Numerous factors, such as passive smoking, reclining feeding position, and daycare attendance have been identified as increasing the risk of one of the most common childhood illnesses, acute otitis media (AOM). Now a study by Niemela and others (2001) provides evidence for the association between pacifier use and the occurrence of AOM. The participants were recruited from 14 well-baby clinics in Finland. The clinics were paired according to the number of children and the social classes of the parents they served. One clinic in each pair was randomly selected for intervention and the other clinic served as a control.
The intervention group (n=272) received counseling from a nurse about the risks of pacifier use (candidiasis, dental problems, AOM). The parents were encouraged to limit pacifier use for infants aged 6-10 months to when their infants were falling asleep, and then to stop pacifier use after 10 months. The control groups (n=212) were counseled about possible AOM, but received no information about pacifier use. Parents recorded evidence of AOM on daily, symptom sheets that were mailed to the investigator.
The results of the study indicate that AOM occurrence was 29% lower among the intervention group (those who received counseling about pacifier use). In addition, AOM occurrence was 33% higher in continuous pacifier users compared to bedtime users or nonusers. The authors conclude that restricting pacifier use to bedtime by 6 months of age and only during the first 10 months of life when the need for sucking is strongest can reduce AOM.
How pacifier use affects the development of AOM is not known. Pacifier use does not increase the risk of respiratory infection, but may alter the pressure between the middle ear and nasopharynx. The change in pressure may impair Eustachian tube function.
Nurses are in a unique position to counsel parents about pacifier use. Since suggesting that parents eliminate the pacifier is often unsuccessful, the findings of this study offer the alternative of restricting its use while maintaining the benefit of reduced AOM.
March 15, 2002