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PubMed2005

Breastfeeding and pacifier use in Brazil.

OBJECTIVE: To determine the relationship between pacifier use and the duration of exclusive breast-feeding in the first six months of age, among poor children with unfavourable birth weight, from an underdeveloped region in Brazil. METHOD: Prospective cohort study with infants followed from birth to 6 months of age. Healthy children born with unfavourable birth weight (< 3,000), being exclusively breastfed, were selected from 8 maternity hospitals in the city of Fortaleza (Brazil) between November 1996 and April 1997. Two main outcome measures were used: (i) time to stop exclusive breast-feeding at the 1st and (ii) at the 6th month of life. Main exposures were pacifier use at 1st and 6th month of age. Data were collected at maternity hospitals and during home interviews, using structured questionnaires, by trained data collectors unaware of the study aims, and analyzed using survival analysis and the Cox Proportional Hazard Model. RESULTS: 500 children were enrolled and 13% were lost to follow up at the 1st month. Most of the families had a monthly income less than five times the minimum wage. One third of the mothers were adolescents, one fifth were working outside the home by the 6th month and most attended prenatal care visits. Approximately 60% of the children were using pacifiers by the 1st month. The average number of days for exclusive breast-feeding for pacifier use by the 6th month was 125.3 compared to 87.0 among non-users (p=0.0001). Children using pacifiers were 1,9 more likely to have stopped exclusive breastfeeding by the 6th month compared to non-users, even after controlling potential confounders. CONCLUSION: Pacifier use was associated with the early termination of breast-feeding in Brazil, among poor children with unfavourable birth weight, living in an underdeveloped area. As a possible marker of early weaning, pacifier use can help health workers identify those mothers in need of extended counselling to reinforce breast-feeding practices.

Birth Weight↗

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↗

PubMed2006

Pacifiers: a microbial reservoir.

The permanent contact between the nipple part of pacifiers and the oral microflora offers ideal conditions for the development of biofilms. This study assessed the microbial contamination on the surface of 25 used pacifier nipples provided by day-care centers. Nine were made of silicone and 16 were made of latex. The biofilm was quantified using direct staining and microscopic observations followed by scraping and microorganism counting. The presence of a biofilm was confirmed on 80% of the pacifier nipples studied. This biofilm was mature for 36% of them. Latex pacifier nipples were more contaminated than silicone ones. The two main genera isolated were Staphylococcus and Candida. Our results confirm that nipples can be seen as potential reservoirs of infections. However, pacifiers do have some advantages; in particular, the potential protection they afford against sudden infant death syndrome. Strict rules of hygiene and an efficient antibiofilm cleaning protocol should be established to answer the worries of parents concerning the safety of pacifiers.

Analysis of Variance↗

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↗

PubMed2005

International Child Care Practices study: breastfeeding and pacifier use.

Although the Baby-Friendly Hospital Initiative advises that no pacifiers be given to breastfeeding infants, both breastfeeding and pacifier use may protect against sudden infant death syndrome. The International Child Care Practice Study data set on child care practices associated with sudden infant death syndrome risk from 21 centers in 17 countries was used to describe infant-feeding practices and pacifier use and assess factors associated with breastfeeding. At approximately 3 months of age, rates of breastfeeding only (4%-80%) and pacifier use(12.5%-71%) varied between centers. Pacifier use was negatively associated with breastfeeding, and a dose-response effect was noted. Other negative (multiple birth, smoking by mother) and positive (intention to breastfeed, bed sharing, mothers' education) associations with breastfeeding only were identified. Although causality should not be inferred, these associations are consistent with previous studies. Advice on pacifiers should include potential benefits as well as risks.

Breast Feeding↗

PubMedDate not supplied

Prevalence of pacifier-sucking habits and successful methods to eliminate them--a preliminary study.

PURPOSE: The goal of this study was to verify the prevalence of nutritive (breast-feeding and bottle-feeding) and non-nutritive (pacifier) sucking habits, the methods used to eliminate them, and success of these methods. METHODS: To collect the data, 502 questionnaires were distributed to parents of 0- to 6-year-old children. RESULTS: Bottle-feeding was used by 83% and pacifier by 63% of children. The professional's explanation, the use of substances on the pacifier, the abrupt interruption of the habit, and parents' explanations were efficient in 90%, 80%, 64%, and 38% of the cases, respectively. CONCLUSIONS: Sucking habits had a high prevalence in this sample. An indirect linear relationship between breast-feeding and pacifier use demonstrated that the more the child was breast-fed, the less the pacifier was used. The most efficient method to end the pacifier-sucking habit was professional explanation; however, it was used less often.

Bottle Feeding↗

PubMedDate not supplied

Accuracy of pacifier thermometers in young children.

Nurses and families are continually searching for less invasive yet accurate methods of measuring temperature in children. Although pacifier thermometers are readily accessible to consumers, few studies report the accuracy of such instruments. This study aimed to determine the validity/reliability of one type of pacifier thermometer in approximating core body temperature using a prospective, within-subjects design, comparing pacifier and rectal temperatures in children (n=25), ages 7 days to 24 months, in one pediatric hospital-based setting. The mean +/-SD difference between rectal and supralingual temperatures adjusted upward by 0.5 degrees F was 0.012 degrees F +/- 0.777 degrees F, which was not statistically significant. The 95% confidence interval (-0.309-0.333) fit within the manufacturer specifications. The correlations between the rectal and adjusted pacifier temperature was 0.772 and between 3-and 6-minute pacifier temperatures was 0.913. These data provide support to previous assertions that pacifier thermometry is an acceptable method of temperature approximation in young children.

Cross-Sectional Studies↗

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↗

PubMed2002

The relationship between pacifier use, bottle feeding and breast feeding.

OBJECTIVE: To investigate the influence of pacifier use and the introduction of formula milk on breast feeding. METHODS: The mothers of 356 healthy newborn infants who initiated breast feeding while in-patients were interviewed within 3 days of birth and later at 2 and 6 months postpartum. Information regarding previous birth, breast-feeding frequency, pacifier use and the adoption of formula milk were obtained. The data were analyzed using chi2 and Kruskal-Wallis tests. RESULTS: At the end of the second month, 264 (74%) of the mothers were still breast feeding; by the end of the sixth month this had fallen to 236 (66%). Among the 356 mothers, 152 had at least one previous infant, and 132 (86.8%) of them had breast fed a previous infant. Of the women who breast fed their previous infant for more than 2 months, 112 (84.8%) breast fed the current child until the end of the second month and 104 (78.7%) until the end of the sixth month after delivery. Of all investigated patients, 204 were primiparous (57.3%). Of these, 152 (74.5%) breast fed until the end of the second month, and 132 (64.7%) until the end of the sixth month after delivery. Amongthe 204 primiparae, 92 (45%) gave formula to their newborn infants. Forty-four of these 92 mothers (47.8%) had discontinued breast feeding by the end of the second month. Among the 356 newborn infants, 220 used pacifiers at the end of the second month. Within this group, 72 (33%) of the infants did not breast feed, while 148 (67%) did breast feed. Of all investigated mothers, 136 did not give pacifiers to their infants and only eight of these mothers (6%) had stopped breast feeding at the end of the second month. CONCLUSIONS: We found an inverse correlation between pacifier usage and breast feeding. Breast feeding was most common among multiparous mothers.

Breast Feeding↗

PubMed2003

Pacifier use and early childhood caries: an evidence-based study of the literature.

This evidence-based study of the literature investigated the relationship between pacifier use (with and without sweetening and prolonged or short-term) and early childhood caries (ECC). The review was based on evidence from 3 main sources: a search of several electronic bibliographic databases, a review of the references from relevant studies for additional potentially relevant articles and a review of several dental textbooks. A total of 74 articles were reviewed. Of these, 8 were deemed relevant and were critically appraised according to a "causation checklist" of 13 items. The 8 studies assessed were methodologically inconsistent in terms of definitions of ECC, diagnostic criteria for identifying carious lesions, dental examination procedures, interviewing methods, and descriptions of pacifier use. None of the studies achieved a score greater than 6 and hence none was considered to present strong evidence. Six studies did not control for confounding variables, and the conclusions they generated were inconsistent. The evidence from the other 2 studies, which did control for confounding factors, presented slightly stronger evidence, but they indicated no statistical difference in pacifier use between children with and those without ECC; furthermore, the reported odds ratios suggested that pacifier use might have had a mildly protective effect. Overall, the evidence does not suggest a strong or consistent association between pacifier use and ECC.

Child, Preschool↗