Question:

As ST/OT therapists, we have been doing feeding readiness and oral stimulation via pacifier dips for infant with controlled volumes, comfort during cares, etc….  Some of us do them as pacifier dips: milk in a medicine cup/medela bottle lid and some of do a mixture of the pacifier dips along with having the infant actively suck, offering 1 drip via a 1cc syringe.

The question has come up: Is there a standardization across the board regarding how and when to do pacifier dips/syringe drips?  The concerns with syringe drips, is that the bolus may be larger than with dips.  Another concern that I have is with oral organization, removing the pacifier multiple times makes the infant relatch and reorganize.  Versus allowing an infant to suck and offering syringe drips with time in between, allows infant to remain orally organized.

Is there a standardization? What do you guys practice?  Any research out there regarding the benefits?

Answer:

Pacifier dips can provide the opportunity for purposeful swallows that create the motor maps for swallowing in the course of a PO feeding. Supportive elongated swaddled sidelying, careful titration of bolus size, support for the swallow-breathe interface and physiologic stability all become essential components of our intervention that support infant-guided learning as co-morbidities permit.

Once the infant is tolerating a dry pacifier with physiologic stability utilizing co-regulated pacing, I use my gloved finger to place a tiny droplet of EBM or formula on the tip of the pacifier, and then offer it using the infant’s rooting response, when engagement, GI comfort, WOB and RR permit.

Re-latching in a supportive context can allow for prolonged resting to focus on respiratory reserves in between offerings, with when one is first introducing pacifier dips. This is especially true for infants for whom respiratory or airway co-morbidities are part of the differential. After resting, recruiting the root-to-latch sequence again, followed by onset of non-nutritive sucking promotes the motor mapping required for PO feeding.

Then one can begin to allow the pacifier to remain in the oral cavity, when infant is ready for that added aerobic workload. With the pacifier in the infant’s mouth, I can wait until WOB and RR look optimal, then deliver successive tiny droplets on the pacifier hub (I do it with my gloved finger to assure it is only a droplet). With each droplet I would be providing imposed breaths  to assure they are timely and sufficient, via use of contingent co-regulated pacing. Use of deep tactile cues at the cheek corner or at the anterior alveolus during imposed pauses creates the sensory-motor learning for future PO feeding.

I am not aware of standardization. I think it is more about being thoughtful and informed about why this intervention can help, what to consider and how to support both neuroprotection and safety, as we progress through this important step toward PO feeding in the NICU. The infant’s communication should always guide us.

So much goes into planning and executing this intervention, though it can appear quite simple. I hope this is helpful