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PubMed2004

Asphyxia due to pacifiers--case report and review of the literature.

Pacifiers and bottle nipples entail the risk of asphyxia when they are swallowed, self-made or have become porous, or when used by older children whose teeth and chewing musculature have developed beyond the suckling stage. A further danger lies in the various devices used to tie the pacifier to the child, as they can cause strangulation. On the basis of this first case of a 2-year-old biting off a piece of her pacifier and fatally aspirating it, we point to the dangers and security requirements related to pacifiers and bottle nipples, and give a review of the related literature.

Age Factors↗
PubMed1988

The inability of a temperature-sensitive pacifier to identify fevers in ill infants.

We assessed the utility and accuracy of a temperature-sensitive pacifier in screening for fever in ill children under 2 years of age. Of 189 candidates for study, 83 (42%) did not use pacifiers, and of the 106 who did, 25 (24%) could not sustain a suck for five minutes of direct observation. Among those 81 children who could sustain five minutes of sucking, only two of 20 children with rectal temperatures above 100 degrees F (37.8 degrees C) were correctly identified as febrile. Furthermore, seven of eight children with temperatures of 102 degrees F (38.9 degrees C) or greater were incorrectly identified as being afebrile. There were no false-positive fever assessments in afebrile infants. The temperature-sensitive pacifier tested in this study does not accurately identify fevers in most infants who are shown to have fevers by rectal temperature determination. The use of this pacifier for screening fever in ill infants cannot be recommended.

Fever↗
PubMed1994

Rocking and pacifiers: two comforting interventions for heelstick pain.

The effects of behavioral interventions in reducing the stress of infant pain are not well documented. Two comfort interventions, rocking and pacifiers, were compared with routine care administered to 60 newborn infants randomly assigned to the three conditions following a neonatal screening heelstick. Heart rate, state of arousal, and crying were recorded continuously. Both pacifiers and rocking reduced crying, but pacifiers predominantly produced sleep states and rocking predominantly produced alert states. Pacifiers reduced heart rate levels significantly more than did rocking. Thus, newborns clearly benefit from both comforting methods. Several mechanisms are proposed to account for these findings.

Bloodletting↗
PubMed1993

Use of pacifiers and breastfeeding duration.

Pacifiers are widely used in many developing countries. Although their use is not recommended for breastfeeding infants, there have been no published reports on the association between pacifier use and risk of early weaning. In a study of 354 infants in Brazil, mothers were asked about pacifier use at age 1 month, duration of breastfeeding, and introduction of other foods. Among 249 children still breastfed at 1 month, the risk that a child would be weaned at any age between 1 and 24 months was higher in pacifier users than in non-users (hazard ratio 3.0, 95% CI 2.0-4.6). The association remained even after adjustment for the child's age, sex, birthweight, socioeconomic status, and age at introduction of bottle-feeding.

Breast Feeding↗
PubMed1977

Thumb- and pacifier-sucking habits.

The prevalence of thumb- and pacifier-sucking children was studied in two "kibbutz" settlements and city nurseries. The variables considered were age, sex, duration of breast feeding, and family size. Data on 333 children were collected by interviewing the parents, and nurses (in kindegartens and nurseries). Differences in prevalence were found between the three groups. Among the city children, 95 per cent sucked and 89 per cent and 69 per cent of the kibbutz children had sucking habits. In Group A, from whom pacifiers were withheld, most children sucked their fingers. With the increase in age, the prevalence was lower in all groups. No difference was found between the sexes. A reverse association was found between finger and pacifier sucking. No association was found between the habit and the duration of breast feeding. The prevalence was highest in single children. It is suggested that the pacifier may be a substitute of choice for thumb sucking.

Age Factors↗
PubMed1998

Prolonged pacifier-sucking and use of a nursing bottle at night: possible risk factors for dental caries in children.

At the baseline of this cohort study we determined risk factors for colonization of oral lactobacilli and candida in a group of children (n = 166) whose mean age was 2.5 years. The results showed that pacifier-sucking and the use of a nursing bottle at night increase the occurrence of both salivary lactobacilli and candida. In the present study these children were followed for 2 years, and the progression of caries was recorded with particular reference to the etiologic factors measured before. The results of the logistic regression analysis showed prolonged pacifier-sucking (> or = 24 months) to be a significant risk factor for caries development in children, with a rather high relative risk (RR) of 3.5 (95% confidence interval (CI), 1.5-8.2; P= 0.003). Prolonged use of a nursing bottle at night (> or = 24 months) was also a risk factor, but less significant than pacifier-sucking (RR, 2.6; CI, 1.1-6.4; P= 0.03). On the grounds of this study we conclude that prolonged pacifier-sucking (> or = 2 years) and use of a nursing bottle at night are risk factors for dental caries in children.

Bottle Feeding↗
PubMed2002

Crossover trial of analgesic efficacy of glucose and pacifier in very preterm neonates during subcutaneous injections.

OBJECTIVE: Very preterm newborns undergo multiple invasive procedures. Nonpharmacological interventions are valuable alternatives for pain relief during minor procedures in neonates. Oral sucrose analgesia has been widely studied in term and preterm neonates during painful procedures. The analgesic effect of oral glucose in very preterm infants has not yet been reported. The objectives of this study were to assess the analgesic effect of orally administered glucose and to determine the synergetic analgesic effect of glucose and pacifiers during subcutaneous injections in very preterm neonates using a validated behavioral acute pain rating scale. DESIGN: Two crossover trials. SETTING: One neonatal intensive care unit in a community-based general hospital. METHODS: A prospective study was conducted in 40 very preterm neonates. Each infant received 2 treatments in a crossover manner during 2 consecutive subcutaneous injections of erythropoietin. The first trial (25 infants) was intended to compare oral 30% glucose (0.3 mL) versus placebo (0.3 mL of sterile water); the second trial (15 infants) compared oral 30% glucose (0.3 mL) versus oral 30% glucose (0.3 mL) followed by sucking a pacifier. The primary outcome measure was the evaluation of pain induced by a subcutaneous injection of erythropoietin, using Douleur Aiguë Nouveau-né scale (0 no pain, 10 maximum pain). RESULTS: Twenty-four infants completed the study in the first trial and 15 in the second one. Mean (95% confidence interval [CI]) gestational age, birth weight, postnatal age, and weight at inclusion for neonates in the first and second trial were, respectively, 28.1 (95% CI: 27.3-29.0) and 29.1 (95% CI: 27.8-30.4) weeks, 1036 (95% CI: 944-1128) and 995 (95% CI: 848-1141) g, 26.4 (95% CI: 22.4-30.3) and 26 (95% CI: 22.0-29.9) days, and 1234 (95% CI: 1120-1348) and 1209 (95% CI: 1059-1359) g. In the first trial, median (interquartile) pain scores for placebo and 30% glucose, respectively, were 7 (2.5-9.75) and 4.5 (1-6). In the second trial, median (interquartile) pain scores for 30% glucose and for 30% glucose plus pacifier, respectively, were 4 (2-7) and 4 (1-6). CONCLUSIONS: A small dose of 0.3 mL of 30% oral glucose has an analgesic effect in very preterm neonates during subcutaneous injections. This effect is clinically evident because it can be detected by a behavioral pain rating scale. The synergetic analgesic effect of glucose plus sucking a pacifier is less obvious in very preterm neonates as opposed to what other studies have showed in full-term infants.

Administration, Oral↗
PubMed1994

[The use of pacifiers in children: fecal contamination and association with diarrhea].

A cross-sectional study of 354 children under two years of age was carried out in two periurban slums, with poor sanitary and socioeconomic conditions, located in Pelotas, southern Brazil. Most (79%) of the children studied were current users of pacifiers, 15% had never used one and the remaining 6% were ex-users. Among current users, 38% sucked a pacifier most of the time ("constant users"). Of the pacifiers in constant use, 93% were cultured for evidence of fecal contamination. Fecal coliforms were present in 49% of these. Diarrhoea was reported in 35% of all the children in the two weeks preceding the survey. Among constant pacifiers users, 40% had had diarrhoea in the preceding fortnight; this proportion was 32% for occasional users and 37% for non-users. These differences were not statistically significant.

Brazil↗
PubMed2002

Breastfeeding difficulty and pacifier use.

Research about pacifiers used in the healthy, term infant shows that they are associated with shortened breastfeeding duration, acute otitis media, and may be a marker for breastfeeding difficulty. This case study describes a situation where latch was faulty from the beginning, and a pacifier was introduced when the thriving baby was two and a half weeks old. The baby's average number of daily feeds dropped from 14 breastfeeds a day to nine breastfeeds. The baby's rate of weight gain dropped from 1135 g (2 lb 7 oz) gain in the first 16 days of life, down to a gain of 180 g (6 oz) over the next 15 days. The baby's fussiness and the mother's nipple soreness disappeared after a lactation consultant helped the mother to correct the latch and stop using the pacifier. While it is not possible to say that the pacifier caused slower weight gain, less frequent breastfeeds or nipple soreness, it would seem to be implicated in the changes.

Adult↗
PubMed2003

Detecting fever in young infants: reliability of perceived, pacifier, and temporal artery temperatures in infants younger than 3 months of age.

OBJECTIVES: Fever in young infants frequently triggers a laboratory evaluation because of the increased likelihood of serious bacterial infections. Reported fever by methods other than rectal thermometry is of concern. This study evaluates the validity of perceived, pacifier, and temporal artery (TA) temperatures. METHODS: A convenience sample of 200 babies younger than 3 months of age presenting to an emergency department was evaluated for parental perception of fever and with TA, pacifier, and rectal temperatures. RESULTS: The sensitivity and specificity of perceived and TA detection of fever were similar at 91 and 79, and 83 and 86, respectively. Febrile pacifier readings had a sensitivity of 99, but a specificity of only 46. CONCLUSIONS: Rectal thermometry must remain the standard for infants younger than 3 months of age.

Caregivers↗
PubMed2001

Cardiovascular responses to pacifier experience and feeding in newborn infants.

This study examined the effects of sucking on a pacifier immediately before feeding on cardiovascular responses to feeding. Twenty-eight bottle-feeding infants were studied at 12 to 40 hr of age. Blood pressure and heart rate measurements were made during three periods: Period 1-while infants rested in their cribs before a regularly scheduled feeding, Period 2-while being held by the feeder immediately before feeding, and Period 3-during the first 3 to 5 min of feeding. Half of the infants were given a pacifier during Period 2. Blood pressures and heart rates increased across the periods; however, increases in systolic blood pressure during feeding were reduced for the group of infants given a pacifier prior to feeding. We suggest that cardiovascular responses to feeding in infants are comprised of multiple elements. Most of the systolic blood pressure responses to feeding are elicited by sucking whereas the heart rate response is dependent on both sucking and nutrient intake.

Blood Pressure↗
PubMed1998

Airway obstruction by a child's pacifier--could flange design be safer?

UNLABELLED: The use of pacifiers (dummies or soothers) for infants is prevalent. Rare episodes of an adverse consequence must be taken seriously. We report a case of aspiration of a pacifier by a 6-month-old baby. Nine similar cases were found in the literature since 1966. The details of these cases are outlined and changes to flange design proposed ahead of a new European Union Standard document. CONCLUSION: Pacifier ventilation holes are essential, flanges should have a minimum horizontal and vertical diameter of 43 mm. Rings should be attached to the flange to facilitate removal if aspirated.

Airway Obstruction↗
PubMed1998

Are breastfeeding problems related to incorrect breastfeeding technique and the use of pacifiers and bottles?

BACKGROUND: In Western countries during the 1960s and 1970s, sore nipples and insufficient milk were common problems that made it hard for mothers to maintain breastfeeding for long. This study investigated the relationship of breastfeeding problems to nursing behavior and pacifier use. METHODS: Fifty-two healthy mother-infant pairs with breastfeeding problems were referred for observation of nursing behavior to a breastfeeding clinic at the Department of Pediatrics of Malmö General Hospital, Malmö, Sweden, from August 1987 to July 1989. The infants ranged in age from 1 to 17 weeks. A faulty nursing pattern was corrected as necessary. Forty mother-infant pairs with no breastfeeding problems provided a control group. RESULTS: In most cases the nursing problems were related to incorrect sucking technique. The difference in technique of the study group compared with the control group was significant (p = 0.0001). The continuation of breastfeeding was poorer if the infant already had become used to bottle-feeding. Pacifier use was more common in conjunction with breastfeeding problems and in cases with a faulty superficial nipple-sucking technique. CONCLUSION: Breastfeeding problems may be prevented by the adoption of hospital routines that do not interfere with the start of breastfeeding and by the avoidance of extensive use of pacifiers.

Adult↗
PubMed1996

Penetrating eye injury from a rigid infant pacifier.

BACKGROUND: The use of infant pacifiers (dummies) is common in Australasian communities and has been reported to be associated with various injuries, but to date ocular trauma has not been reported. CASE REPORT: A 14-month-old child sustained a penetrating eye injury from the infant pacifier that was in his mouth during a minor fall. Only a lid laceration was detected at the time. One week later he presented with mydriasis, heterochromia and a poor red reflex. Diagnosis of a penetrating eye injury was made by examination under anaesthesia, with B-scan ultrasonography demonstrating hypotony but no retinal detachment or intraocular foreign body. Funduscopy revealed a small inferior vitreous haemorrhage. Exploration of the globe adjacent to the lid wound showed a 6 mm laceration through the sclera plugged with prolapsed vitreous. CONCLUSION: Serious ocular injury may result after a minor fall with some designs of rigid infant pacifiers. Heterochromia and anisocoria noted by the mother heralded more serious ocular injury in this case. The delay in diagnosis of this injury emphasizes the importance of ocular examination to exclude eye trauma when injuries occur around the orbit.

Anisocoria↗
PubMedDate not supplied

Pacifier use and the occurrence of otitis media in the first year of life.

PURPOSE: The purpose of this study was to assess pacifier use as a risk factor for otitis media during the first year of life. METHODS: A volunteer cohort of 1,375 infants was recruited from eight hospital postpartum units in Iowa. Parents were asked to provide detailed information on their child's health at 6 weeks, 3, 6, 9 and 12 months of age. Questions were posed concerning occurrence of specific childhood illnesses, including otitis media, at each time point, as well as other factors. RESULTS: Over 70% of children were reported to have experienced one or more episodes of otitis media during their first year of life, with its occurrence much more common during the second six months. Multivariate analyses using Generalized Estimating Equations assessed factors associated with otitis media during the entire 12-month period. These analyses showed that pacifier use, age, male sex, greater number of childcare days, and higher family incomes were significantly associated with occurrence of otitis media. CONCLUSIONS: Multivariate analyses found that the occurrence of otitis media was associated with pacifier use, one of few modifiable risk factors for otitis media.

Female↗
PubMed1984

Volatile N-nitrosamines in baby bottle rubber nipples and pacifiers. Analysis, occurrence and migration.

A simple direct extraction method has been developed for rapid determination of volatile N-nitrosamines in rubber nipples and pacifiers. It consists of overnight extraction of the sample with dichloromethane in the presence of ascorbyl palmitate for N-nitrosation inhibition, filtration of the extract and rinsing of the samples with dichloromethane, concentration of the extract using a Kuderna-Danish concentrator, and final analysis by gas-liquid chromatography-Thermal Energy Analyser. The method gave excellent (80-100%) recoveries of various volatile N-nitrosamines that had been added to cut nipples or pacifiers at 20-80 micrograms/kg levels, and gave comparable or lower values than those obtained with another published method. The method is recommended for rapid screening purposes. A survey of 30 samples of various nipples and pacifiers indicated the presence of the following N-nitrosamines: N-nitrosodimethylamine (up to 70 micrograms/kg), N-nitrosodiethylamine (up to 88 micrograms/kg), N-nitrosodi-n-butylamine (up to 2796 micrograms/kg), N-nitrosopiperidine (up to 180 micrograms/kg), and N-nitrosomorpholine (up to 86 micrograms/kg). A more recent study, however, indicated a general decline in the levels of various volatile N-nitrosamines in these products. These N-nitrosamines were shown to migrate easily from the rubber products to liquid infant formula, orange juice and simulated human saliva.

Humans↗
PubMed1994

An examination of alveolar stop retraction during pacifier use.

Employing a single subject A-B-A experimental design, a four year old female with normal articulation and a history of pacifier use was observed to demonstrate alveolar stop retraction more than fifty percent of the time while using her orthodontic device. Contextual factors appeared to have played a role in this variability. Upon confirming this phenomenon in the four year old subject, a follow-up investigation was undertaken with seven children between the ages of three and five years. All subjects had age appropriate articulation skills with no evidence of alveolar stop retraction without the pacifier in place and only rarely with the pacifier in place (.85%). Implications of these findings and the need for further research are discussed.

Articulation Disorders↗
PubMed1997

Pacifiers in the NICU: a lactation consultant's view.

Many infants, especially premature infants, may benefit from the regular use of pacifiers in the NICU. The NICU nurse who has a variety of pacifiers to choose from can select the one that best meets the infant's needs. But although mother's milk at the breast may not be the choice of all mothers, or may not be an option, it ought to be viewed as the norm. Full-term infants at the breast generally do better with no pacifiers at all. For the NICU patient, smooth transition to successful oral feedings at the breast or bottle is an important step in the direction of home.

Breast Feeding↗