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Pacifiers, Sippy Cups and Thumb Sucking - UhOh!? - August 2007

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Pacifiers, Sippy Cups and Thumb Sucking, UhOh!?

By: Denise Dougherty, MA, CCC-SLP

When my children were born, our local hospital sent us home with a bag of freebies, bottles, nipples and a pacifier. There were days AND nights when I wished they would take the pacifier to help calm them AND me! But my children were never fond of the pacifier or their thumb. Looking back, I'm happy they never developed a liking to either one. As they moved from nursing to the bottle, and finally to the cup, we used sturdy sippy cups with a small spout. These cups helped decrease spills, but I tried to make it a rule that my children didn't travel with the cup, they drank then put the cup down.

During my children's' infant/toddler years, I worked with adults in long term care. When I began seeing more children for therapy, my continuing education focused on oral motor skills, pediatric dysphagia and orofacial myofunctional therapy. As my awareness of oral motor skills increased, I couldn't help but notice the number of children well over the age of two with a pacifier, children playing with a bottle hanging from their teeth, sippy cups with a very large spout, and children sucking their thumb. There is nothing wrong with utilizing the pacifier or having an infant suck their thumb, but overuse can create issues with tongue posture that changes the swallow, dentition and impairs articulation.

There is a difference between suckle and sucking. In a suckle pattern, the infant has an in/out movement of the tongue and the fatty sucking pads are used for stabilization. The suckle/swallow reflex is present from birth to 9 months. Between the age of 4 and 6 months, the suckle is used in anticipation of the spoon during feeding. From 7 to 9 months, there is a mixture of tongue movements in/out and up/down. The true suck is found between 10 and 12 months. Lips are used for stabilization and the tongue retracts rather than moving forward. Tongue retraction is important and using a suckle for nutrition will prevent the tongue from developing adequate retraction. Even one bottle a day is a problem

Pacifiers help calm infants, encourage lip rounding and help develop non-nutritive suckle/suck at birth. It is important to try to match the shape of the pacifier to the shape of the nipple used in bottle feeding. The infant doesn't have to adjust to the difference between the two. Thumb sucking can help increase awareness, and results in a deep tendon response from the TMJ.

A helpful rule of thumb is if you no longer need to suck for nutrition, you no longer need a pacifier. If you can talk, you don't need a pacifier! If a pacifier is not phased out, the tongue tip cannot elevate for a swallow. In addition, use of the sippy cup with a spout contributes to the tongue tip down position. The best type of trainer cup has a recessed lid with the hole for the liquids, just like your travel coffee cup. To wean a child off a pacifier, it is helpful to change the feel. This can be accomplished by putting holes in it or cutting off the tip. Also putting an extract on the pacifier changes the taste and may be unacceptable to the child. If you are attempting to wean off the bottle, you may put holes in the sides of the nipple, the child will become wet when drinking. You may also water down the milk gradually over the course of two weeks. Always give the child an option of a liquid in a cup during the weaning process.

Thumb sucking or digit sucking can help calm a child. If the child has sensory integration issues, sucking can help organize them and provide increased awareness. But if the thumb/digit sucking is a habit, you should begin removing it. Without eliminating the thumb/digit sucking, there is an increased probability that a tongue thrust will develop. Tongue thrust will prevent the teeth from meeting properly, impact the child's ability to bite and chew food efficiently, contribute to jaw joint problems and grinding of the teeth in addition to poor articulation of sounds. Orthodontics can reposition the teeth, but without correcting the tongue thrust/muscle imbalance, the child may have orthodontic relapse where the teeth move after the braces are removed.

Speech pathologists work with children with tongue thrust, muscle imbalance, and articulation problems that may develop. Early identification and treatment is important; however, parent education is critical in preventing these problems.

This Month's Featured Vendor: Cross Country Education

Special Thanks to Denise Dougherty for providing an article for this issue's Therapy Corner.

Denise Dougherty, MA, CCC-SLP, is a Speech Pathologist who has her own private practice, where she conducts therapy with both children and adults. Ms. Dougherty received her Bachelor's degree at Marywood University, Scranton, Pennsylvania, a Master's Degree from St. Louis University and has completed postgraduate courses at Johns Hopkins University and several doctoral courses at University of Phoenix.

She is certified in VitalStim therapy and is an instructor for VitalStim certification, is a member of the American Speech and Hearing Association and has received numerous ASHA ACE Awards. During more than 27 years as a Speech Pathologist, Ms. Dougherty has worked at United Cerebral Palsy, Easter Seals, in long-term care; is a board member of The American Academy of Private Practice in Speech Pathology and Audiology (AAPPSPA), AAPPSPA Program Chair for 2006 and 2007 Conference; is a AAPPSPA liaison for the ASHA Health Care and Economics Committee; served as secretary of CORSPAN; and as a private practitioner.

Ms. Dougherty was also an adjunct faculty member at York College of Pennsylvania and Wesley College in Dover, Delaware. Ms. Dougherty is the Vice President of The American Academy of Private Practice in Speech Pathology and Audiology and received the Academy's 2007 Honors Award for achievements.

Denise also speaks regularly for Cross Country Education. Please support our contributing authors and vendors. Check their website for her upcoming schedule of seminars. You can find their website at: Cross Country Education online at:

Tags: August 2007 Newsletter OT SLP Oral Motor Therapy Article