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PubMed1997

UNICEF/WHO baby-friendly hospital initiative: does the use of bottles and pacifiers in the neonatal nursery prevent successful breastfeeding? Neonatal Study Group.

UNLABELLED: To promote breastfeeding, UNICEF/WHO have launched the "baby-friendly hospital initiative" focusing on hospital care routines during delivery and the first days of life. In industrialised countries, two aspects of the initiative have raised controversy: how do restriction of supplemental feedings and ban of bottles and pacifiers affect long-term breastfeeding performance? From ten centres 602 healthy newborns were randomly assigned either to a UNICEF group with restrictive fluid supplements and avoidance of bottles and pacifiers during the first 5 days of life, or to a standard group with conventional feeding practice. Breastfeeding was encouraged in both groups. The main study endpoints were the prevalences of breast-feeding on day 5, and after 2, 4 and 6 months. Of the newborns 46% violated the UNICEF protocol, mostly because of maternal requests to give a pacifier or supplements by bottle. In the standard group, the drop-out rate was 9.7%. No significant differences in breastfeeding frequency and duration could be found: (UNICEF vs standard) day 5: 100% vs 99%; 2 months: 88% vs 88%; 4 months: 75% vs 71%; 6 months: 57% vs 55%. Inclusion of drop-outs due to pacifier use did not alter the results. CONCLUSION: In our study population fluid supplements offered by bottle with or without the use of pacifiers during the first 5 days of life were not associated with a lower frequency or shorter duration of breastfeeding during the first 6 months of life.

Breast Feeding↗

PubMed1994

Pacifiers and dental structure as risk factors for otitis media.

The purpose of the study was to examine the relationship between ear infections and dentition, sucking habits, pacifier sucking and atopic and allergic diseases in a historic cohort survey. The series comprised 944 5-year-old children representing about 3/4 of the whole age cohort. The parents completed a questionnaire that asked for details of the children's ear infections, sucking habits and atopic or allergic diseases diagnosed by a physician. The dental status was examined by the child's own local dentist. The children who had used a pacifier had a greater risk of having recurrent attacks of acute otitis media in their history than those who had not used a pacifier (risk ratio (RR), 1.43; 95% confidence interval (CI), 1.06-1.93; P = 0.02). Mouth breathing was significantly associated with acute otitis media (RR, 1.87; CI, 1.28-2.73; P = 0.01), as was open bite (RR, 1.36; CI, 1.01-1.84; P = 0.04), but no other mode of malocclusion. The population attributable risk of otitis media caused by pacifier amounted to a total of 478 attacks or 0.7 per child. The association between otitis media and the use of a pacifier remained even after adjusting for mouth breathing and the measures of malocclusion. Neither thumb sucking nor atopic eczema showed such an association.

Acute Disease↗

PubMed1999

Use of a pacifier and behavioural features in 2-4-month-old infants.

This study aimed to analyse a possible association between the use of a pacifier and particular behavioural features in 2-4-month-old infants as estimated by the means of the Early Infancy Temperament Questionnaire (EITQ). It comprised 192 randomly selected clinically healthy infants born in St Petersburg in 1997-1998. The mothers were asked to complete the questionnaires addressing infant, maternal and major demographic characteristics, and childcare practices, with particular emphasis on the use of a pacifier, as well as to fill in the EITQ. The EITQ scores nine different aspects of infant temperament: activity, rhythmicity, approach, adaptability, intensity, mood, persistence, distractibility and threshold. A total of 117 of 192 infants (60.9%) used pacifiers, and they appeared to have more rhythmic behaviour than non-users. This effect remained after adjustment was made for major potential confounding and/or modifying factors, including gender, parity, details from perinatal history and familial social background, feeding pattern, bed sharing and room sharing. With the exception of rhythmicity, no significant association was found between the use of a pacifier and any other particular feature of infant temperament. Use of a pacifier may be associated with higher rhythmicity in 2-4-month-old infants.

Breast Feeding↗

PubMed1997

Breastfeeding and the use of pacifiers.

BACKGROUND: This study was designed to test the hypothesis that incorrect sucking technique and pacifier use are factors contributing to breastfeeding failure. METHOD: The nursing patterns of 82 exclusively breastfeeding mother-infant pairs were observed 4 to 5 days postpartum on the maternity ward at University Hospital in Malmö, Sweden. The breastfeeding outcome and pacifier use was assessed by regular telephone contacts during a 4-month follow-up. RESULTS: The breastfeeding rate at 4 months was 91 percent in the nonpacifier group and 44 percent in the pacifier group (p = 0.03). An incorrect superficial nipple-sucking technique at the breast from the start combined with pacifier use resulted in early weaning in most cases. CONCLUSION: To promote successful breastfeeding and to reduce nursing problems, an incorrect sucking technique should be prevented or corrected, and the use of pacifiers should be avoided or restricted.

Adolescent↗

PubMed1999

Pacifier use and sudden infant death syndrome: results from the CESDI/SUDI case control study. CESDI SUDI Research Team.

OBJECTIVES: To investigate the relation between pacifier use and sudden infant death syndrome (SIDS). DESIGN: Three year population based, case control study with parental interviews for each death and four age matched controls. SETTING: Five regions in England (population > 17 million). SUBJECTS: 325 infants who had died from SIDS and 1300 control infants. RESULTS: Significantly fewer SIDS infants (40%) than controls (51%) used a pacifier for the last/reference sleep (univariate odds ratio (OR), 0.62; 95% confidence interval (CI), 0.46 to 0.83) and the difference increased when controlled for other factors (multivariate OR, 0.41; 95% CI, 0. 22 to 0.77). However, the proportion of infants who had ever used a pacifier for day (66% SIDS v 66% controls) or night sleeps (61% SIDS v 61% controls) was identical. The association of a risk for SIDS infants who routinely used a pacifier but did not do so for the last sleep became non-significant when controlled for socioeconomic status (bivariate OR, 1.39 (0.93 to 2.07)). CONCLUSIONS: Further epidemiological evidence and physiological studies are needed before pacifier use can be recommended as a measure to reduce the risk of SIDS.

Breast Feeding↗

PubMedDate not supplied

[Use of pacifiers in children: patterns and determinants].

Although pacifiers are commonly used by Brazilian children and are potentially harmful, there are no studies about their patterns and determinants. These were investigated in a cross-sectional study of 354 children under two years of age living in two slum areas of Pelotas, southern Brazil. Most children (79%) were pacifiers users, 15% had never used them, and 6% had used them in the past. Among users, 38% spent most of the time sucking a pacifier. For two-thirds of the children, pacifiers were offered on the very first day of life. Pacifier use was most common among younger children,among those of low-schooling mothers and among non-breastfed infants.

English Abstract↗

PubMedDate not supplied

Evaluation of the effects of orthodontic pacifiers on the primary dentitions of 24- to 59-month-old children: preliminary study.

This study was designed to compare the occlusions of 24- to 59-month-old children who used orthodontic or conventional pacifiers to the occlusions of a group of controls who had no sucking habits. Information on the habits was collected by parental questionnaires. Ninety-five children were examined for malocclusions involving overbite, overjet, canine, and molar relationships, and posterior crossbites. Users of orthodontic pacifiers had statistically significantly greater overjets, and there was a significantly higher proportion of subjects with open bite in the conventional pacifier group. There was a trend toward a greater number of subjects in the control and orthodontic pacifier group with overbites less than or equal to 50%. These differences were not clinically significant, however. There appeared to be only minor differences between the occlusions of the two pacifier groups.

Child, Preschool↗

PubMed1989

Soothing pain-elicited distress in infants with swaddling and pacifiers.

The effectiveness of pacifiers and swaddling in reducing pain-induced distress was compared in 2-week-old infants who underwent heel-sticks and 2-month-old infants who received injections. Crying, state, and heart rate were measured on 32 infants at each age during baseline, the stress of heel-stick or injection, and during 3-min soothing intervention and postintervention periods. At 2 weeks, infants' HR levels and crying declined significantly more rapidly in the pacifier than in the swaddling condition. At 2 months, both conditions produced similar rates of decline in HR and crying. At both ages, infants in the pacifier group spent significantly more time in an alert state than did swaddled infants. Following termination of the intervention at both ages, HR and crying tended to rebound more in the pacifier than in the swaddling group. Swaddling and pacifiers thus reduce pain-elicited distress differently.

Crying↗

PubMedDate not supplied

Volatile N-nitrosamines in infant pacifiers sold in the United States as determined by gas chromatography/thermal energy analysis.

Volatile N-nitrosamines in infant latex rubber pacifiers were determined using a modification of a previously described dichloromethane extraction procedure, followed by gas chromatography/thermal energy analysis. Under an interagency agreement between the National Center for Toxicological Research and the Consumer Product Safety Commission (CPSC), data were obtained on the baseline and compliance concentrations of volatile N-nitrosamines in infant pacifiers sold in the United States. Pacifiers made by 18 different manufacturers before and after the January 1, 1984 action level of 60 ppb was set by the CPSC were analyzed for volatile N-nitrosamines. N-Nitrosodibutylamine was the principal N-nitrosamine found, along with trace amounts of N-nitrosodimethylamine, N-nitrosodiethylamine, and N-nitrosopiperidine. Mean total volatile N-nitrosamine levels for baseline and compliance samples were 63.9 and 21.2 ppb, respectively. The pacifier lots sampled after January 1, 1984 showed a significant decrease in contamination levels, indicating that at least 98% of the market share is in compliance with the CPSC enforcement policy for N-nitrosamines in infant pacifiers sold in the United States.

Chromatography, Gas↗

PubMed1995

Use of pacifiers is associated with decreased breast-feeding duration.

OBJECTIVE: To determine the relationship between pacifier use at 1 month of age to the duration of breast-feeding to 6 months of age. DESIGN: Longitudinal study of infants from birth to 6 months of age. POPULATION: Six hundred five rooming-in infants born at the largest hospital in Guarujá, São Paulo, Brazil, during January and February 1993. MAIN OUTCOME MEASURES: Prevalence of breast-feeding (exclusive, predominant, and complementary) at 1, 4, and 6 months of age. RESULTS: Relative risk for weaning between 1 and 6 months of age was 3.84 (95% confidence interval 2.65-5.50) for pacifier users at 1 month of age, compared with nonusers. When an adjustment was made for possible confounding variables through Cox regression analysis, the relative risk dropped to 2.87 (95% confidence interval 1.97-419). CONCLUSION: Pacifier use is highly correlated with early weaning, even after controlling for possible confounders. Until it is determined if pacifier use is causally related to weaning or is a marker for other undetermined causes, pacifier use probably should not be recommended for breast-fed infants.

Breast Feeding↗

PubMed1994

Release of preventive agents from pacifiers in vitro. An introduction to a novel preventive measure.

Clinical data show that the later primary teeth are colonized by mutans streptococci (MS), the less caries will develop, if at all. Since up to 90% of teething children develop a sucking habit, pacifiers were designed to release preventive agents into the mouth. Simultaneous use of sodium fluoride and xylitol increases the enamel fluoride content. Xylitol affects specifically growth and metabolism of mutans streptococci. The aim of this study was to determine the release of fluoride, xylitol and sorbitol from pacifiers in vitro. A disintegration apparatus was designed to test the dissolution of tablets containing NaF resp. 0.25 mg F, 160 mg xylitol and 150 mg sorbitol from the pacifiers. Six pacifiers were agitated simultaneously with a standardised pump movement, 30 strokes/min, in 15 ml normal saline at +37 degrees C for 2, 5, 10, 20, 40, 60 and 90 min. The released fluoride was determined in 1 ml samples of saline to which 1 ml Tisab was added using a combined F-ion electrode. Xylitol and sorbitol were analyzed by using an ion chromatograph with a pulsed-amperometric detector. A linear slow release of fluoride, xylitol and sorbitol from the pacifiers could be observed up to 90 min. After 2700 strokes the residual saline in the suction chambers (vol. approximately 0.4 ml) was equally analyzed, where all 3 ingredients could still be detected.

Cariostatic Agents↗

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↗

PubMed2004

Analgesic effects of oral sucrose and pacifier during eye examinations for retinopathy of prematurity.

Oral sucrose reduces pain during heel sticks and venipunctures in preterm infants, but no studies have been done to determine the effectiveness of sucrose during eye examinations for retinopathy of prematurity. Therefore, the purpose of this study was to determine the effectiveness of local anesthetic eye drops and a pacifier, plus repeated doses of 24% sucrose, to relieve pain associated with eye examinations for retinopathy of prematurity. In this double-blind randomized controlled trial, 30 preterm infants were randomly assigned to one of two treatments, in which they received either local anesthetic eye drops, a pacifier, plus three doses of sterile water or local anesthetic eye drops, a pacifier, plus three doses of 24% sucrose during the eye examination. Treatment effectiveness was determined using a validated infant pain measure, the Premature Infant Pain Profile (PIPP), which includes measures of facial expressions, heart rate, and oxygen saturation and takes behavioral state and gestational age into consideration. Data were collected before, during, and following an examination of the left eye. Statistically significant differences in mean PIPP scores were found between the sucrose and water groups during the left eye examination. The mean PIPP score was 8.8 for the sucrose group and 11.4 for the water group ( t = 2.87, p = .008 two-tailed). No significant differences were found in PIPP scores immediately following the procedure. Sucrose and a pacifier may be beneficial for minimizing pain during eye examinations in preterm infants and should be considered as a part of evidence-based guidelines for relieving pain during this procedure.

Analgesia↗

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↗