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PubMed2002

Using pacifiers: what are breastfeeding mothers doing?

The objective of this study was to identify the impact of pacifier use on the duration of breastfeeding amongst Australian women. A cohort of 556 mothers who delivered in Perth, Western Australia was recruited to study their infant feeding practices. The mothers were interviewed in hospital and again at 2, 6, 10, 14, 18 and 24 weeks postpartum, or until they ceased to breastfeed. At two weeks 62% of breastfed babies were using a pacifier, increasing to a peak of 78% at six weeks. Infants who were using a pacifier had slightly fewer feeds each day at every age period (for example 6.9 versus 7.4 feeds at six weeks of age), but there was no difference in the number of night feeds. A recent study suggested that the mothers resorted to the use of pacifiers when they were having problems breastfeeding, and any impact of pacifiers on breastfeeding duration was due to confounding factors. However in this longitudinal study, after adjusting for the presence of breastfeeding problems, the use of a pacifier at two weeks was associated with reduced likelihood of breastfeeding to six months (odds ratio 0.40; 95%CI 0.25-0.63). Based on the results of this study we concluded that the use of a pacifier at two weeks of age reduced the likely duration of breastfeeding to six months. A possible mechanism of action was the reduced number of daily feeds in breastfed infants that would reduce breast stimulation. If mothers choose to use a pacifier they should introduce it later and use it infrequently.

Adult↗
PubMed1997

Breast feeding, pacifier use and infant development at 12 months of age: a birth cohort study in Brazil.

Many studies suggest that breast feeding confers developmental and intellectual advantages on children. In a recent study, however, no association was found between breast feeding and intelligence in adult life after adjustment for other variables, and the use of pacifier in infancy was the most important predictor of intelligence. We analysed the associations between breast-feeding duration, pacifier use and suspected developmental delay at 12 months of age in a birth cohort in Pelotas, southern Brazil. All 5304 hospital births occurring during 1993 were studied and a sample was followed up at 1, 3, 6 and 12 months of age. Breast-feeding practices and use of pacifiers were assessed at each visit, as well as suspected developmental delay, measured by the Denver II test. The prevalence of developmental delay was analysed, through logistic regression, according to breast-feeding status and pacifier use, accounting for the possible confounding effect of other variables. The prevalence of suspected developmental delay at 12 months was 34.1%, being slightly higher among children who used pacifiers at 6 months than among non-users (35.3% and 28.7% respectively). There was a marked negative association between breast-feeding duration and developmental delay, with children breast fed for 9 months or more presenting significantly less suspected developmental delay (25.5%) than those breast fed for less than 1 month (42.4%). The effects of multiple variables were tested, and only high parity, smoking during pregnancy, birthweight, gestational age, pacifier use and breast-feeding duration remained significantly associated with suspected developmental delay. The effect of pacifier use, however, disappeared after adjusting for breast-feeding duration, suggesting that breast feeding, and not pacifiers, affects child development.

Age Factors↗
PubMedDate not supplied

Pacifier use and sleep position in 2 to 4 month old infants.

UNLABELLED: Much interest has been raised in optimal infant care practices which can be preventive against sudden infant death syndrome (SIDS). In particular, avoiding prone sleep and the use of a pacifier were reported to be associated with a reduced risk for SIDS. It was suggested that potential beneficial effect resulted from the use of a pacifier might be ascribed at least in part to the prevention of an infant to be put prone to sleep and/or to turn down prone in sleep. To explore this hypothesis, the study aimed to analyse potential interaction between the habitual sleep position and the regular use of a pacifier in 2-4-month-old infants, age known for the peak incidence of SIDS. 192 randomly selected clinically healthy infants born in St. Petersburg in 1997-1998 entered the survey. The mothers were asked to complete the questionnaires addressing infant, maternal, and demographic major characteristics as well as sleep routine and other child care practices with particular emphasis on the use of a pacifier. Of 181 infants for whom the mothers were able to define typical position the baby was put to sleep and/or found, 174 (96.1%) were usually put to sleep non-prone: 103 on the back, and 71 on the side. In 51 of 181 cases (28.2%) the babies habitually changed their position in sleep. Of 174 babies usually put to sleep non-prone, 6 (3.5%) usually turned to front. Putting baby to sleep on the side compared with on the back bore the risk to turn to front equal to 3.01 (95% CI: 0.42-34.0). There was no difference in any infant, maternal, and demographic characteristic between the groups of the babies usually put to sleep prone and non-prone. Of 192 infants, 117 (60.9%) were usually left to sleep with a pacifier, and there was no significant association between the use of a pacifier and optional prone or non-prone position the baby was usually put to sleep. Likewise, the use of a pacifier did not significantly influence infant's position when found. CONCLUSION: In clinically healthy 2-to-4-month-old babies, the use of a pacifier does not have major influence on the choice of sleep position and infant's propensity to spontaneously modify it during sleep.

Female↗
PubMed1999

Pacifier use and morbidity in the first six months of life.

OBJECTIVE: To assess the prevalence of pacifier use and whether this habit adversely affects the health of 6-month-old infants. DESIGN: Data collected via self-completion questionnaires from mothers forming part of the prospective, population-based Avon Longitudinal Study of Pregnancy and Childhood. METHODS: The mothers of 10 950 infants gave information on their child's use of a pacifier at 4 weeks and 6 months of age and the presence of specific health symptoms. Adjusted logistic regression was performed to identify any associations between pacifier use and ill health. RESULTS: Two thirds of the sample had been given a pacifier at some point, with 42% being reported as having one at both ages. Younger, lower educated mothers, mothers who smoked, those living in council and overcrowded accommodation, and those reporting financial difficulties were significantly more likely to give their infant a pacifier. Pacifier use was associated significantly with a higher risk of symptoms such as wheezing, earache, vomiting, fever, diarrhea, and colic as well as with the general practitioner being called to the home and hospital admission. CONCLUSIONS: Although significant differences exist in the risk of experiencing several health symptoms between infants who do and infants who do not use a pacifier, stronger and more detailed evidence is required before recommendations can be made to discourage the use of pacifiers based purely on reducing occurrences of these symptoms.

England↗
PubMedDate not supplied

Pacifier use and otitis media in infants twelve months of age or younger.

PURPOSE: The purpose of this study was two fold: to determine if within a selected population of infants the prevalence of otitis media was greater in pacifier users than in non-pacifier users, and to reveal if an association existed between otitis media and pacifier use. METHODS: The study consisted of 200 children, 12 months of age or younger. Parents were surveyed regarding children's pacifier habits, day care attendance, feeding habits, thumb sucking habits, exposure to parental smoking, and parental education level. RESULTS: The prevalence of otitis media in pacifier users (36%) was larger than that of non-pacifier users (23%), P < 0.05. A logistic regression analysis determined an association existed between otitis media and pacifier use, bottle feeding, thumb sucking, and day care utilization, P < or = 0.05. No association was discovered between otitis media and breast feeding, parental smoking and parental education level. CONCLUSION: The risk of developing otitis media in an infant is two times greater if a pacifier is used and five times greater if bottle fed or attending a day care facility.

Bottle Feeding↗
PubMed1993

[Utilization of pacifiers: distribution, causes and sequelae].

UNLABELLED: A survey of 293 children in a pediatric practise showed that in 80% a pacifier was used. This spread is the result of a distribution in the hospital at birth on the one hand and appreciation of its tranquilizing effect by the parents on the other hand. According to the parents, the use of a pacifier is a habit. A sucking child can, thus, restore its emotional equilibrium. This self-control reappears in certain situations. With time the child learns to control its behavior by other means. Only few children have difficulties in giving up this habit. Children using an alternative to the pacifier have more dental and jaw deformations than those using a pacifier. Dental pacifiers cause far less deformations than the other types. CONCLUSIONS: 1. Children who suck their fingers should be given a pacifier. 2. One should give a pacifier to babies with emotional problems up to the age of 6 months. Later on, an object harmless to the teeth should be given. 3. A pacifier should only be used if really necessary.

Child Behavior↗
PubMedDate not supplied

Effects of current and former pacifier use on the dentition of 24- to 59-month-old children.

Two hundred eighteen children ages 24-59 months participated in a study to examine the effect of pacifier use on the occlusion of the primary dentition. A questionnaire was used to gain information on habit history. Eighty-two children were current or former users of functional exercisers, 38 had a history of conventional pacifier use, and 98 had no history of oral habits. Compared to children with no habit, those with a history of pacifier use had a significantly larger mean overjet (P < 0.001), as well as significantly higher occurrences of Class II primary canines (P = 0.015), distal step molars (P = 0.014), openbite (P = 0.001), and posterior crossbite (P = 0.025). Compared to users of conventional pacifiers, users of functional exercisers had a significantly higher occurrence of Class II primary canines (P = 0.013) and distal step molars (P = 0.037). Pacifier use time in months was significantly higher for children with openbite (P = 0.02) and posterior crossbite (P = 0.019). Compared to former pacifier users, those with current habits had a significantly higher prevalence of openbite (P = 0.002) and posterior crossbite (P = 0.001), and a greater mean openbite (P = 0.19). The reported number of hours use per day was not related to any aspect of the occlusion of pacifier users. African-American and European-American children began their habits at about the same age and used their pacifiers for an equivalent number of hours per day. Among those who had discontinued their habits, African-American children had maintained theirs for a significantly shorter period (P < 0.001), leading to a longer elapsed time between habit discontinuation and the examination.

Analysis of Variance↗
PubMed2000

Socio-demographic associations with digit and pacifier sucking at 15 months of age and possible associations with infant infection. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

AIMS: To assess the prevalence of pacifier and digit sucking at 15 months of age and to investigate whether this habit adversely affects the health of 18 month old infants. STUDY DESIGN: Data collected via self-completion questionnaires from mothers forming part of the prospective, population based Avon Longitudinal Study of Pregnancy and Childhood. SUBJECTS AND METHODS: The mothers of 10006 infants gave information on their child's use of a pacifier and of digit sucking at 15 months of age and the presence of specific health symptoms at 18 months of age. Adjusted logistic regression was performed to identify any statistically significant associations between pacifier use, digit sucking or a combination of the two with possible infection. RESULTS: 36.3% of infants sucked a pacifier, 21. 3% their thumb or finger and 2.7% sucked both at 15 months. Statistically significant differences were observed among various socio-demographic variables. Mothers were more likely to give their child a pacifier if they were younger, had lower levels of education, experienced greater financial difficulties or lived in council housing (compared to owned/mortgaged). The opposite was apparent for digit suckers. After allowing for these possible confounding factors, pacifier users had a higher incidence of earache and colic compared to children with no sucking habit, however digit suckers had a lower incidence of these symptoms. Children who sucked both were significantly more likely to have reported wheezing, earache, and poor health in the past month. CONCLUSIONS: Significantly different sociodemographic characteristics were observed with pacifier suckers compared to those who sucked their thumb or finger. It is almost impossible to attribute the direction of causality between infection and a sucking habit. Further and more detailed studies are needed before any recommendations can be made based on the statistically significant associations found as they are unlikely to be of major clinical significance.

Adult↗
PubMed1997

Bacterial colonization of pacifiers of infants with acute otitis media.

The presence of aerobic and facultative anaerobic bacteria on the surface of pacifiers used by children with acute otitis media was investigated. The surface of 40 recently used pacifiers was swabbed after they were allowed to dry for five to six minutes. The swabs were processed quantitatively for the presence of aerobic bacteria. The antibacterial activity of the pacifier material was tested in vitro. Microorganisms were isolated from 21 (52.5 per cent) pacifiers. The number of colonies per pacifier varied between one and 35 (average six). The isolates included eight alpha-haemolytic streptococci, six Staphylococcus epidermis, five Candida albicans, five alpha-haemolytic streptococci, three Neisseria spp. and two Staphylococcus aureus. The pacifier material was shown to be inhibitory against S. aureus. This study illustrated that pacifiers do not contain high numbers of organisms and therefore are not likely to serve as a source of persistence of transfer of organisms.

Acute Disease↗
PubMed2002

Does pacifier use cause ear infections in young children?

The aim of this review was to identify whether, in children under 2 years of age, pacifier (dummy) use results in an increased risk of ear infection (acute otitis media). The Cochrane Library, Medline, CINAHL and Embase databases were searched for cohort studies and randomised controlled trials that compared infants who used pacifiers with those who didn't or examined the effect of reducing pacifier use in a group of infants. One cluster randomised trial and two cohort studies met the review criteria and were available to be included in the body of the review. These studies show a clear increase in risk of ear infection to be associated with use of a pacifier that may well be causal. The risk of ear infections is up to three times higher in those who use a pacifier and there does appear to be a 'dose response' with continual users more at risk than occasional users. However, this relationship may be confounded by socio-demographic factors. Rather than advising a parent not to use a pacifier for fear of causing otitis media, advice in relation to this issue might best be restricted to pacifier users suffering from the problem in order to reduce the chances of recurrence.

Acute Disease↗
PubMed1999

Breastfeeding patterns in relation to thumb sucking and pacifier use.

OBJECTIVES: To analyze the influence of thumb sucking and pacifier use on breastfeeding patterns in exclusively breastfed infants, on the duration of exclusive breastfeeding, and on the total breastfeeding duration. STUDY DESIGN: Descriptive, longitudinal, prospective study. SETTING: The subjects were recruited from a population of 15 189 infants born in the maternity ward at the University Hospital, Uppsala, Sweden between May 1989 and December 1992. STUDY POPULATION: 506 mother-infant pairs. METHODS: Daily recordings by the mothers on infant feeding from the first week after delivery through the duration of the study. Fortnightly home visits with structured interviews by a research assistant. RESULTS: Pacifier use was associated with fewer feeds and shorter suckling duration per 24 hours, shorter duration of exclusive breastfeeding, and shorter total breastfeeding duration compared with no pacifier use. These associations were not found for thumb sucking. The possible negative effects of pacifiers on breastfeeding seemed to be related to the frequency of their use. Maternal age and education only slightly modified the association between pacifier use and breastfeeding duration. CONCLUSIONS: More frequent use of a pacifier was associated with shorter breastfeeding duration, even among a group of mothers who were highly motivated to breastfeed. breastfeeding duration, breastfeeding pattern, exclusive breastfeeding, pacifier use, thumb sucking.

Breast Feeding↗
PubMed2000

Pacifier as a risk factor for acute otitis media: A randomized, controlled trial of parental counseling.

OBJECTIVES: To evaluate the association between pacifier use and the increased occurrence of acute otitis media (AOM) in an intervention trial. METHODS: Fourteen well-baby clinics were selected to participate in an open, controlled cohort study. These 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 allocated for an intervention, while the other served as a control. The nurses at the intervention clinics were trained to instruct the parents of children <18 months old to limit pacifier use during their prescheduled visits to the clinic. The intervention consisted of a leaflet explaining the harmful effects of pacifier use and instructions to restrict its use. Two hundred seventy-two children were successfully recruited from the intervention clinics and 212 from the control clinics. The data about pacifier use and the occurrence of respiratory infections and AOM were collected similarly in both groups. RESULTS: After the intervention, a 21% decrease was achieved in continuous pacifier use at the age of 7 to 18 months (P =.0001), and the occurrence of AOM per person-months at risk was 29% lower among children at the intervention clinics. The children who did not use a pacifier continuously in either of the clinics had 33% fewer AOM episodes than the children who did. CONCLUSION: Pacifier use appeared to be a preventable risk factor for AOM in children. Its restriction to the moments when the child was falling asleep effectively prevented episodes of AOM.

Acute Disease↗
PubMed2002

Associations of pacifier use, digit sucking, and child care attendance with cessation of breastfeeding.

OBJECTIVE: Breast milk is the recommended method of nutrition for newborns and infants. Several studies have investigated factors associated with the cessation of breast-feeding. This study assessed the associations between pacifier use, digit sucking, childcare attendance, and breastfeeding cessation among 1387 infants in the Iowa Fluoride Study. STUDY DESIGN: This was a longitudinal questionnaire survey. Mothers completed mailed questionnaires sent at infant ages 6 weeks, 3 months, and 6 months. POPULATION: Parents were recruited postpartum at 8 Iowa hospitals. OUTCOMES MEASURED: Survival analysis (using Cox proportional hazards model) assessed the time covariate effects of pacifier use, digit sucking, and child care attendance on cessation of breastfeeding, while adjusting for other possible confounding variables (not planning to breastfeed, maternal smoking, infants' sex and antibiotic use, maternal and paternal age and education, and income group). RESULTS: Percentages of women who did any breastfeeding were 46%, 36%, and 27%, at 6 weeks, 3 months, and 6 months, respectively. Percentages using pacifiers were 81%, 71%, and 59%. Combinations of pacifier use and digit sucking for various levels of child care had statistically significant associations with cessation of breastfeeding, with the effect being strongest for pacifier users and digit suckers with no child care days (hazard ratio = 1.88; 95% CI, 1.36-2.62). CONCLUSIONS: Pacifier use and digit sucking were associated with cessation of breastfeeding, with results dependent on the level of childcare attendance. The strongest associations were found for those not attending childcare and for combined use of pacifier with digit sucking.

Child Day Care Centers↗
PubMedDate not supplied

The influence of pacifier sucking on mesenteric blood flow in infants.

Thirty-six neonates were randomly assigned to 2 groups of 18 neonates each. In the pacifier group, infants were given a pacifier before milk feeding. Newborns in the control group were fed without preprandial use of a pacifier. Doppler measurement of peak systolic velocity, end-diastolic velocity, and Pourcelot resistance index in the superior mesenteric artery was performed in both groups. Peak systolic and end-diastolic velocities were significantly increased after pacifier sucking in the preprandial stage. The resistance index decreased significantly after milk feeding but not after pacifier sucking. The feeding volume was not affected by preprandial pacifier sucking.

Humans↗
PubMed1997

The pacifier thermometer. Comparison of supralingual with rectal temperatures in infants and young children.

OBJECTIVE: To determine the correlation between supralingual temperatures obtained with a new electronic pacifier thermometer (Steridyne) and rectal temperatures obtained with a digital electronic thermometer. DESIGN: Prospective study. SETTING: Pediatric emergency department and pediatric inpatient ward of a tertiary university hospital. PARTICIPANTS: Convenience sample of 100 patients, aged 7 days to 24 months. MAIN OUTCOME MEASURES: A supralingual and rectal temperature were obtained for each patient. For the first 30 patients, the time needed for the pacifier thermometer to signal a final, steady-state reading was recorded. RESULTS: The mean +/- SD difference between rectal temperatures and supralingual temperatures adjusted upward by 0.5 degree F was -0.01 degree F +/- 0.42 degree F (statistically zero) (95% confidence interval, -0.09 degree F to 0.07 degree F). The correlation coefficient between supralingual and rectal temperatures was 0.95. Sensitivity and specificity of the pacifier thermometer for detecting fever (temperature > or = 100.4 degrees F [> or = 38.0 degrees C]) was 72.0% and 98.0%, respectively (positive predictive value, 97.3%; negative predictive value, 77.8%). Increasing supralingual temperatures by 0.5 degree F increased sensitivity to 92.0%, and decreased specificity to 76.0% (positive predictive value, 79.3%; negative predictive value, 90.5%). It took an average time of 3 minutes 23 seconds for the pacifier thermometer to display a steady-state temperature. CONCLUSIONS: The pacifier thermometer evaluated here was found to be an accurate means of temperature measurement when recorded temperatures were adjusted upward by 0.5 degree F. The approximate 3 minutes required for a final temperature determination makes the pacifier thermometer most appropriate for use in low-volume ambulatory care settings and in the home. Further investigation of this device is recommended.

Body Temperature↗
PubMed1992

[The development of the deciduous dentition under the influence of differently shaped pacifiers].

Intending to perform a prospective study after the birth of their children 312 mothers were asked for co-operation and a newly developed preventively shaped pacifier was given them (free of charge) for use. Two years later it was possible to join 202 children and morphologically investigate their primary dentition. On the base of the real behaviour in the meantime the subjects formed five groups: children without sucking habits, finger suckers, user of cherry-shaped pacifiers, so-called health pacifiers and test pacifiers. The findings show specific significant differences. Especially cherry-shaped pacifiers but also medically recommended pacifiers can badly influence the development of the deciduous dentition. However, the harmful results can be minimized by a special preventive shape.

Chi-Square Distribution↗
PubMedDate not supplied

Development of a pacifier for low-birth-weight infants' nonnutritive sucking.

Nonnutritive sucking can provide low-birth-weight infants with an opportunity to organize their behavior, an important component of developmental care. A pacifier specifically designed for low-birth-weight infants facilitates their nonnutritive sucking to more fully meet their needs. The research and development of a pacifier for low-birth-weight infants incorporated a naturalistic approach and used the best model, the infant thumb, in the design. Clinical trials with infants randomized to control and experimental groups were conducted to compare the prototype pacifier to a commercially available pacifier. Observations using the Anderson Behavioral State Scale demonstrated that infants using the prototype pacifier more often were found to be in an alert state. This pacifier may contribute to infants' state organization for optimum feeding and could be a component in developmental care planning.

Clinical Trials as Topic↗
PubMed1990

Non-nutritive suckling and use of pacifiers.

One hundred and sixteen infants and children with normal development were studied for their non-nutritive suckling habit with special reference to pacifier suckling. The use of pacifier was more common among the lower socio-economic group (83.6%) and those residing in slums (58.6%). In 88.7% of cases it was the mother, family member, friend or relative who was responsible for introduction of pacifier to the baby with the aim to soothe the child. The other indications for use of pacifier were to facilitate dentition (60.0%) and nutritive function (18.1%). The use of pacifier in most of the cases was associated with chronic diarrhea (86.2%), respiratory illnesses (52.5%) and pica (10.2%). Defective dentition was noted only in 5.1% of children. The medical/paramedical staff were against the use of pacifiers.

Child↗