Pacifier use, early weaning, and cry/fuss behavior

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Craig Elice Date: 4/25/2009
Article title: Pacifier Use, Early Weaning, and Cry/Fuss Behavior
Author(s): Kramer MS, Barr RG, et al..
Journal: JAMA 286(3)
Volume (number): 322-326
Date: July 18, 2001
Major topic: Pacifier and its effect on Breast feeding
Type of Article: Double blind, randomized clinical trial
Main Purpose: This study evaluated whether advice to avoid use of the pacifier and use other techniques to soothe an infant reduces the risk of early weaning from breast feeding, and increases the risk of crying and fussing.
Materials and Methods: 281 randomized mothers were placed into two groups. Both groups received a basic breastfeeding package consisting of a 45 minute interview promoting breastfeeding. In the experimental group, mothers were asked to avoid pacifiers when the infant cried or fussed, and instead offer the breast. In the control group, all options were suggested to calm the infant. Follow up calls were placed at 10 days and 3 weeks postpartum. A behavior diary was completed by the mothers at 4, 6, and 9 weeks for 3 days at each interval.
Findings: 258 mothers, 127 experimental and 131 controls completed the study. The experimental intervention resulted in 38.6% avoiding the pacifier use, while the control group avoided pacifiers in 16% of the cases. The diaries confirmed a reduced number of pacifier insertions per day. However, early weaning from breast feeding was similar between the two groups at 3 months of age (18.9% vs 18.3%). Observation analysis indicated the daily pacifier use was more significant for early weaning, 25% vs. 12.9% who had never received a pacifier. The response rate for the diaries was fair with only 57.4% at the 9 weeks. Observations noted included slightly less crying and fussing at 4 and 6 weeks, and identical at 9 weeks
Key points/Summary : The experimental intervention reduced pacifier use, yet it did not reduce crying and fussing behavior at all time intervals. It also did not have an effect on reducing the risk of early weaning of breast feeding. However the pacifier use was strongly associated with early weaning, perhaps because of breastfeeding difficulties or reduced motivation to breastfeed.
Assessment of article: Interesting study to contrast with the advocates of breastfeeding who suggest that pacifiers use cause nipple confusion and early weaning

The effect of sucking habits, cohort, sex, intercanine arch widths, and breast or bottle feeding on posterior crossbite in Norwegian and Swedish 3 yea

Department of Pediatric Dentistry
Lutheran Medical Center

Resident’s Name: Craig Elice Date: 4/25/2009
Article title: The effect of sucking habits, cohort, sex, intercanine arch widths, and breast or bottle feeding on posterior crossbite in Norwegian and Swedish 3 year-old children
Author(s): Ogaard B, Larsson E., Linsten R.
Journal: Am. J. Orthod. 106 (2)
Volume (number): 161-6
Date: August 1994
Major topic: Habits influence on posterior cross-bites
Type of Article: Research article
Main Purpose: This study evaluated the prevalence of posterior cross-bites in children from Norway and Sweden and its relationship with sucking habit.
Materials and Methods: 445 3 year olds, 250 from Norway, and 195 from Sweden were included in the study. During the exam, the families were questioned about sucking habits , duration of finger sucking or dummy sucking (pacifier) and if ongoing, gender, and if Swedish. Clinically, intercanine width of both maxillary and mandibular arches were measured, and if a posterior cross-bite was present. As a control, 15 medieval skulls with full primary dentition were measured. No sucking habits were assumed from these skulls.
Findings: Of the posterior cross-bites, 90% involved cuspids. Finger sucking was more common in females. The duration of pacifier use is longer in Swedish children. In finger suckers, posterior cross-bites could be predicted with upper intercanine width while in the pacifier group, posterior cross-bite groups could be predicted with upper and lower intercanine widths. Both arches were narrower in Swedish children, especially in girls, and pacifier use decreased upper and increased lower intercanine width. At least 2 years of pacifier use affected the upper jaw and 3 years in lower jaw. Breast vs. bottle feeding had no influence on the development of posterior. Swedish children tended to have narrower jaws and also a higher prevalence of posterior cross-bites. Norwegian children had a normal or slightly increased prevalence of posterior cross-bites with pacifier use. Intercanine width was significantly influenced by the duration of the habit in years. It was seen that the longer the pacifier habit, the stronger the effect of the intercanine width: decrease in maxillary width and increased mandibular width. “This study supports the hypothesis that in a pacifier habit, the cheeks show increased activity and the tongue repositions back and downward. The low position of the tongue decreases maxillary arch development thus decreasing intercanine width and expands the lower arch causing the lower intercanine width to increase.
Key points/Summary : Nonsuckers showed no relationship between the tested variables and development of a posterior cross-bite. Pacifier use influences development of a posterior cross-bite. And lastly, finger sucking has some effect but it is less certain
Assessment of article: Thorough discussion of the influence of habits on intercanine width. Useful in practice.

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

Resident’s Name: Chad Abby Date: 4/17/2009
Article title: Effects of current and former pacifier use on the dentition of 24 to 59 month old children
Author(s): Steven M. Adair, Michael Milano, Isabel Lorenzo, Carl Russell
Journal: American Academy of Pediatric Dentistry
Volume (number): 17:7
Month, Year: 1995
Major topic: pacifier use
Minor topic(s): effects of current and former pacifier use on the dentition
Type of Article: Scientific article
Main Purpose: purposes of this study include: compare the occlusions of 24-59 mnth old current and former pacifier users to children of the same age with no pacifier habits, the effects on the occlusion of conventional pacifiers and functional exercisers, the effects of pacifier use time on the occlusion, differences between current and former pacifier users, and differences between pacifier use patterns of European-Americans and African-Americans.
Overview of method of research: 218 children ages 24-59 months participated in a study. A questionnaire was used to gain info on habit hx. 82 children were current or former users of functional exercisers, 38 had a hx of conventional pacifier use, and 98 had no hx of oral habits. Primary canine relationships, terminal plane relationships, overbite and openbite, overjet, and posterior crossbite were all recorded.
Findings: It has been reported that non-nutritive sucking habits occurs between 61 and 95%. The prevalence of malocclusions among children with the habit has been reported to be 38-94%. Anterior opentbites have been reported in as many as 74%. Increased overjet has been noted in 79% of pacifier users. An increased prevalence of class 2 canines and distal step primary molars also has been reported.
Key points/Summary: It was found that children with a history of pacifier use had a significantly larger mean overjet, as well as significantly higher occurrence of class 2 primary canines, distal step molars, openbite, and posterior crossbite compared to children with no habit. Pacifier use time in months was significantly higher for children with openbite and posterior crossbite. Compared to former pacifier users, those with current habits had a significantly higher prevalence of openbite and posterior crossbite, and a greater mean openbite. 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 discontinued their habits, African –American children had a maintained theirs for a significantly shorter period, leading to a longer elapsed time between habit discontinuation and the examination.
Assessment of article: What are functional exercisers? I suppose they are a non-conventional pacifiers