The accessibility of a new oral motor pacifier to infants

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Abstract

Objective

The aim of the present study was to examine whether infants would accept an oral motor pacifier (OMP).

Children and methods

Sixteen infants were examined for their immediate acceptance of an OMP. The pacifier was regarded as accepted, if the child took it in the mouth and kept it there actively, i.e. sucked it in one way or other. Their parents were informed verbally and in writing literally about how to offer the OMP to the child and how to use it. The OMP was presented to the child and the child permitted to insert it into her/his mouth by her/himself or if the child failed to do so, the OMP was gently put to the child's mouth. The subjects’ reactions were structurally evaluated in terms of 11 statements. The parents of the children received a structured questionnaire with a space for optional free comments and personal opinions.

Results

The median age (6 females, 10 males) was 18 months (mean 19.2 months, s.d. 10.6 and range 2–38 months). The statement scores showed no significant differentiation based on the age of the subject. The parents’ reports indicated that 14 (87.5%) of the 18 subjects accepted the OMP, 13 (81.3%) enjoyed watching the pacifier as it was shown to them, and 11 (68.8%) explored it with their fingers while holding it in their hands.

Conclusion

The vast majority of the children accepted the new OMP either at the first trial or after a few trials.

Introduction

The ability to suck begins to develop in utero by 15–18 weeks of gestational age and matures to the typical burst-pause pattern around 32 weeks. Nutritive sucking in the newborn is primarily an automatic reflex stimulated by tactual receptors of the mouth and face, and is an adaptive reflex vital to survival as it helps the child to search for, suck on and swallow nutrition. The ability to suck is supposed to reflect the normal development of the integrity of CNS [1], [2], [3]. During the first months of life, sucking becomes a habit that also fulfills the infant's affective needs [4].

Healthy full-term neonates and infants have two distinct sucking patterns. The nutritive pattern consists of a continuous stream of sucking cycles interspersed with swallows at a frequency of about 1 Hz, whereas a non-nutritive sucking consists of bursts of about 6–12 sucking cycles interspersed with pauses at and pauses in between them at a typical frequency of about 2 Hz [5]. During non-nutritive sucking with a pacifier or feeding nipple, the infant coordinates the burst-pause pattern with respiration.

Up to 90–95% of small children are estimated to exhibit various non-nutritive sucking habits [6], such as pacifier or thumb sucking. Pacifiers are widely used in industrial countries, where infants receive a pacifier to help them calm down and feel secure, as well as to satisfy their oral needs. The prevalence varies from about 40% to 80% [6], [7], [8] and about 18% to 38% of children have been found to suck their fingers [6], [8]. The majority (63%) of children uses pacifiers (38%) or sucks their fingers (23%) up to 15 months of age [6]. Pacifier use drops to 1% in five-year-olds, and thumb sucking to 12% in four-year-olds [9].

The tongue and jaw move together during sucking feeding, but non-liquid foods trigger new motor reorganization and motor skills which helps the child to develop mature swallowing. This development requires differentiation of the movements of the tongue, lip and jaw. The infant is expected to elevate the tongue tip intermittently by 12 months and consistently by 18 months of age without associated tongue retraction/protrusion [1]. Even though refined movements for mature swallowing will develop until the age of 24 months, mature speech motor patterns develop much later. Even though 6–7 years old children can produce correctly most speech sounds they commonly misarticulate the sounds that require relatively fine-graded articulator adjustments, such as voiceless sibilants and voiced tremulants [10]. Articulatory accuracy precision continues to develop between the ages 6 and 14 [11]. The absence of independent, differentiated movements of oral structures limits the development of mature swallowing, deglution and mature speech patterns [1], [12].

Undifferentiated lingual gestures are common in children with speech sound disorders. As many as 71% of children with articulatory/phonological disorders exhibit with a tongue tip/blade and body moving together without the ability to produce differentiated movements of the tongue's lateral and medial regions, and experience difficulty coarticulating speech sounds with subsequent ones [12]. Children with articulation errors and other oral myofunctional disorders are often unable to keep the tongue tip up while simultaneously keeping the back of the tongue in the resting position. Instead they exhibit their tongue in contact with the hard palate, thereby forming a linguopalatal seal at rest [1].

Orofacial myofunctional functions are strongly suspected to affect both speech articulation and dentofacial development. Children with a closed mouth posture exhibit with an adequate tongue rest position as retroflexed with alveolar contact, whereas children with an open mouth position maintain the tongue in a forward plane. The open mouth posture is associated with reduced maxillary arch width and increased facial height [13], [14]. Infantile tongue-thrust swallowing may result in an anterior open bite and related speech sound disorders, such as lisping. The open bite that children display trends toward less consistent production of closures during speech, as evidenced by a more posterior pattern of electropalatography (EPG) contact and relatively sparse EPG contacts during swallowing [12], [15].

Delayed non-nutritive sucking habits are suggested to affect negatively on dentofacial structural and functional development [6], [9], [16], [17], [18]. The use of a pacifier for two and three years may result in significant alterations of the maxilla and mandible, respectively [19]. Posterior crossbites have been found in about 7% and interfering teeth of primary canines and forced guidance of the mandible and a midline shift in 30% of girls who sucked on pacifiers up to 2.5–3 years of age [16]. Non-nutritive sucking habits lasting longer than 48 months may have detrimental effects on occlusion in late dentition [9].

Children whose non-nutritive sucking habits last no longer than 12 months seem to have no occlusal characteristics different from children who were breast fed for 6–12 months [9]. Breast feeding for at least six months [20] is preferred before bottle feeding because bottle feeding is suspected to be followed by prolonged use of the pacifier, which may result in orthodontic problems such as open and crossed bites [19], [21] and the need for orthodontic treatment [22]. Breast feeding is supposed to help to maintain the rest posture for lip closure and related nasal breathing [23].

Oral plate therapy (OPTH) has been widely used to reduce tongue thrust and deviated speech articulation as well as to promote more mature swallowing. Oral plates have been used in Down syndrome babies without teeth to improve orofacial appearance and lip closure as well as tongue posture [24]. Various removable palatal plates, including knots and beads as activators of lingual movements, have been used in infants to correct false oral motor movement patterns and structural abnormalities as well as to promote normal occlusion, to eliminate lingual dysfunctions during speech sound production, and to stimulate differentiated lingual gestures [25], [26], [27], [28]. Oral plates aimed to improve speech articulation can be used in children who can tolerate to impressions to be taken, and whose dental development allows the plates to be firmly and therefore safely fixed in the teeth. However, such plates are individually prepared and thus costly [26].

There is a need for standardized commercial oral motor stimulators that are more easily and cheaply available even for small children, and which are safe to use and require no fixation on the teeth. This need led manufacturers to design a prototype for a specific pacifier (oral motor pacifier, OMP) with a nipple stimulating the tip of the tongue. This stimulation would stimulate the child to turn the tongue up and backward and to lift up the lateral margins of the tongue so that the medial region of the tongue would form a central groove (Fig. 1a and b). The aim of the present study was to examine whether infants would accept the OMP.

Section snippets

Subjects and methods

The subjects were 16 infants whose parents voluntarily participated in the study. Four of the infants were drawn from patients participating in the examination of speech language development at the Helsinki Uusimaa District Hospital and the rest came from either the patients’ healthy siblings or families familiar to the staff or their relatives. A local ethics committee approved the study protocol and the children's guardians provided their written informed consent.

We examined the subjects to

Results

The median age (6 females, 10 males) was 18 months (mean 19.2 months, s.d. 10.6 and range 2–38 months). Five (31%) subjects exhibited with orofacial structural abnormalities or dysfunctions, one of them had Down syndrome. Three of the children had never used a pacifier before.

The statement scores showed no significant differentiation by the subject's age. The child's sex did not affect the distribution of the statement scores except the sixth statement. The females scored higher (mean score 5)

Discussion

The present data indicate that the vast majority of the children accepted the new OMP either during the first trial or after some trials. No parent reported typical non-nutritive burst-pause sucking patterns in their optional free comments, nor did they observe such patterns among the children who were observed by a speech pathologist.

Pacifiers vary in many respects (e.g. shape, size, material and stiffness), which may influence the habits of non-nutritive sucking. The sucking maneuvers of

Conflict of interest

The authors declare that there is no conflict of interest.

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