October 2000
OULU, Finland - Pacifier use may be a preventable risk factor for acute otitis media (AOM) in children, according to a new study.
Finnish researchers reported in Pediatrics that when parents were counseled to limit their child's pacifier use, the occurrence of AOM per person-months at risk was 29% lower than that of children whose parents received no advice. Moreover, children in both groups who did not use a pacifier continuously had 33% fewer AOM episodes than children who did.
The intervention was successful
in achieving a 21% decrease in continuous pacifier use. "Continuous use of a
pacifier increases the risk of otitis media," said Marjo Niemelä, MD, PhD,
associate professor, department of pediatrics, University of Oulu and lead
researcher of the study. "The pacifier can be used freely until the age of 6
months, but after that the use should be limited to the moments when the child
is falling asleep."
Just how pacifier use leads to AOM remains unknown. The re searchers speculated that the effect may lie in an alteration in the pressure equilibrium between the middle ear cavity and the nasopharynx, which would impair the functioning of the eustachian tube.
The only variable with a significant effect on the occurrence of AOM per person-months at risk beyond counseling (P=.047) was day care (P=.001), according to linear regression analysis.
The randomized, controlled, prospective, open cohort study enrolled 484 children from 14 well-baby clinics here. Clinics were paired according to size and area served, and one from each pair was chosen for the intervention. Thus, 272 children were enrolled at the intervention clinics and 212 at the control clinics. Nurses at the intervention sites were trained to instruct parents about the harmful effects of both pacifier use and AOM and how the two are linked. The nurses were told to encourage parents to allow free use of the pacifier until the child was 6 months old, to restrict use to bedtime until 10 months and to terminate use after that. Leaflets were given out reiterating these points.
Both the intervention and control group parents were instructed to register the occurrence of AOM on a daily symptom sheet. Parents also recorded the dates of possible changes in the habit of pacifier use on the sheet. The monitoring lasted from three to six months depending on when the child entered the study, but all children included had monitoring data available for at least one month.
The occurrence of AOM was calculated per person-months at risk according to pacifier use (continuously, when falling asleep or not at all) and according to membership in the intervention or control group. The effect of the intervention on pacifier use was evaluated by calculating the time for which children younger than 6 months used a pacifier all the time, only when falling asleep or not at all during the monitoring period, and the proportion differences were then calculated. Their significance was tested by Fisher's exact test.
The researchers used linear regression modeling to evaluate what variables played a role in pacifier use and AOM: age, sex, intervention group, method of nursing and mode of day care. Similar modeling was used to evaluate the effect of the intervention itself on the occurrence of AOM.
The mean age of the children at the beginning of the study was 8.1 months. Nearly one-third (31.6%) already had AOM episodes. At the time of enrollment, 79% of the intervention group and 74.7% of the control group had been using a pacifier.
The researchers suggested that the counseling used in this study could also be used to prevent other adverse effects of pacifier use, such as oral candidiasis and dentition problems.
For more information:
- Niemela M, Pihakari O, Pokka T, et al. Pacifier as a risk factor for acute otitis media: a randomized, controlled trial of parental counseling. Pediatrics. 2000;106(3):483-488.
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