A Very Bad Pacifier

Very good in NICU, but using this pacifier with older infants and children creates problems with feeding, tongue and teeth.

About 20 years ago, a new pacifier came into production designed for babies in NICU.  It was completely latex free which was it’s feature.

It is OK for very small NICU babies… definitely not OK for bigger babies.  This is why.

Teaches bad sucking:  There are 2 ways a baby gets milk out of the bottle or breast; by sucking, an event that uses tongue, palate and cheeks to pull a stream of milk out and by chewing the end of the nipple which only empties milk at the end of the nipple into the baby’s mouth.  A full term baby is born knowing how to suck, he has probably been sucking a thumb for months, but not so the preemie.  Sucking occurs at the back of the tongue and he must be taught.

Keeps the tongue in the front of the mouth or sticking out of the mouth: There is not enough of a hub on this nipple to capture for sucking or to keep the pacifier from falling out of  the mouth when at rest. Therefore the baby must press it against the top of his mouth with his tongue, and this is a mistake.  You can understand the problem if you put this pacifier in your mouth and attempt to hold it in place without using bottom teeth.  Then try sucking on it, there is no bulb to keep the back of the tongue down and curled… no way to engage it to suck and therefore it essentially blocks the throat.

Risking ‘buck teeth’:  The basic physical things a baby learns remain his preference for a lifetime.  Learning to apply pressure with the tongue against the upper ridge of teeth will possibly cause him to tongue-thrust during deep sleep.  This applies heavy pressure against the back of his upper teeth, pushing them outward.  Braces will change it but his tongue thrusting will continue recreating the problem.  The tip of the tongue has a normal position, gently resting against the upper palate.

For more pacifier tips and tricks see PACIFIER posts on sidebar.

Preemies are Survivors

Comments we get from parents of children who were very tiny preemies are ‘he is so feisty’. The baby is thinking and problem solving all the time. He’s going through Rites of Passage  events akin to the Indian boy in the Sweat Lodge, the African boy with tribal scaring  a first skydive or standing on a mountain top.  But he is going through it at 1 pound. He will come out, smart, fearless, and happy. These kids are always happy. Think of it. Life is just getting better… all the tubes are gone, he is held by those he loves dearly, he rides in a car, home is wonderful and he spends time outdoors. Every day is better for him and he is learning to expect that in his entire life.

Teaching a Preemie to Suck

There is only one pacifier shape that teaches good sucking.  All others, except the Nuk, work against it.

Because of prematurity the baby is born before the full, strong sucking reflex was established.  He must be taught to suck,  to gain cheek muscles,  to learn the correct combination of sucking and pulling without air leaks and to transfer these skills from the bottle to the breast. Working in NICU for 20 years, I’ve used this system of teaching sucking efficiency with hundreds of babies and it works every time.

  • Hold the bottle near the neck with the thumb and middle finger and using your last 2 fingers, support him under the chin, then when he starts sucking, put traction on the bottle. The chin support  brings the jaw forward and the tongue forward and his response to the traction is to curl his tongue around the nipple. This with the ring of the nipple against his mouth gives a firm, efficient package and he will begin to build up strength, cheek muscles and stamina.  He will take a few sucks and then stop to rest.  This is hard work for him in the beginning.  Some nurses twist the nipple repeatedly in the baby’s mouth, others pump up and down or back and forth. The baby will not learn to suck if that’s the case. They are simply expressing milk into it’s mouth. (and it makes me crazy)
  • The Pacifier. There is only one pacifier that teaches them to suck correctly. It’s the original Binky (pink image below), a rather large, rounded bulb with a stem fitting into a curved mouthpiece. This thing is magic.  It will teach him to suck at breast like a normal newborn. Email Binky (Playtex) and ask where to buy them near you.  The NUK pacifier was designed by a German orthodontist to bring a receding chin out and it does not strengthen the tongue.  Other pacifiers are either too short, too straight or too flat, preventing the infant’s learning a good tongue curl and grip.





Gerber is again marketing the original Binky for which every parent should grateful.  It’s called First Essentials and if not in your grocery stores, it’s available on Amazon.

Holding and Carrying the Baby

First time parents are afraid to touch the tiny baby and handle him stiffly but there’s a way to fix that. Before a feeding, sit with your partner, cross legged on the bed and practice handing the baby back and forth, putting him up to the shoulder, different feeding positions and practice the football hold. (Holding his head in your hand, his back along your forearm, legs on either side of your elbow.  This allows you full control, he can see your face and you can clamp his leg against your body for a more secure carry.)

About sling carriers… with a one piece cloth sling carrier,  gravity forces the newborn down into a deep curve at the bottom, bending his head so the chin is tight against his chest.  This can obstruct, clamp-off the airway.

Important in an infant carrier is stability, supporting the head and exposing the face to air. The perfect front or back carrier and one that keeps the newborn’s chin up and carries  growing children easily is the Boba,  (formerly SleepyWrap). Their page of pictures is very exciting. Almost makes you want to have another baby!


Preemies are Overprotected

They are made of tough stuff and fearless.  Here’s a story.

The mother of one of our smallest, in NICU for a year (20 years ago, with new technology that never happens any more) and trached at home for two years more called into NICU one night and said she felt awful.   Ryan  was jumping on the sofa, fell off and broke his arm.  I told the nurses working nearby and they cheered!  The mother on the phone asked what that was about.

I told her they were cheering her because preemies are so tenderly overprotected as they’re growing up that they can never experience life.

Your preemie as a toddler will climb on a chair and jump to the sofa. Again and again.  Even falling does not stop him.  I wondered why this was so common.  Maybe because he has learned to trust.  He trusts people because everyone in this NICU experience was essentially kind to him, and gentle.  But he also has learned to trust space!  Infants understand perspective and there are studies where a deep floor of black and white squares was painted on the bottom of a large sheet of glass.  The mother was on the far edge and the newly crawling baby near the opposite edge.  The mother called him to her and he crawled to the part of the glass painted with his edge, saw what appeared to be a drop-off and would go no further.  So why do preemie infants seem to not react to the drop-off?  It may be because he has lived in a glass house, perceived that it was high and was not worried about the consequences of falling.

The truth about preemies growing up is that they are made of strong stuff, happy, brave, daring, smart.  Enjoy them.

Bringing Baby Home to Pets

Bringing  a new baby or preemie home to a family that includes dogs?  Here’s a bonding trick.

Take a clean piece of cloth, a wash cloth, or maybe use a worn out NICU shirt they are going to throw away… one for each dog, and shortly before the baby goes home, ask the nurse to put it in the crib, next to the baby.  If it’s a shirt, put it on the baby.

Then carry it home in a plastic bag to insure the baby’s smell is strong, and one by one, give each dog in the family a treat, pet him, talk lovingly to him and then give him the shirt to smell.  Then put it into the dog’s bed.

Repeat this for each dog.  They will then bond with the baby before it comes home.

Baby’s Head Shape

About fifteen years ago, researchers did a world survey about SIDS and found that SIDS was low in China and Eastern Europe where children slept on their backs and very high in New Zealand and Australia where children slept on their stomachs (on sheepskins, the real kind from the sheep).

From this, rules for positioning newborns changed.  Sheepskins were gone and babies were placed on their backs, flat or gently tipped to the side.  Incidence of SIDS fell dramatically and many of the remaining SIDS happened at daycare.  (Read SIDS and Daycare post).

Until the 1940s, babies in America slept on their backs and children had round faces.  (See Change Your Baby’s Head Shape post). Then it was said that if a child slept on their back, it could vomit, aspirate and die.  THIS IS NOT TRUE.  The only group that cannot clear their vomit sleeping on the back are adults too drunk to wake up. Now children sleeping on the stomach had long, narrow faces and this became the beauty standard in America.

Sleeping on the back will give the child an entirely different look. The face is now wider and called ’round’ or ‘square’ and no longer ‘oval’.  Ears stick out in a charming way because the baby is not lying on them.  Eyes are big because the bones behind the eyes are now flattened a bit and eyes are no longer deeply recessed.  The entire look is beautiful and now corresponds with the beauty of European women such as Penelope Cruz for example.

Change Your Baby’s Head Shape

A baby’s head is bigger in ratio to the body than adults by a large factor.  It would be as if we were dealing with a head that weighed 70 pounds with no neck muscles.  Newborns for the first 2 months are unable to lift their heads and remain rooted to the spot.  Newborns on their backs cannot even turn the head.

Because of this, the normal rounded back of the head forces the baby’s chin to the chest position (which you don’t see from the front and which is not good for maintaining an open airway), and the head from neck up  becomes flattened from it’s weight.  Weeks and months of this position leaves the baby with a flat head coming to a point and as an adult, he will be heartbroken.  (Adult women can hide it somewhat by fluffy hairstyle.)

Long term preemies in NICU began to show this headshape change.  P;acing a folded blanket under their backs, from the shoulder down, allowed their head to remain on the unraised portion of the bed with less of a weight factor.  Then I would put one of the Ross cards on the top of the isolette dome and they turned the head to look at it.  Now the newborn could freely turn his own head and create a nice shape to it.

You have 6 months before the bones of the baby’s head are solid to the point they will never change shape:

  • Raise his body by padding under it, with a thin blanket folded,  from shoulders down when in bed.
  • Same thing in the stroller, jump seat etc.  Pad from shoulders down, keeping alignment of the head with the chin in a straight line, not tilted down.  Tilting down bends the airway.
  • Padded inserts to car seats and strollers that form an arc around the child’s head force the chin down.  Without the arc, the baby’s head will fall to the shoulder when he sleeps so do what mothers have done forever, prop it up with a folded cloth or stuffed toy.

Preemies as Genius

Now for some fun. When he’s at the point where he’s held, fed, contented and you sit with him on your lap, position him so he can see the ceiling and watch his eyes…  you can tell what he’s thinking.  Preemies, more so than normal newborns, are very alert and problem solve. (newborns are not that alert until about 4 months. This is because all the while these NICU events have been going on the preemie has been figuring them out.)  The artist’s foundation of IQ is pre-cognition, finding the problem and then solving it and, applying this theory to everything in life, these preemies become masters at it at about 26 weeks. I have hundreds of stories.

While watching hundreds of babies during thousands of feedings over 20 years in NICUs, I’ve come to believe that we are all born genius and what happens to us from birth on determines if it’s supported and nurtured or harmed.

Preemies and newborns focus on straight lines. Watching their eyes as they look at a large square black and white checkerboard you see that they are doing two things, they trace the outline of the shape and then compare one to the other. Always in that order. Then they recognize perspective. If you place the grid so one edge is in their direct vision, they will see the perspective and begin to compare only the closest and furthest. You will also see that their attention span is very long. I would time them and the range was from 18 to 26 minutes.

Our NICU ceiling was about 10 feet above the baby in my arms and it was made of white acoustic tiles set into a white metal framework. After the first intense minutes of sucking, he began tracing the shape of the closest, then the one next to it and kept going… learning that they were smaller each time and continuing to the point they would arch their backs to see further down the line. Then they would compare the very smallest to the one above their head, recognizing perspective White on white, ten feet away. (the warm-nummy theory in America about how life works is that the baby can only see as far as the mother’s face. What nonsense.) The edge of our NICU had a narrow ridge of lights behind white louvers extending 40 feet and with this they saw a bold example of perspective. So their vision extended to at least 40 feet.

Eventually I began to wonder about the socio-economic standing of the family and learned that this brilliance included all babies who were not drug effected.

When you take him home, videotape him as he examines his surroundings. The living room for example. Then watch him every time you bring him into that room. He will reexamine it all, again and again until he knows it all. Then sit in a different place in the room and watch what he does.

Play Mind to Mind Games With Your Preemie

Preemies and infants are bored.  Forget the American adult  bias that infants are blank slates.  They are thinking and problem solving, just as we all do, with all the assessment skills and conclusions we have and probably more because theirs is pure and without the influence, fear and worry acquired during childhood.

You can play silent mind games with them and see that this is true.

The first time I posted this design on the outside of the isolette of a baby who was 2 weeks old and now 29 weeks gestation.  She was not supposed to be born for almost 3 months.  I watched  as her eyes outlined each side and compared it to the other, again and again, over and over.  She would just keep doing it and I had to feed the next baby so I began to time her.  Twenty three minutes.

Then after a few days of this, when she was asleep, I rotated the card 1/3 of a turn and stood, waiting for her to wake up.  She opened her eyes, looked at it, frowned, cocked her head, straightened her head, pulled her neck back, pushed her face closer…  the classic ‘double-take’ sequence.  She had immediately identified the problem, checked her facts, verified what she was seeing and accepted it.  She weighed less than 3 pounds.

So I did this for at least a hundred babies over the years.  Stable feeder /grower babies, all with the same results.  The attention span time was from  18 to 26  minutes.

We are all born genius.