What role for the pacifier in acute otitis media risk?
Keywords:child, otitis, pacifier, review
Introduction: Sucking reflex is acknowledged as a comforting mechanism for infants. When used for short periods of time, it is considered a healthy habit. Acute otitis media is one of the most frequent infections in pediatric age and has been associated with pacifier misuse.
Objectives: To review available evidence regarding the association between pacifier use in the first years of life and otitis media risk. Methods: A literature search was conducted on several databases using MeSH terms “otitis” and “pacifiers” for guidelines, systematic reviews, randomized controlled trials, and observational studies over the last 20 years. SORT scale of the American Family Physician was used to evaluate evidence levels.
Results: A total of 56 articles were retrieved, of which four guidelines, one systematic review, and one original article were selected. According to guidelines, there is no reason to discourage pacifier use, as it can be particularly beneficial in the first six months of life. Afterwards, pacifier use should be limited to moments of falling asleep. Its use should also be avoided in infants with chronic or recurrent otitis media. The systematic review stablished pacifier use as a risk factor for recurrent acute otitis media (RAOM) which is susceptible to intervention. In the observational study, a statistically significant association was found between pacifier use and RAOM risk.
Conclusions: Pacifier use should not be actively discouraged in the first semester of life, as it can have beneficial effects for children (SORT A). Afterwards, its use should be discontinued due to increased otitis risk (SORT A).
Levin S. Dummies. S Afr Med J. 1971; 45:237-40.
Gale CR, Martyn CN. Dummies and the health of Hertfordshire infants, 1911-1930. Soc Hist Med. 1995; 8:231-55.
Niemelä M, Pihakari O, Pokka T, Uhari M. Pacifier as a risk factor for acute otitis media: A randomized, controlled trial of parental counseling. Pediatrics. 2000; 106:483-8.
Zempsky WT, Cravero JP, American Academy of Pediatrics Committee on Pediatric Emergency M, Section on A, Pain M. Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics. 2004; 114:1348-56.
Pinelli J, Symington A. Non-nutritive sucking for promoting physiologic stability and nutrition in preterm infants. Cochrane Database Syst Rev. 2005:CD001071.
American Academy of Pediatrics Task Force on Sudden Infant Death S. The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics. 2005; 116:1245-55.
Sexton S, Natale R. Risks and benefits of pacifiers. Am Fam Physician. 2009; 79:681-5.
Hauck FR, Omojokun OO, Siadaty MS. Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics. 2005; 116:e716-23.
Gartner LM, Morton J, Lawrence RA, Naylor AJ, O’Hare D, Schanler RJ, et al. Breastfeeding and the use of human milk. Pediatrics. 2005; 115:496-506.
Salone LR, Vann WF Jr, Dee DL. Breastfeeding: An overview of oral and general health benefits. The Journal of the American Dental Association. 2013; 144:143-51.
American Dental association. For the dental patient. Thumb sucking and pacifier use. The Journal of the American Dental Association. 2007; 138:1176.
Niemela M, Uhari M, Mottonen M. A pacifier increases the risk of recurrent acute otitis media in children in day care centers. Pediatrics. 1995; 96:884-8.
Salah M, Abdel-Aziz M, Al-Farok A, Jebrini A. Recurrent acute otitis media in infants: analysis of risk factors. Int J Pediatr Otorhinolaryngol. 2013; 77:1665-9.
Lubianca Neto JF, Hemb L, Silva DB. Systematic literature review of modifiable risk factors for recurrent acute otitis media in childhood. J Pediatr (Rio J). 2006; 82:87-96.
Warren JJ, Levy SM, Kirchner HL, Nowak AJ, Bergus GR. Pacifier use and the occurrence of otitis media in the first year of life. Pediatric Dentistry. 2001; 23:103-7.
Niemelä M, Uhari M, Hannuksela A. Pacifiers and dental structure as risk factors for otitis media. Int J Pediatr Otorhinolaryngol. 1994; 29:121-7.
Uhari M, Mäntysaari K, Niemelä M. A meta-analytic review of the risk factors for acute otitis media. Clin Infect Dis. 1996; 22:1079-83.
Marchisio P, Bellussi L, Di Mauro G, Doria M, Felisati G, Longhi R, et al. Acute otitis media: From diagnosis to prevention. Summary of the Italian guideline. Int J Pediatr Otorhinolaryngol. 2010; 74:1209-16. doi: 10.1016/j.ijporl.2010.08.016.
Rovers MM, Numans ME, Langenbach E, Grobbee DE, Verheij TJ, Schilder AG. Is pacifier use a risk factor for acute otitis media? A dynamic cohort study. Fam Pract. 2008; 25:233-6.
Canadian Paediatric Society. Recommendations for the use of pacifiers. Paediatr Child Health. 2003; 8:515-28.
Brook I, Gober AE. Bacterial colonization of pacifiers of infants with acute otitis media. The Journal of laryngology and otology. 1997;111:614-5.
Ford-Jones EL, Friedberg J, McGeer A, Simpson K, Croxford R, Willey B, et al. Microbiologic findings and risk factors for antimicrobial resistance at myringotomy for tympanostomy tube placement--a prospective study of 601 children in Toronto. Int J Pediatr Otorhinolaryngol. 2002; 66:227-42.
Jackson JM, Mourino AP. Pacifier use and otitis media in infants twelve months of age or younger. Pediatric dentistry. 1999; 21:255-60.
Subcommittee on Management of Acute Otitis Media. Diagnosis and Management of Acute Otitis Media. Pediatrics. 2004; 113:1451.
Direção Geral da Saúde. Diagnóstico e Tratamento da Otite Média Aguda na Idade Pediátrica. Recommendation 007/2012, updated in 28/10/2014.
How to Cite
Copyright and access
This journal offers immediate free access to its content, following the principle that providing free scientific knowledge to the public provides greater global democratization of knowledge.
The works are licensed under a Creative Commons Attribution Non-commercial 4.0 International license.
Nascer e Crescer – Birth and Growth Medical Journal do not charge any submission or processing fee to the articles submitted.