Pacifier Use in Children: A Review of Recent Literature

Meghan Sullivan Walsh June 8, 2011

Literature Review - St. Joseph/LMC Pediatric Dentistry

Pacifier Use in Children: A Review of Recent Literature

Resident: Meghan Sullivan Walsh

Program: Lutheran Medical Center- Providence

Article Title: Pacifier Use in Children: A Review of Recent Literature

Authors: Steven M. Adair, DDS, MS

Journal: Pediatric Dentistry

Volume (number), Year, Page #’s; 25:5, 2003, 449-458.

Major Topic: Review of literature concerning the role of pacifier in nonnutritive sucking in four areas 1) SIDS, 2) breast-feeding 3) otitis media and other infections and 4) safety.

Overview of Method of Research: Review of studies published since 1950. Searches limited to clinical trials, meta-analysis and multicenter studies. Diagnosis limited to sensitivity and specificity. Etiology/harm limited to cohort studies, case control studies and risk. Natural history/prognosis included prognosis, cohort studies, disease progression and time factors.

Findings:

1) Relationship between pacifier use and SIDS

Studies have shown that pacifier use at sleep time was associated with a greater than 50% reduction in the risk of SIDS. There were several explanations offered: 1) Airway may be less compromised or restricted with pacifier use. 2) Pacifier use may prevent the infant from turning to a prone position. 3) Infants are aroused while sleeping when they lose their pacifier 4) other misc such as reduced risk of GERD, simulation of saliva, simulation of somatostatin and gastrin and altered mother’s behavior causing the mom to check on the infant more frequently.

2) Effect of pacifier use on breast-feeding

Recent decades have shown a trend towards reduced breast-feeding and many studies blame pacifier use. Studies have refuted the “nipple confusion” theory, however, mother’s have admitted to using pacifiers to control the interval between breast-feeding, or to wean their infants from the breast. It is reasonable to consider that mothers who do not plan on breast-feeding may use a pacifier to comfort the infant and assist in weaning.

3) Pacifier use and it’s relationship with acute otitis media and other aspects of health.

Data shows a strong relationship between pacifier use and acute otitis media (AOM). Higher percentages of children with a history of AOM has used a pacifier for less than 4 years. In addition pacifiers have been proved to become a vector for bacterial and fungal transport.

4) Physical safety.

Pacifier material and design, combined with improper usage has been reported towards morbidity and mortality. Ventilation holes are essential as well as flanges with a minimum horizontal and vertical dimension of 43mm. Parents and caregivers are warned not to use cords on pacifiers for fear of strangulation.

Chemical safety includes a volatile n-nitrosamines found in baby bottle nipples that have shown to produce carcinogens in animal testing. In addition, there are questionable reports on latex allergies associated with pacifier use.

Key Points: Summary: Recommendations for our patient’s parents should include:

1) Education on the safety of pacifier use

2) Withhold pacifiers until breast-feeding is established. Limit pacifier use for soothing only.

3)Advise parents to exercise judgment and restraint with pacifier use.

4) Instruct parents to clean pacifiers routinely and avoid sharing.

5)Curtailing pacifier use before the age of 2 to prevent habits and malocclusion.

Assessment of the Article: Great article. Very thorough and usefu