Continuous Pacifier Use Linked to Ear Infections

Sept. 11, 2000 -- Say bye-bye to Binky, except for a brief bedtime visit while the baby is falling asleep. That's the advice from a new study that links the use of pacifiers to increased risk for ear infections.

Ear infections, called otitis media, are among the most common reasons for a visit to the pediatrician. More than 25 million doctor visits each year are because a child has an ear infection. Health experts are anxious to find new ways to reduce the risk of these usually harmless but very painful afflictions.

In Finland, a team of pediatricians suspected that the very popular pacifier might be a factor in some ear infections. They conducted a study comparing the use of pacifiers and risk of ear infections. Results of the study, reported in the September issue of Pediatrics, suggest that limiting pacifier use can cut the number of ear infections by 29%.

Study author Marjo Niemelä, MD, PhD, tells WebMD that "although we thought that we would have to totally restrict pacifier use to see an effect, we discovered that by simply limiting the use of the pacifier to the brief period when the infant is falling asleep, one can reduce the episodes of otitis media."

Niemelä says, "We used a very simple intervention which was positive and was designed so that it didn't increase the parents' anxiety." She says that in Finland, "about 80% of babies use pacifiers until about age 2 or 3, so [pacifier use] is very common." Niemelä is an associate professor of pediatric infectious diseases at the University of Oulu in Finland.

The Finnish team advised parents of about 270 children that after the age of six months, pacifiers should only be used when the child is falling asleep. The parents were also told that pacifier use should be discontinued at 10 months. Parents of another group of more than 200 children were told to continue unrestricted pacifier use. All of the children were treated in state-run well-baby clinics and were followed until age 18 months.

Compared with children with unrestricted pacifier use, children in the first group decreased continuous pacifier use by 21% and had more than a one-fourth reduction in ear infections, Niemelä says. Overall, in both groups, children who were "never continuous users of pacifiers" had 33% fewer ear infections.

Niemelä tells WebMD she isn't advocating restricting all pacifier use. For example, among babies "six months old or younger, continuous use of a pacifier is not harmful." Therefore, she doesn't recommend advising parents of newborns to limit pacifier use.

Although makers of pacifiers often tout one design over another, Niemelä says she can't comment on the sales pitch. She says, "We didn't study pacifier design to determine if risk increased depending upon type of pacifier."

Many parents think the trick to safe pacifier use is cleanliness. Here again, Niemelä says that wasn't a factor in this study. She says it is unlikely that bacteria growing on the pacifier are the reason for the increased number of ear infections, although she says that bacteria do "grow very easily in pacifiers."

Robert C. Sprecher, MD, chief of the division of otolaryngology at Rainbow Babies and Children's Hospital in Cleveland, tells WebMD he is not convinced that pacifiers increase ear infections. He says, for example, that another likely explanation is that babies who are more susceptible to ear infections are fussier and thus more likely to "have a parent stick a pacifier in their mouths to calm them down. So what comes first? The pacifier or the otitis?"

Sprecher says that known risk factors for ear infections are "day care and a genetic predisposition. You can't do anything about genetics and it is difficult to keep children out of day care."

He adds, however, "One thing that can be done is to reduce exposure to secondhand smoke. I do tell parents this all the time: Don't smoke." He says the no smoking message is "probably more important than a warning about pacifier use [in preventing ear infections]."

Sprecher says that pacifier use is already associated with increased oral infections, and with dental problems. "For those reasons, I think it may be wise to encourage less use of pacifiers," he says. "But I'm not going to tell a mother to get rid of the pacifier to protect against ear infections."

The American Academy of Pediatrics, in its book for parents Caring for Your Baby and Your Child, Birth to Age 5, says this about pacifiers: "Pacifiers do not cause any medial or psychological problems. If your baby wants to suck beyond what nursing or bottle-feeding provides, a pacifier will satisfy that need."

Reviewed by Michael W. Smith, MD, April 2002