Healthnotes Newswire (September 21 2000)—Counseling parents to limit their children’s use of pacifiers can reduce the incidence of ear infections, according to a study published in this month’s issue of the journal Pediatrics.¹

In this study, the parents of 272 children (under the age of 18 months) attending 14 different pediatric clinics were given instructions at their normal post-natal visits regarding pacifier use. Specifically, they were told that the need for sucking is great during the first six months of life, and that pacifier use could be unlimited during that time. However, when the child reached six months of age, pacifier use was to be limited to the time the child was falling asleep, and use should be discontinued entirely by the age of 10 months. Another 212 children at 14 other clinics were not given any instruction regarding pacifier use and served as a control group.

At the onset of the study, 78% of the children in both groups were using a pacifier, and 43% were using it continuously. Among the children between the ages of 7 and 18 months whose parents received instructions to limit pacifier use, a 21% reduction in continuous pacifier use was seen compared to controls. However, the proportion of children using a pacifier at all did not differ between the two groups, indicating that pacifier use per se is not the problem, only continuous pacifier use.

The total incidence of ear infections in the group that was counseled about pacifier use was 29% lower than that seen in the control group. When the two groups were analyzed together, it was found that the occurrence of ear infections was 33% higher in children who used a pacifier continuously than in those who either did not use one at all or used one only when falling asleep.

Ear infections are perhaps the most common problem for which children require medical treatment. One study found that 83% of children had at least one ear infection by the age of three years, and 46% had at least three episodes by their third year.²

This new study strongly suggests that continuous pacifier use may increase the risk of ear infection in children, although limited pacifier use does not appear to be harmful. However, use of pacifiers is by no means the only modifiable risk factor for ear infections. Several studies have shown a clear association between food allergy and ear infection, with a reduction in infections seen when allergenic foods were avoided.^{3 4 5} Children who are exclusively breast fed for at least four months are at a lower risk of ear infections than are children who are formula fed.^{6 7} Parental smoking has also been shown to be a risk factor for ear infection.⁸

Pacifier use has long been thought to be a harmless habit in children. This new study, however, raises the possibility that continuous pacifier use can increase the risk of ear infections. The way in which pacifiers are used should, therefore, be reconsidered.