucks before
a swallow

Indicator of neurological impairment

Since nutritive sucking is sensitive to
arousal and environmental
distractions, it is not
interchangeable with NNS as an
early measurable index of
neurological function

Respiration
improved oxygenation in preterm
infants up to 35 weeks
Improved in non crying, breathing
frequency, tidal volume, minute
ventilation
Remain unchanged in term infants
Indicator of neurologic impairment
Suggested as a potential early sign in
infants with perinatal distress
Traditional neurologic evaluation

Long Term Effects

Brain development

Product
Link to video will be here
(have made sure materials are at mentorship site)

Conclusion
I will conclude here
Ask questions

Thank You
I would like to thank my mentor, Angeline Chin, for taking time out of
her schedule and meeting with me in the mornings
I would like to thank all the evaluators here

I would like to thank Mrs. Click for being an amazing ISM teacher and
guiding us through the semester
I would also like to thank my parents for being supporting me and
taking my brother to school on the days I met with my mentor

Works Cited
"The Power of a Pacifier." Thrive Occupational Therapy. N.p., 17 Apr. 2016.
Web. 02 Oct. 2016.
Ponti, M. "Recommendations for the Use of Pacifiers." Protecting and
Promoting the Health of Children. Canadian Pediatric Society, 01 Oct.
2003. Web. 02 Oct. 2016.
Sexton, Sumi, MD, and Ruby Natale, PhD, PsyD. "Risks and Benefits of
Pacifiers." - American Family Physician. American Academy of Family
Physicians, 15 Apr. 2009. Web. 02 Oct. 2016.

Pinelli, Janet, and Amanda J. Symington. "Non-nutritive Sucking for

Promoting Physiologic Stability and Nutrition in Preterm Infants." Cochrane.
The Cochrane Collaboration, 19 Oct. 2005. Web. 02 Oct. 2016.
Wolf, Lynn S., and Robin P. Glass. Feeding and Swallowing Disorders in
Infancy: Assessment and Management. Tucson, AZ: Therapy Skill Builders,
1992. Print.