Nutritive / Non-Nutritive Sucking

Objectives: Participants will...

• Recognize the significance of nutritive and non-nutritive sucking in the oral facial development of the infant.
• Learn the effect upon dentofacial development of the type of artificial nipple used.
• Be able to advise mother of benefits of breast feeding.
• Be alerted to pacifier safety measures.

The habit of sucking is a reflex occurring in the oral stage of development at approximately the 29th week of gestation, disappearing during normal growth between the ages of one and three and a half years of age.

There are essentially two forms of sucking – nutritive and non-nutritive. Nutritive sucking includes breast or bottle feeding and provides the infant’s essential nutrition. The tongue and oral facial muscles function differently with breast or bottle feeding. Breast feeding requires more suction and muscle movement and usually takes significantly longer. A breast or bottle is often used as a pacifier to calm a crying infant or to put an infant to sleep. This practice is the main cause of ECC and should be avoided.

Data from the 1981 National Health Interview Survey suggest that breast feeding protects against malocclusion and may have measurable impact upon the oral facial development. Because of its beneficial nutritional effects and its positive influences on oral and psychological development, breast feeding should be encouraged over bottle feeding, when feasible.

At this time the effects of bottle-feeding on dentofacial development have not been scientifically correlated with the type of nipple used. The size of the hole in the nipple must be carefully evaluated to assure a minimal free flow of liquid. Excessive liquid may stimulate a forward positioning of the tongue, which may be retained as a habit (tongue thrusting). Physiologically designed (orthodontic) nipples have been suggested as adapting to the anatomy and physiology of sucking than non-physiologic nipples. According to one study, sucking on a artificial nipple does not require the same degree of activity of facial and oral musculature as sucking on a breast. It has been found that the longer time a child uses a pacifier, the more likely reshaping of the jaw occurs.

Non-nutritive sucking is considered a natural reflex to satisfy a child’s need for contact and may include unrestricted sucking on a breast, digit, pacifier or other object like a blanket or toy. This non-nutritive sucking may make a child feel secure and relaxed, and allow the child to learn about the environment through mouthing objects.

According to studies with Swedish children, the prevalence of pacifier use has increased greatly, while the number of children with finger or thumbsucking habits has diminished. The overwhelming majority of pacifier use is discontinued between one and three years of age.

There are many sizes and shapes of pacifiers from which to choose. According to manufacturers, a physiologically designed pacifier also called “orthodontic pacifier” offers many advantages: it conforms to the baby’s lips; its smooth, adapted contour promotes nasal breathing; its flat nipple simulates the shape of the mother’s breast, allowing the tongue to touch the palate in a more natural sucking position and improving lip seal. At this time, there are too few scientific data to substantiate the desirability of the physiologically designed pacifier over conventional ones.

Recently, the association of otitis media and pacifier use has been an area of concern. A few studies imply an association between otitis media and pacifier. However, none has demonstrated causality, but may imply infant pacifier usage as a soothing mechanism for an undiagnosed otitis media.

Safety Measures: When a pacifier is used, parents must be advised of the danger of a cord or ribbon around the neck; a break-away pacifier holder is commercially available. The importance of a large flexible protective shield to prevent possible aspiration and of selecting a pacifier constructed of a single unit of durable material should be stressed. Parents should be cautioned against the child placing the pacifier shield inside the mouth, as it can damage both the marginal gingiva and the bone supporting the anterior teeth.

The possible effects of non-nutritive habits, pacifier or digit sucking, on the oral structures are determined by the intensity, direction and nature of the force, all of which can vary greatly. Studies indicate that for the first three or four years of life, impact on the occlusion may be confined largely to the anterior segment, causing an anterior open bite, for which self-correction can be expected. If the habits continue through the early mixed dentition stage, there is an increasing probability that the malocclusion will not self correct. Studies have demonstrated a correlation between digit sucking and a posterior crossbite (a narrow maxillary arch which does not properly occlude with the mandibular arch). Since a pacifier is easier to be taken away, it is preferred to digit sucking.

The effectiveness of prenatal dental health education has been reported. Health professionals should consider teaching the subject of oral habits as part of their health prevention programs.

Summary

Breast feeding should be encouraged as the best method of feeding, with the prevention of malocclusion an additional benefit. Neither breast nor bottle feedings should be used to pacify a child, due to the risk of ECC. Parents need to hear special recommendations on the child’s sucking need and its role in oral muscular activity.

Physiologically designed nipples or pacifiers may be better than conventional ones, but more research is needed to substantiate the claim. Pacifier is preferred for non-nutritive sucking over a digit or a bottle.