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PubMed2003

Does the use of pacifiers shorten breastfeeding duration in infants?

Breastfeeding has a number of benefits for both mother and baby, which appear to increase with longer duration of breastfeeding. The use of pacifiers has been negatively associated with shortened breastfeeding duration. The aim of this review was to determine whether the use of pacifiers actually shortens breastfeeding duration in infants. The Cochrane library, Medline, CINAHL and Embase databases were searched for systematic reviews, randomized controlled trials and cohort studies examining the effect of pacifier use on breastfeeding duration. After applying appropriate inclusion criteria only two cohort studies were identified. In one the overall breastfeeding duration was longer in non pacifier-using infants compared to those given pacifiers (10 months vs. 7.5 months). The mean breastfeeding duration in children who were given pacifiers before 6 weeks of age was 168.5 days compared to 196.0 days for children who had a pacifier introduced later or never. However, there is no evidence to suggest any effect from occasional pacifier use, and it remains unclear whether pacifiers are an independent causal factor for reducing breastfeeding duration in infants.

Breast Feeding↗

PubMed2002

Effect of pacifier use on oral breathing in healthy newborn infants.

We tested the hypothesis that the use of a pacifier may affect the ability of some term infants to maintain effective oral breathing during prolonged nasal occlusion. Three nasal occlusion tests without a pacifier and 3 with a pacifier were alternately carried out in 20 healthy term infants (age 2-5 days). Once the infant commenced oral breathing, nasal occlusion was continued for up to 90 sec (prolonged nasal occlusion), provided the infant did not start crying and that arterial oxygen saturation (SaO(2)) did not drop to < or = 80%. The response to nasal occlusion was considered maladaptive if oral breathing was accomplished with signs of upper airway obstruction. After nasal occlusion, the infants succeeded in starting oral breathing in all instances after a delay which was strongly correlated to the drop in SaO(2) (P < 0.001). Once the infants commenced oral breathing, 17/20 infants presented a maladaptive response to 62% of all tests without pacifier, whereas 10/20 infants presented a maladaptive response to 30% of all tests with a pacifier in place (P < 0.001). Following prolonged nasal occlusion, 18 of 19 infants presented a maladaptive response to 84% of all tests without pacifier, whereas 12 of 19 infants presented a maladaptive response to 41% of all tests with a pacifier in place (P < 0.001). Thus, after prolonged nasal occlusion with or without pacifier, the drop in mean SaO(2) from baseline values changed in accordance with an appropriate and maladaptive response (-4 +/- 1 vs. -7 +/- 1; P < 0.001). We conclude that normal term infants often present with a maladaptive response to prolonged nasal occlusion. The use of a pacifier enhances the infant's ability to maintain a more adequate oral air flow.

Female↗

PubMed2001

The impact of pacifier use on breastfeeding: a prospective cohort study.

OBJECTIVES: To determine the predictors of pacifier use during the first year of life and to assess the influence of pacifier use on the duration of breastfeeding. METHODOLOGY: A prospective cohort study was conducted. Three hundred and fifty mother-infant pairs were followed to 1 year of age to determine the impact of the use of a pacifier on the duration of breastfeeding. RESULTS: A cohort of 441 mothers were enrolled and 79% participated. Ninety four per cent were followed up to 1 year. Daily pacifier use was associated with early cessation of breastfeeding (risk ratio (RR) 1.71; 95% confidence interval (95%CI) 1.29, 2.28) and a reduced duration of full breastfeeding (adjusted (adj.) RR 1.35; 95%CI 1.05, 1.74). Finger sucking was not associated with a reduced duration of breastfeeding (RR 1.05; 95%CI 0.81, 1.37). Pacifier use less than daily was not associated with a change in duration of breastfeeding (RR 1.02; 95%CI 0.75, 1.39). Most mothers commenced the use of a pacifier within the first month. Multiple logistic regression analysis found that the use of a pacifier was associated with male gender (adj. RR 1.97; 95%CI 1.23, 3.13), maternal smoking in pregnancy (adj. RR 2.23; 95%CI 1.01, 4.95), and low maternal confidence with breastfeeding (adj. RR 2.70; 95%CI 1.48, 4.93). CONCLUSIONS: Daily pacifier use is associated with a reduced duration of breastfeeding. Less frequent pacifier use does not reduce the duration of breastfeeding.

Adult↗

PubMedDate not supplied

A sugar-coated pacifier reduces procedural pain in newborns.

PURPOSE: To examine the efficacy of pacifiers and sugar, alone and in combination, for pain management in neonates. METHODS: An experimental design examined pain responses of 84 newborns undergoing heelstick. They were randomly assigned to one of four groups: (a) water-moistened pacifier, (b) sugar-coated pacifier, (c) 2 cc of a 12% oral sucrose solution, or (d) control. Pain measures were duration of cry, vagal tone, and salivary cortisol. RESULTS: Multivariate analysis of variance (MANOVA) revealed that the sugar-coated pacifier group cried significantly less than the water-moistened pacifier and control groups. Repeated measures analysis of variance (ANOVA) revealed that the sugar-coated pacifier group demonstrated significantly lower vagal tone during heelstick than the oral sucrose solution and control groups. This difference between the sugar-coated pacifier and control groups persevered for 15 minutes after heelstick. CONCLUSIONS: Offering a sugar coated pacifier during heelstick in healthy neonates reduces pain behaviors more effectively than a water-moistened pacifier, 2 cc of a 12% sucrose solution, or no intervention.

Administration, Oral↗

PubMed1995

A pacifier increases the risk of recurrent acute otitis media in children in day care centers.

OBJECTIVE: To follow up a previous retrospective analysis in which we found the use of a pacifier to be a risk factor for recurrent acute otitis media (AOM). METHOD: In the present prospective study, the occurrence of AOM and the use of a pacifier were recorded in 845 children attending day care centers during a 15-month period. RESULTS: More than three attacks of AOM occurred in 29.5% of the children younger than 2 years using pacifiers and in 20.6% of those not doing so (relative risk, 1.6; 95% confidence interval [CI], 0.6, 4.1); in children 2 to 3 years of age, the figures were 30.6% and 13.2%, respectively (relative risk, 2.9; 95% CI, 1.2, 7.3). Logistic modeling with adjustment for age and the duration of monitoring showed the occurrence of AOM to be associated with the time during which a pacifier was used. The use of a pacifier increased the annual incidence of AOM from 3.6 (95% CI, 2.5, 4.9) to 5.4 episodes (4.4, 6.6) in children younger than 2 years and from 1.9 (1.4, 2.5) to 2.7 (2.2, 3.3) in children 2 to 3 years of age. The population-attributable risk of AOM attacks due to the use of a pacifier was 176 attacks, ie, 459 to 635 attacks per year, in the youngest children and 69 attacks, ie, from 264 to 333 attacks per year, in those 2 to 3 years of age. It can be calculated that the use of a pacifier was responsible for 25% of the attacks in children younger than 3 years. Breastfeeding, parental smoking, thumb sucking, using a nursing bottle, and the social class of the family failed to show such strong associations with the occurrence of AOM. CONCLUSION: We conclude that the use of a pacifier is a significant risk factor for recurrent AOM and suggest that pacifiers should be used only during the first 10 months of life, when need for sucking is strongest, and AOM is uncommon.

Acute Disease↗

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↗

PubMedDate not supplied

Pacifier use in children: a review of recent literature.

Pediatric dentists are generally well aware of the oral implications of nonnutritive sucking (NNS). NNS via digit or pacifier can effect changes in the occlusion, including openbite, excessive overjet, and possibly posterior crossbite. Skeletal changes have also been attributed to NNS. There is some evidence that pacifiers may do less harm to the dentition, particularly because pacifier habits are often spontaneously shed at about 2 to 4 years of age. Digit habits are more likely to persist into the school-age years and can require appliance therapy for discontinuation. Thus, some authorities suggest that pacifiers be recommended for infants who engage in NNS. While pediatric dentists understand the oral and perioral effects of pacifiers, they may be less well versed in other aspects of pacifier use that have been reported in the medical, nursing, chemical, and psychological literature. This paper provides reviews of literature concerning the role of pacifier NNS in 4 areas: (1) sudden infant death syndrome; (2) breast-feeding; (3) otitis media and other infections; and (4) safety. Knowledge of current literature in these areas may assist pediatric dentists with their decisions of whether to recommend or discourage pacifier use in infants.

Breast Feeding↗

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↗

PubMed2002

Sweet solutions and pacifiers for pain relief in newborn infants.

In this study we aimed to assess and compare the analgesic effects of orally administered sucrose, dextrose, dextrose or sucrose followed by a pacifier, and sterile water during minor painful procedures in neonates. One hundred thirty-eight healthy term newborn infants were enrolled in this prospective study. They received either sweet solutions or sweet solutions followed by pacifiers before the heel prick (group 1, dextrose 12.5%; group 2, dextrose 12.5% followed by a pacifier; group 3, sucrose 12.5%; group 4, sucrose 12.5% followed by a pacifier; and group 5, sterile water). The median values for crying time and the pain scores performed according to the neonatal facial coding system were recorded. The median crying times were 16.5, 55, 92.5, 102, and 132 seconds in groups 4, 2, 3, 1, and 5, respectively (P = .0001). The pain scores showed that babies in group 4 had significantly lower scores followed by groups 2, 3, 1, and 5 (P = .0001). Although group 4 had a lower pain score and shorter crying time than group 2, the difference was not statistically significant (P = .27 and P = .39). In conclusion, 12.5% dextrose or sucrose followed by a pacifier was found to be superior to dextrose only and sucrose only solutions in pain relief; sucrose followed by a pacifier resulted in lower pain scores and shorter crying time than dextrose when combined with a pacifier. The antinociceptive effect of sweet solutions can be enhanced with a pacifier.

Journal Article↗

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

[A study on protozoan cysts, helminth eggs and larvae in pacifiers].

OBJECTIVE: Due to the high prevalence of enteroparasitoses among Brazilian children and the possible involvement of objects in carrying these diseases, a study was conducted to investigate the presence of protozoan cysts, larvae and helminth eggs in pacifiers. METHODS: Over the period of March to December of 1993, 86 pacifiers of zero to seven-year-old children resident in Vila Promessa, a suburb in Alfenas, MG, were examined. The investigation of cysts, larvae and eggs was made by the microscopic exam of the sediment obtained from centrifuging the liquid resulting from washing the pacifiers. The results were evaluated by employing the percentile analysis. Along with the examination of the pacifiers, an interview was carried out with the people responsible for the children whose pacifiers were examined, aiming at detecting how much was known about the transmission of intestinal parasitoses and the proper hygiene of pacifiers. RESULTS: Among the 86 pacifiers examined, 10 were found to be contaminated (11.63%) and presenting eggs of Ascaris lumbricoides, Enterobius vermicularis, Trichuris trichiura, Taenia sp and Ancylostomatidae larvae. CONCLUSION: Pacifiers were found to be an important means of transmitting intestinal parasites in the age range studied what makes it a need to set a proper and persistent sanitary policy in fighting intestinal parasitoses.

English Abstract↗

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↗

PubMed2005

[Presence of temporomandibular joint discomfort related to pacifier use].

AIM: The goal of the present study was to analyze if the duration of pacifier use influenced the stomatognathic system in children that did not present any other parafunctional habits. STUDY DESIGN: Transversal cohort study. MATERIAL AND METHOD: To collect data, a questionnaire was used and answered by the mothers of 90 children aged three to seven years old. RESULTS: The children were divided into three groups: did not use pacifier; used pacifier until 2 years old; and used pacifier for more than 2 years. Greater prevalence of pain or discomfort in the stomatognathic system was observed among the children who had not used pacifier and the children who had used it for more than 2 years. The prevalence was smaller among the children who used pacifier until 2 years of age. CONCLUSION: Thus, it is concluded that pacifier is important to induce children to perform suction movements, preparing them to the introduction of solid foods. However, if used for a prolonged period of time, it may damage the joint and consequently the child's quality of life.

Brazil↗

PubMed2006

Should pacifiers be recommended to prevent sudden infant death syndrome?

OBJECTIVES: Our aim was to review the evidence for a reduction in the risk of sudden infant death syndrome (SIDS) with pacifier ("dummy" or "soother") use, to discuss possible mechanisms for the reduction in SIDS risk, and to review other possible health effects of pacifiers. RESULTS: There is a remarkably consistent reduction of SIDS with pacifier use. The mechanism by which pacifiers might reduce the risk of SIDS is unknown, but several mechanisms have been postulated. Pacifiers might reduce breastfeeding duration, but the studies are conflicting. CONCLUSIONS: It seems appropriate to stop discouraging the use of pacifiers. Whether it is appropriate to recommend pacifier use in infants is open to debate.

Humans↗

PubMed2005

[The symbolic and utilitarian facets of pacifiers according to mothers].

OBJECTIVE: Despite governmental initiatives that control, discourage and even prohibit the divulgation of the usage of dummies and pacifiers in maternity wards, the frequency of pacifier use by Brazilian children is still high. In light of this phenomenon, the aim of the present study was to investigate the social representations of the pacifier constructed by mothers whose children used pacifiers. METHODS: The present study is based on the conceptual framework of social representations, proposed by Moscovici. We studied women who gave birth at a teaching hospital in the city of Sao Paulo that prohibits the use of pacifiers during hospital admission. We conducted non-structured individual interviews that were transcribed in full and organized for analysis according to the collective subject discourse method. RESULTS: Our results indicate maternal representations that the pacifier "symbolizes the child," that is "is a tranquilizer for the child and an aid for the mother," and that "its use is inherited from generation to generation". CONCLUSIONS: Pacifiers are an alternative for the mother for comforting and hushing her child in moments of agitation or for when the mother is not able to tend to the child in a direct and continuous manner.

Female↗