Episode 284: The Gold Standard In Pacifiers with Hallie Bulkin

Hi and welcome to episode 284 of the Untethered Podcast. We are going to jump into the topic of pacifiers today. Why? Because many of you have been sending me some reels on Instagram that have gone viral by an account that I will allow to remain nameless. And what I want to share in regards to that account is I'm not diving too deep into, into the why or the how or, you know, all those fun details. But what I will say is they've had three reels in the past couple days that have gone to over, let's see, 337,043.9 million people. Holy cow. And 193K. And the issue is that it's, you know, it's saying, you know, is your baby's pacifier doing more harm than good? Let me take a deep breath before we jump in. Quick disclaimer. All information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Welcome to the Untethered Podcast. I am your host, Holly Balkan. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, airway, tethered oral tissue and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct coral rest posture, tongue up, lips closed, teeth apart, breathe through your nose. Let's get started. Okay, I gathered my thoughts, so let's, let's get going. Here is the thing, right? There are people who are paid online to do, you know, to market certain products, right? There's also people who are paid to do collaborations with other large accounts that have multiple, you know, six figures worth of followers. But when it comes to pacifiers, we need to really understand that companies in the United States are not and do not have research to actually back up their products or the products claims for that matter. And so when the research does exist, it's also not typically done via a third party organization. It's usually done by that same company. It's funded by the company that's creating the product. Which creates implicit bias. Right. So you need a third party organization to remove implicit bias. And so in other words. Right. Again, when companies conduct research on their own physical products, the information that they choose to share often weighs more favorably toward their product than against it. Otherwise they probably wouldn't be sharing that research or publishing it. Hi. Is this making sense? So, as a speech language pathologist myself, you know, I can tell you we don't research every toy out there before using it in therapy. Um, the same can be said for tools used in feeding therapy or in other developmental types of milestones and other oral, sensory, oral motor, you know, skills that we work on. But pacifiers sometimes are used as a tool in feeding therapy. So we need to talk about it. And the other thing I want to talk about too is what do we do when the research on a topic does not exist? Like when, when we don't know which pacifier is the best for infant orofacial development because there's no research article to tell us? Well, evidence based practice, my friends, includes expert opinion and experience. Right. And so just as much as it includes the research and it also includes the patient. Right. But let's just look at turning to those colleagues who are experts in this space, who specialize in this space and in research and related areas. You know, professionals, for example, who treat babies on a regular basis will have really good insight into what products they, that they use, what works, what's leading to successful outcomes, what we might want to trial with an infant who's, who's struggling to feed. And the other thing I want to stop and point out too, before we get too far, is that pacifiers, just like sippy cups, are not a milestone. We do not need pacifiers if our orofacial complex is developing as it's intended. Okay. In the cases where it may help prevent sids, Sudden infant death syndrome are cases where children who are probably cannot safely sleep on their back. And so this whole back to sleep campaign is questionable. Why? Because if these children need a pacifier to keep their jaw open and forward and their tongue low and forward, it's helping keep that tongue from following falling back into their throat and obstructing their airway and their jaw. Right. When the jaw goes back or airway gets smaller too, we should be going, huh? Is it even safer, these children who need pacifiers to sleep on their back? Just going to throw that question out there. I think somebody should research that. Yeah. Or do some, some deep investigations into that. If you do choose to use a pacifier, that is okay. Right. We don't want to demonize the use of pacifiers, but we should be weaning them around 6 months of age or so before they become habitual. That is that, that, that timeline, that deadline of when you want to start to take it away. If you haven't done that and you're like, oh my gosh, have I messed up my kid? No. Take a deep breath. It's never too late. It's never too late. Can't promise you that there won't be more work to undo, but it's never too late. And if you're worried or curious, just keep listening. So when a child does not need a pacifier, that is because the tongue is doing its job. It's living in the roof of the mouth. Our tongue is a nice U shape right around the sides and the tip side, tip side, it kind of goes in a nice U shape and that should form the U shaped palate. But that can only happen if the tongue is resting up in the roof of the mouth when not feeding or vocalizing. Right. Or verbalizing. So the tongue ultimately fills the same void, if you want to call it that, as a pacifier would, when the tongue is not doing its job. Right. Well, let me back up. When we don't need the pacifier, that's because there's no room for it. And that goes the same goes for the thumb because the tongue is up there doing its job. So there is no room for a pacifier, there is no room for a thumb, there is no room for finger sucking or any other foreign objects going into the mouth. Right. So while this is not medical advice. Right. As I always say in the beginning of every episode, I want you to be advised that medically involved children with compromised airways due to recessed jaws, like I was talking about a few minutes ago, or other health related causes may benefit from a pacifier because it can bring their lower jaw, their mandible forward and help keep their airway open while sleeping. Like that is what I was talking about when I was talking about SIDS and sleeping on your back versus your belly. This is a decision that needs to be made by a child's medical team, but I wanted to just highlight that. Okay, so when we are using pacifiers, right, or like, let's say, let's say you're using it with your child or you're using it as a tool in feeding therapy, what kind of pacifiers do we recommend and why? I can tell you it's not the quote unquote, orthodontic ones, because those, the, the sole purpose of those. And as this individual is talking about, to these multi million dollar, million, not dollar, but million people, millions of people who are watching this very misinformed reel, it is not the orthodontic ones that are flat because that holds the entire tongue down. And so yes, maybe it doesn't move the teeth as much. But let me tell you, for most children, if the palate is already misshapen, the child's going to need some form of expansion later in life anyways. The pacifier is not necessarily going to help that now. But the tongue also, most likely, especially after like 6 months of age or so. We believe that the tongue is not going to like reshape the palate and prevent future orthodontia. Okay, that's just number one, number two, children who suck their thumb or who need some of these pacifiers, and we see that it flares the teeth. Oftentimes when that pacifier or thumb is no longer needed, the teeth tend to go right back down to where they'd be had the pacifier never been there. Had the thumb never been there. It's still going to follow the shape of the palate though. And in many of those cases, the child's still going to need expansion. Okay, so this fear mongering of like not wanting to flare your child's teeth, like, yeah, sure, we don't want that to happen, but that is the least of your worries, the absolute least. What we need to be focused on is sustaining life. How are they breathing and how are they feeding? Those are our two basic needs in life. And if the pacifier is able to support them because they need that support right now, the best pacifier, typically. Right. This could be different. There may be cases where we recommend a different kind of pacifier. Typically the gold standard is a cylindrical shaped soothing pacifier like the Philips Advent pacifier, for example. Okay. We want to avoid those flatter pacifiers, as I was mentioning, because they hold the tongue down to the floor of the mouth and we don't want that. We need the tongue to be able to move around the pacifier and elevate. We want the lateral borders, the sides of the tongue to elevate around that pacifier so that, that they have more range of motion to help work towards proper oral rest posture. Right. And to help shape the tongue in the same way that it needs to be shaped when drinking from a breast or bottle. All right, so the goal is to have full range of motion and support proper oral rest posture when the pacifier is not in the mouth, right? When our mouth is closed, tongue is up on the top of the mouth or the roof of our mouth, Our gums are or teeth are slightly apart. We're breathing through our nose, right? So that is why we recommend these cylindrical shaped pacifiers like that avant soothy. Now, we do not want the bulbous shape at the end of the tip of the pacifier because that actually keeps more of the tongue down, okay? It is worth noting that while an infant uses a suit soothing pacifier, the front of the tongue will also be kept down, which is not ideal, but that's going to happen with any shape pacifier. So if you're using a pacifier in general, that's just what's going to happen. The SUVI is similar to using a finger for suck training. And the SUV can actually be used in place of that, which can be very beneficial for some parents who are afraid of putting their finger in their child's mouth. They'll put like a pinky or a pointer finger inside the soothy pacifier and use that. Or they'll hold the outside rim of the sue and use that to help with suck training, okay? And that, like I said before, encourages elevation of the lateral borders of the tongue, which is what we want when working on that sucks follow breathe pattern. It is worth also noting that if you have the wubba nubs, right, those little stuffed animals that hang off the pacifier, those levies that are attached to the end, we want to cut those off and give the levy to your child as soon as your child is rolling over or sitting or crawling. We don't want them using that, okay? Because it does put extra weight on the pacifier and we do not want to create extra weight that can actually also impact all kinds of things in the mouth, including the teeth, which again I said, are the least of our worries. But not no worry, but the least of them compared to breathing and eating. But like I said, you can cut it off and give the child the levy and they can even keep the lovey after you ditch the pacifier. Right? After six months of age, right guys? Or whenever you're ready. But really, ideally, in a perfect world, six months of age, right? So why am I so adamant about removing that? Because we've actually seen infants and toddlers like misuse their jaw or like fix their jaw and bite down on the pacifier to stabilize their jaw to hold the weight of that lovey, okay? With the pacifier in their mouth. And that creates. That also leads to that open bite and that jaw fixing then leads to changes in orofacial development like your musculature can cause, you know, clenching, grinding, tension, all kinds of stuff like that. So if you're planning to use a pacifier, we do recommend the Avent SUV and not all these other ones that this individuals recommending. And we want you to be sure to attempt to wean around six months of age. If you haven't and they're older than that, like I said, it's okay. But creating a plan to wean and figuring out why they need it in the first place is ideal. I will never recommend taking away the thumb because take away the thumb, they're going to replace it with something else. Take away the pacifier, they're going to replace it with the thumb. If they need that, it may be an airway support, it may be helping them breathe at night. A lot of people say, oh, they do it as a, you know, when they're really tired. Well, guess what happens when you're really tired? Your body relaxes. And without all that tension in place, as your body relaxes, things collapse more. So maybe the jaw is more open or the tongue, if they're laying down, the tongue is falling into the airway. But they know if they suck on a pacifier or they suck on their thumb, it's going to bring the lower jaw forward. It's going to keep that tongue low and forward out of the airway. That's going to be safe. The body is going to go for past path of least resistance and what is most safe at all times. And so that is why like thumb sucking elimination programs, pacifier elimination programs, yes, they can become habitual, but they were there for a reason in the first place. So we need to figure out why they're there and if it's safe to take them away. And so with that you can, you can work with pediatric feeding therapists, go to the pediatric feeding or go to pediatricfeedingtherapist.com and you can always find somebody on there who is trained in how to address these issues. But I just wanted to come on here because the SUVI is being demonized. And quite honestly, it is the gold standard when it comes to breathing and feeding and really listening to an orthodontist whose sole goal is straight, pretty teeth. Yes, we all want that. But you're gonna get there if you follow function when it comes to airway and it comes to the or sensory oral motor skills. Right. And orofacial development overall. So pacifiers, no pacifier is perfect, but the Best. The gold standard is that cylindrical shape. Not bulbous at the end, but cylindrical shape, like the Su, the Advent. If it looks like the Su the Advent, then it's okay. I get all kinds of questions. Is this one okay? Is that one okay? It has to look like the sue the Avent Pacifier. So look that one up, and if it looks the same and it's a different brand, that's fine. All right, I hope this is helpful. I hope that. I really do hope that that account will reach out to me, because at the time of recording this, I reached out to them. I posted to my stories, I tagged them in zero, zilch, nothing. They probably see me as someone who only has like 24,000 people on their Instagram, you know, following me. And that's fine, but it would be really lovely if we could have a conversation. But, you know, I'm sure there's some kind of a monetary deal there, and I'm sure they're making lots of money over that partnership they've created with these reels and with these promotions. So they probably don't want to have me mess with that, unfortunately, at the expense of all the parents on those threads who seem super confused and who are now ditching their sus and buying all these orthodontic pacifiers. Please don't do that. Keep your soothies. Ditch the others. All right, everybody, I hope this is helpful. This is Hallie signing off. Thanks for listening to this podcast. If you found value in this episode and want to hear more of these Myotots, Airway and Feeding related episodes, be sure to leave a review on Apple Podcasts and share this episode on your social media platforms. You can access free resources and all I offer@halliebalkin.com or pop over to Hollybulcan on Instagram to get all the latest updates.