by Woods M

Premature infants may be fed through a tube to the stomach until they develop the ability to coordinate the sucking, swallowing, and breathing abilities needed to feed. The ability to feed usually develops by 32 to 34 weeks gestation.

Sucking on a pacifier, known as non-nutritive sucking, has been thought to encourage sucking behavior and improve digestion. Researchers wanted to assess the effects of non-nutritive sucking on physiologic stability and nutrition in preterm infants. The study, published in the Cochrane Database of Systematic Reviews, found that non-nutritive sucking reduces the time infants need to transition from tube to oral feeding.

About the Study

The systematic review included 12 randomized and quasi-randomized controlled trials comparing non-nutritive sucking versus no provision of non-nutritive sucking in 746 preterm infants (born at less than 37 weeks gestational age). Non-nutritive sucking involved the use of a pacifier or gloved finger before, during, or after tube feeding or outside of feeding times.

Compared to the participants in the control group, the review found that non-nutritive sucking reduced:

  • The time needed to transition to full oral feeding by 5.51 days in 2 trials with 87 babies
  • The length of time from the start of oral feeding to full oral feeding by 2.15 days in 2 trials with 100 babies
  • Length of hospital stay by 4.59 days in 6 trials with 501 babies

Non-nutritive sucking did not affect weight gain in 3 trials with 103 participants. No adverse events were reported.

How Does This Affect You?

A systematic review combines a number of smaller trials to create a larger pool of participants. The larger the pool of participants the more reliable the outcomes are. However, the review is only as reliable as the studies that are included. The number of participants in the studies that were included in this review were generally small, making the results less reliable. Furthermore, it is unknown whether those involved in the study knew which group the infants would be placed in, which could result in bias.

More research needs to be done that employs well-designed studies with reliable methods of randomization, concealment, and blinding. Future studies should also consider using similar outcomes measures so they can be compared to past studies.

Infants need to develop the ability to suck in order to feed. Pacifier use is safe and helps to promote this ability. It is also has a calming effect on newborns and reduces the risk of sudden infant death syndrome. If your infant is born prematurely and feeding via a tube, talk to your doctor about the possibility of providing your infant with a pacifier. In some cases, this may not be possible. Depending on your infant's condition, your doctor may be able to accommodate this request.


Family Doctor—American Academy of Family Physicians 

Healthy Children—American Academy of Pediatrics 


Evaluation and management of the premature infant. EBSCO DynaMed Plus website. Available at: . Updated May 15, 2017. Accessed June 14, 2017.

Foster JP, Psaila K, et al. Non-nutritive sucking for increasing physiologic stability and nutrition in preterm infants. Cochrane Database Syst Rev. 2016 Oct 4;10:CD001071.

Pacifiers: satisfying your baby's needs. Healthy Children—American Academy of Pediatrics website. Available at: Updated November 21, 2015. Accessed June 14, 2017.

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