Milestone or Modern Convenience? Part 1: OverUse of the Sippy Cup or Pacifier

Lacy recently wrote a blog for Virginia’s Early Intervention Program – specifically geared for therapists that work for that program, but the information is important for clinicians AND parents and caregivers. We have reposted it here but you can find the original HERE.

 

Written by: Lacy Morise, M.S. CCC/SLP

Although shocking to many, the sippy cup is NOT a developmental milestone. Nor is sucking on a pacifier, for that matter. But why do we (therapists,??????????????????????????????? parents and caregivers) celebrate these acquired “skills” as developmentally appropriate achievements? Why do we allow these “skills” to happen for much longer than they should? Is it just easier to always have a pacifier (aka mute button) in the baby/toddler’s mouth? Sippy cups are so easy to take along with us everywhere, how can it be harmful if a preschooler continues to exclusively drink from one?
The pacifier is a great thing for infants. It meets a physiological need to suck and allows baby a way to comfort himself. It may reduce the risk of SIDS as it appears to allow baby’s airway to remain more open and prevent baby from falling into a deeper sleep. Not to mention the other fringe benefits like quieting rowdy babes, helping them sleep longer and making outings and car rides more enjoyable for all. It certainly has a “place” in an infant’s world! And the sippy cup is an awesome convenience must-have. Drinks can be toted everywhere with baby/toddler and a sippy’s use means less spills to stain the carpet! Beautiful!
But aside from these benefits, there are risks associated with the over-use of both. Pediatricians and family physicians recommend weaning or stopping pacifier use in the second six months of life. Shocking I know considering how many toddlers we see with pacifiers in their mouths! The sippy cup can be skipped all together if natural development is occurring with no issue. Created for convenience, the sippy cup now has an entire market (and aisle in most stores) devoted to it! However a baby can transition to a straw (as early as 9 months) or open cup just as easily and drinking from both of these IS developmentally appropriate.

 

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As trusted resources on development, it is our job as early interventionists to inform families of both the positives and negatives of (prolonged) sucking. Some points to keep in mind as you discuss these “milestones” with parents and caregivers:
Prolonged sucking on a pacifier puts children at (a higher) risk for misaligned teeth. As those tiny white pearls are erupting, the pressure of the nipple of the pacifier can cause teeth to move around and shift. Also, the pressure can cause their hard palate, the roof of their mouth directly behind the front teeth, to change. It can push the palate forward, again changing the position of the teeth. In his research, J. Poyak concludes, “The greater the longevity and duration of pacifier use, the greater the potential for harmful results.”
A sippy often allows access to drinks all day long for a toddler. Not necessarily a bad thing, depending on what is in the sippy. If it is a sugary drink, the sugar increases the risk of developing cavities. The Medline Plus article titled, “Tooth decay – early childhood” states, “When children sleep or walk around with a bottle or sippy cup in their mouth, sugar coats their teeth for longer periods of time, causing teeth to decay more quickly.” Also, if a sippy is the only way a child gets liquids the developmentally appropriate skills of drinking through a straw and open cup are inhibited.
If children are allowed to have a drink (in a sippy or other cup) all the time, they may fill up on liquids and not eat meals as well, negatively impacting their nutrition. 

 

Although inconsistent, research suggests a relationship between prolonged sucking and speech delays. Barbosa et al. (2009) concluded in their research of 128 Patagonian preschoolers that, “The results suggest extended use of sucking outside of breastfeeding may have detrimental effects on speech development in young children.” When speech sound development is negatively impacted, so is the child’s intelligibility of speech making it difficult for others to understand them.
Sucking on a pacifier increases a child’s risk of developing otitis media (ear infection). The AAP (American Academy of Pediatrics) and AAFP (American Academy of Family Physicians) advocate for limited to no use of the pacifier in the second six months of the child’s life to decrease this risk.
A pacifier or sippy cup that is always in the mouth of a child, even when the child is walking around, puts him/her at a higher risk for mouth injuries. A 2012 study by Dr. Sarah Keim of Nationwide Children’s Hospital in Columbus, found that “a young child is rushed to a hospital every four hours in the U.S. due to an injury from a bottle, sippy cup or pacifier.” When little ones are just learning to walk, doing two things at once requires a bit more coordination than they are capable of!
Besides the physical risks, beyond the age of 1 a stronger emotional attachment to the pacifier (or sippy cup) makes it increasingly difficult for the child to detach. The pacifier/sippy goes from meeting a physiological need during infancy to providing emotional comfort to the toddler when scared, upset or sleepy.
However, it is our job to know and respect the individuality of each child. Therefore it is best practice to reassure parents that we recognize they know their child best. We all want our children to be happy and if using a pacifier and/or sippy is what’s best for them and their family, that is okay. Our job is to inform the families we serve the best we can. Equipping them with knowledge on why prolonged sucking may be detrimental to their child allows the family to make the final call. Education and Support, that’s what we are there for.
Have you ever had the “prolonged sucking” discussion with any of the families you serve? How might you begin this conversation with a family?
Today’s blog is Part I of a two-part series on prolonged sucking and what we can do to educate families about it. Stay tuned for “Part II – What to do When the Convenience Becomes a Hard to Break Habit” next week featuring ideas you can share with families who are ready to wean their child off of the pacifier or sippy!
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References
Barbosa, Clarita, Sandra Vasquez, Mary Parada, Juan Carlos Velez Gonzalez, Chanaye Jackson, N David Yanez, Bizu Gelaye, and Annette Fitzpatrick. “The Relationship of Bottle Feeding and Other Sucking Behaviors with Speech Disorder in Patagonian Preschoolers.” BMC Pediatrics. N.p., n.d. Web. 20 Mar. 2015. http://www.biomedcentral.com/1471-2431/9/66
EG, Gois, HC Rubeiro-Junior, MP Vale, SM Paiva, JM Serra-Negra, ML Ramos-Jorge, and IA Pordeus. “Influence of Nonnutritive Sucking Habits, Breathing Pattern and Adenoid Size on the Development of Malocclusion.” Angle Orthod.4 (2008): 647-54. Print. http://www.ncbi.nlm.nih.gov/pubmed/18302463
Guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents (n.d.): n. pag. Web. 18 Mar. 2015. http://www.aapd.org/media/Policies_Guidelines/G_Periodicity.pdf
Hauck, Fern R., MD, MS, Olanrewaju O. Omojokun, MD, and Mir S. Siadaty, MD, MS. “Do Pacifiers Reduce the Risk of Sudden Infant Death Syndrome? A Meta-analysis.” PEDIATRICS5 (2005): E716-723. Do Pacifiers Reduce the Risk of Sudden Infant Death Syndrome? A Meta-analysis. PEDIATRICS. Web. 17 Mar. 2015. http://pediatrics.aappublications.org/content/116/5/e716
Keim, Sarah A., MA, MS, Erica N. Fletcher, MPH, Megan R.W. Tepoel, MS, and Lara B. McKenzie, PhD, MA. “Injuries Associated With Bottles, Pacifiers, and Sippy Cups in the United States, 1991-2010.” N.p., n.d. Web. 19 Mar. 2015. http://pediatrics.aappublications.org/content/129/6/1104.long
Natale, Ruby, PhD, PsyD. “Risks and Benefits of Pacifiers.” American Family Physician79 (2009): 681-85. – American Family Physician. Web. 18 Mar. 2015. http://www.aafp.org/afp/2009/0415/p681.html
Poyak, J. “Effects of Pacifiers on Early Oral Development.” Int J Orthod Milwaukee4 (2006): 13-6. Print. http://www.ncbi.nlm.nih.gov/pubmed/17256438
Regulatory Summary for Pacifier (n.d.): n. pag. U.S. Consumer Product Safety Commission. Web. 18 Mar. 2015. http://www.cpsc.gov//PageFiles/120645/regsumpacifier.pdf
“Tooth Decay – Early Childhood: MedlinePlus Medical Encyclopedia.” S National Library of Medicine. U.S. National Library of Medicine, n.d. Web. 17 Mar. 2015. http://www.nlm.nih.gov/medlineplus/ency/article/002061.htm
Zardetto, CG, CR Rodrigues, and FM Stefani. “Effects of Different Pacifiers on the Primary Dentition and Oral Myofunction Structures of Preschool Children.” Pediatric Dentistry6 (2002): 552-60. Print. http://www.ncbi.nlm.nih.gov/pubmed/12528948
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Lacy Morise, M.S. CCC/SLP educates families on the risks involved with over-use of the pacifier and sippy as an early intervention speech-language pathologist in the West Virginia Birth to Three Program. She guiltily confesses to allowing all of her children to abuse the use of the pacifier! She owns Milestones & Miracles, LLC a company devoted to educating families about child development and the importance of PLAY! Check out her website and blog and follow her on Facebook, Pinterest, Twitter and YouTube.
Website: www.milestonesandmiracles.com
Blog: www.milestonesandmiraces.com/blog/
Facebook: https://www.facebook.com/milestonesandmiracles
Pinterest: https://www.pinterest.com/milestonesm/
Twitter: https://twitter.com/MilestonesM
YouTube: https://www.youtube.com/watch?v=HmuWPFDcqZ4

Making New Ways To Play In Dad’s Old Shop

My Dad is a plumber and a contractor. When I was a kid I loved playing in his shop. I used to stack wooden scraps, bang things together, and pretend copper pipe was my wedding band. (Princesses hang in tool shops too).

Today I got to be a bit of a kid in Dad’s shop again and it was so fun!

I have a few “go-to” gifts that I LOVE giving to my “therapy kids” when they turn 3 and are no longer eligible for my services. They are part “graduation” gift and part birthday gift. Every once in a while though, I have a kid who needs something that is specifically made just for them.

It’s nice having a handy Dad when you are a self employed early intervention physical therapist, creatively making things work for therapy visits in the homes of children. Dear Old Dad has helped me out a few times and today was no exception.

Together (well mostly him), we made this fun board for my special guy and I wanted to share.

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I liked it so much I decided “we” needed to make 2 so I could keep one for work too!

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I’ve always admired these boards and while they are very focused on fine motor work, I’ll be able to incorporate them into sitting and standing play…maybe even as a motivator for my little ones who are almost crawling but need a bit more motivation!

So if you are interested in making something like this, I’m happy to share that it was not overly expensive. Total cost was about $20 each.  I basically strolled up and down the aisles of Lowe’s choosing mismatched things that were interesting to turn, twist, flick, or flip. (This made the regulars at Lowe’s a wee bit nervous I think).  That part of easy. I will say if you are going to try it you need someone handy and with a few basic tools (electric drill, small saw, nail gun), which worked out much better than my original plan to glue gun everything down!

Here are some of the items I used.


I can’t wait to gift my special guy with his “one of a kind, made with love by my Dad” creation and to try mine out too. Even more fun that playing with these might be the fun I had playing today in the shop.

Like my ring?

 

board ring

The Secret of “The Hot Pink Tape”

This post was originally written for Child Guide Magazine.  Check out the many resources Child Guide offers as well as this article and others HERE.

If you are a runner, or have watched a race or even perhaps a professional sporting event lately, you may find yourself asking, “What is that bright colored tape people are wearing? And why is it cut in crazy patterns?” That trendy tape, often seen in bright pink or blue or sometimes black, is called Kinesiotape and it isn’t exactly new, even though it may have gained popularity in recent years in the US. But did you know that Kinesiotape is not just for athletes? This versatile tape is actually a very effective tool for children with motor challenges as well!

 

Kinesiotape is a progression of Kinesio Tex, which was invented by Dr. Kenzo Kase in Japan in the 1970’s. Dr. Kase was searching for an alternative tape to traditional athletic tape. He noticed that traditional tape often restricted movement, did nothing to aid healing, and could potentially cause additional injuries. Out of his hard work, Kinesiotape was born. What makes it different? Kinesiotape is elastic, latex free, cotton based tape that can stretch up to 30-40% of its original size. These properties allow it to be more versatile than traditional tape. In additional to allowing full range of motion and being very comfortable on the skin, the elasticity of the tape allows it to perform many functions. Kinesiotape is meant to be placed very strategically depending on the reason why someone is wearing it. Depending on placement it can increase healing, decrease inflammation and swelling, and support weak muscle by encouraging activation, or increase function lost by spastic muscle by encouraging a decrease in muscle tone. In addition posture can be improved with use.

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Sounds pretty incredible, right? Here’s how it works. Our muscles are each individually covered in a think filmy layer called fascia. Between the skin and this fascia are layers of connective tissue. When Kinesiotape is applied strategically to the skin, it tugs on the skin, which pulls on the connective tissue, which pulls on the fascia, which tugs on the muscle. The result is either an increased “fascial envelope,” allowing for 1) increased removal of toxins (lactic acid and waste) and increased space to allow fresh blood to restore tissue or aid in healing or 2) Encouragement of activation of a specific muscle for a specific purpose., improving posture or strength through increased use.   When used this way, the tape is like a constant tapping on weak muscles saying, “Use Me!”

kinesio-tape-diagram

This can potentially best be illustrated by looking at something concrete like a bruise.

In the images below, Kinesiotape has been used to increase the space between the fascia and the skin and allow quicker healing in the places where the tape was placed.

How is this used with children or anyone with motor challenges? In many ways! Children with atypical muscle tone (either hypotonia (low tone), hypertonia (high tone) or any sort of weakness may benefit from Kinesotape. When the tape is applied strategically over the muscles that need assistance or strengthening, the result is a slight tug that encourages the child to use their body in a specific way. When used this way, Kinesiotape can be used as a bridge to encourage strengthening or function through active participation. The child wears the tape, the tape encourages the child to move their body in a way that strengthens, stretches, or improves function, and eventually the child may get strong or functional enough to not need the tape. An example would be using the tape on the abdominal or back muscles in a child with Downs Syndrome who has trouble sitting alone or on the hand of a child with Cerebral Palsy who has a hard time opening the hand to grab for things.

Owen Ruffner is a 2 year-old child has benefitted from Kinesiotape in large ways. Owen has Mitocondrial Disease and as a result has weakness and low muscle tone, which challenge him when moving and attempting to control his body. Owen is learning to walk with a gait trainer and without tape, tends to drift to his left weaker side. When Kinesiotape is placed on the left leg, encouraging full activation of his muscles, he able to walk in a straight path. These results were immediately noticed after 1 application by his Physical Therapist. His mother Kasey McDaniel has been thrilled with the progress. She shares, “Kinesiotape has helped Owen by giving him a chance to use his muscles on his weaker side. I have noticed a huge difference with daily function and with helping him as he learns to walk.”

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The possibilities are quite endless with Kinesiotape as it is relatively low cost, is easily tolerated on the skin, is waterproof, and usually lasts 3-5 days per application. It is very important that anyone using the tape is initially taped by someone with strong knowledge of anatomy, such as a licensed physical therapist, and by someone who has had training on the Kinesiotape method.  Once a few applications are applied, tweaked as needed, and monitored, a successful method can be taught to a willing parent, who could continue the taping at home, with the help of a physical therapist.
It is true that Lance Armstrong was one of the first to expose Kinesiotape to the United States, swearing by the pink tape specifically for his knee injury, but your child may benefit as well. If you haven’t tried it yet, the risks and cost are low, but the benefit is often quite high. Ask your pediatric PT about Kinesiotape at your next visit.

 

For more information about Kinesiotape and the Kinesiotaping method, visit: http://www.kinesiotaping.com/ and http://www.kinesiologytapeinfo.com/pediatric-kinesiology-taping/