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January 22, 2026Health & Social Care in the Community2 citationsOpen Access

Non‐Nutritive Sucking (NNS)–Multifaceted Benefits and Limitations: Systematic Review

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HPHanna PopowiczABAleksandra M. BrandtASAnna Weronika Szablewska

Key Points

  • This review aims to summarize the benefits and limitations of non-nutritive sucking (NNS) in neonates and infants.
  • Review based on PRISMA guidelines.
  • Included preterm and full-term infants, and children up to 12 years of age.
  • Evaluated study quality using the Newcastle–Ottawa Scale and GRADE system.
  • Search included multiple databases for studies published between 2019 and 2025.
  • Nineteen articles met the inclusion criteria.
  • NNS associated with improved feeding efficiency and self-regulation in infants.
  • Promotes soothing behaviors and coordination of sucking, swallowing, and breathing.
  • Identified potential risks such as malocclusion and speech development delays from prolonged pacifier use.
  • Found knowledge gaps indicating need for more research into long-term effects of NNS.

Abstract

Background Nonnutritive sucking (NNS) is a common behavior observed in neonates and infants, characterized by sucking motions not associated with nutritional intake. This reflexive activity plays a significant role in early neurobehavioral development and is often considered an indicator of central nervous system maturity. In both term and preterm infants, NNS has been associated with various developmental outcomes, including improved feeding efficiency, self‐regulation, and soothing behaviors. Despite its widespread clinical use, especially in neonatal intensive care units (NICUs), the mechanisms, long‐term effects, and optimal therapeutic applications of NNS remain subjects of ongoing research and debate. Methods The review was conducted in accordance with PRISMA guidelines. The inclusion criteria encompassed preterm and full‐term infants, as well as children up to 12 years of age, and included experimental, randomized, controlled, longitudinal, and cross‐sectional studies. Exclusion criteria comprised studies involving adults or children over 12 years of age, case reports, editorials, diaries, reviews, meta‐analyses, articles lacking assessment tools or numerical data, and publications not in English or Polish. Full texts were assessed using the Newcastle–Ottawa Scale, and the study quality was evaluated with the GRADE system. The databases searched included PubMed, Scopus, Web of Science, Google Scholar, ResearchGate, Cochrane Library, Elsevier, and Wiley Online Library, covering studies published between 2019 and 2025. A total of 19 articles met the inclusion criteria. The final search was conducted on 16 February 2025. Results The analysis of 19 selected studies revealed a range of confirmed and potential benefits, as well as adverse aspects associated with the use of NNS. Additionally, several knowledge gaps were identified, highlighting the need for further research. Conclusion NNS is an effective and safe method for alleviating procedural pain in newborns. It promotes the coordination of sucking, swallowing, and breathing in preterm infants, thereby facilitating the initiation of oral feeding. However, prolonged pacifier use has been linked to an increased risk of malocclusion and delays in speech development, which supports the recommendation to limit this habit early in life.

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Cite This Study

Popowicz et al. (2026) studied this question.

synapsesocial.com/papers/6971be10642b1836717e2a81https://doi.org/10.1155/hsc/9982687
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