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A personal perspective (see page1121)
I have two sets of personal views on dummies (pacifiers, soothers)—from the perspective of a mother and also as a “hands on” paediatric cardiologist. Thus my reactions to the paper by Viggiano and colleagues,1 in this issue, are a synthesis of both. I am actually rather “pro-dummy”; albeit in the right place, at the right time, and for limited applications.
I breast fed both my children, for around 10 months. They were born hungry and sometimes it was a struggle. They are both strong willed young men who like a cuddle. I may be a sort of paediatrician but I am not an “earth mother”, and the logistic and practical details of spending the first six months of each of their lives acceding to their needs to be permanently clamped to my chest were really rather more than I could manage. Also I went back to work when they were 4 months old so they also needed able to take at least some sustenance by other means. My first ever research project was using ultrasound to examine the intra-oral processes of sucking and swallowing,2 so I was well aware that nutritive and non-nutritive sucking are not the same, and that breast and bottle feeding also use different tongue actions. I have to say I didn’t really care very much. It may be heresy, but in those first few days post-partum, exhausted and milk free, bottles and dummies were a lifesaver allowing some sleep between breast “feeds” until the milk came in. I am used to being short on sleep; it’s an occupational hazard, but as a new mum, some sleep (and time) seemed to be required for the metabolic processes involved in milk production. Later on, dummies seemed essential to spacing the feeds out enough to allow a semblance of normality in my life, and hence a little sanity. I’m not decrying those who do have the capacity to nurse continuously, but it’s not for everyone. My children did suck their fingers from time to time but seemed to lose them at the most crucial moments. This also happened with some dummies; it was in fact only the dummies that I initially acquired at work (with orthodontic teats) that eventually stayed in long enough to generate reliable sleep patterns. As my children got bigger, the dummy stayed more and more in the cot (or the parental pocket), and generally became part of the sleeping ritual rather than a habitual oral presence. However, they were also invaluable for major crises (hence the pockets!). Around the age of 2 years they were gradually withdrawn without difficulty. I could not have coped without them and neither boy has obvious malocclusion of their deciduous teeth. I’m also not sure how worried about it I would be if they had, either. I’d be more worried if it was their permanent teeth, or if the paper by Viggiano et al suggested that they would have been hideously deformed and considerably socially handicapped by their appearance, but I don’t think it does. Don’t get me wrong; I am not in the “dummies to keep them quiet” brigade—both my children are frighteningly articulate and talked far too much, too soon, but I suspect that is genetic rather than dummy related!
As a cardiologist I am also fairly pro the generic use of dummies. They are a major aid to accurate echocardiography, and, at least in my view, infinitely preferable to chloral, midazolam, or worse. I get seriously irritated by the well meaning healthcare professional who attempts to deny the benefits of non-nutritive sucking to a freshly transferred neonate needing a detailed echocardiographic diagnosis to save their life. I don’t really mind whether it’s a dummy or a clean and expertly inserted finger, but I am sure that most highly trained professionals generally have better things to do than stand with a finger in a new arrival’s mouth for half an hour or so! I also don’t believe it’s going to adversely affect their ability to breast feed in later life half as much as either getting the diagnosis wrong, or the treatment itself, will.
The other aspect of dummy use which has not been addressed is the role of dummy sucking during tube feeds in ventilated infants and whether this is beneficial to eventual re-establishment or indeed establishment, of oral feeding post-extubation other than in preterm infants.3 My gut feeling is that it is, but I am happy to be guided!
So, fascinating as Viggiano and colleagues’ paper is, forgive me if I remain a little sceptical of its practical validity, I would not like to see dummies go the way of MMR!
A personal perspective (see page1121)
- Community child health, public health, and epidemiology