Significance of

Non-Nutritive
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. "Nonnutritive 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

 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
Rate
2 sucks per second

Nutritive

Development
Sucking and swallowing occur in utero after the
first trimester, suck-swallow-breathe as early
as 32 weeks
Rate
1 suck per second
Pattern
If mature, continuous stream of sucks (10-30)
then variable bursts and rest periods towards
end of feeding
Stimulus
Liquid obtained from nipple

Non-Nutritive Sucking
vs Nutritive Sucking

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

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

Nutritive
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

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.