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Pacifiers not as soothing as once thought


Pacifiers and ear infections linked

Pacifiers increase a baby's risk of ear infection according to recent data emerging from the Utrecht Health Project in The Netherlands. Researchers found pacifier use can be a risk factor for acute otitis media (AOM), a childhood middle ear infection.

"It seems to be related to pressure changes in the back of the throat, caused by constant sucking on the pacifier," explains Dr. Moshe Ipp, pediatrician at The Hospital for Sick Children (SickKids), and Professor of Pediatrics at the University of Toronto. Noting that the back of the throat and the middle ear are connected by the eustachian tube, Dr. Ipp believes these pressure changes propel secretions from the back of the throat into the middle ear.

The process is similar to the sensations felt in the ear when going up or down in a fast elevator. The ride causes pressure on the ear side of the eustachian tube to be different from the throat side of the tube. You can swallow, chew gum, or suck on a candy to equalize the pressure, feeling a 'pop' when that happens. When young children use pacifiers, the same pressure differences are set up. Instead of feeling a 'pop', secretions from the back of the throat are forced into the middle ear, through the eustachian tube, to equalize the pressure.


Ear Anatomy
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For a child who uses a pacifier and has a common cold, the pressure changes can help cold-causing pathogens move from the throat into the middle ear, creating infection. "Otitis media usually occurs following a respiratory tract infection and is very common, especially in young children," says Dr. Sheila Jacobson, paediatrician at SickKids and assistant Professor of Pediatrics at the University of Toronto. Respiratory tract infections, like the common cold, involve the nose, sinuses, and back of the throat.

The study tracked pacifier use in 476 children aged zero to four years over a five year period. Of the 216 children who used a pacifier, 35% developed at least one episode of AOM, and 16% developed recurrent AOM. In comparison, of the 260 children who did not use a pacifier, 32% developed at least one AOM episode, and only 11% developed recurrent AOM.  These results were no surprise to Dr. Jacobson. "Infants and young children who use pacifiers do appear to have an increased risk of otitis media, especially recurrent otitis media," she says, drawing from her own experience as a pediatrician.

Breastfeeding and Otitis Media

As conclusive as these results appear, there is more to the story.  It is known that breastfeeding has a protective effect on infants, reducing the likelihood of many infections. Although not using a pacifier does not automatically mean the child is breastfeeding, there is a close relationship between the two, making it unclear whether pacifier use, or not breastfeeding is the more important risk factor for infection.

Moreover, "pacifier use has been associated with earlier cessation of breastfeeding, and breastfeeding is protective because of the improved immunity it provides against infections," adds Jacobson.    

Pacifier use and not breastfeeding are not the only risk factors for ear infection. Changes in the eustachian tube, a family history of ear infections, and maternal smoking can also play a role.

"If a child attends daycare, it can increase the risk of infection," adds Ipp.

Advice for parents

Even though using a pacifier can have some harmful effects like yeast infections in the mouth, tooth decay, and crooked teeth, there is a bright side. "Pacifiers can be soothing to some infants, diminish crying, and even protect against sudden infant death syndrome," says Dr. Ipp, pointing out some of the benefits which are often overlooked.  "Ideally, babies should be weaned from a pacifier or a bottle around 15-18 months of age," he advises. "If it helps soothe the baby and the mother it is a good thing." 


Rovers MM, Numans ME, Langenbach E, Grobbee DE, Verheij TJ, Schilder AG.Is pacifier use a risk factor for acute otitis media? A dynamic cohort study. Family Practice 2008 Aug;25(4):233-6. Epub 2008 Jun 17