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Counseling Parents About Pacifier Use in Infants



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Am Fam Physician. 2001 Mar 1;63(5):947-948.

Pacifier use is associated with an increased risk of acute otitis media, oral candidiasis and dental caries. Niemelä and associates conducted a randomized, controlled trial in 14 well-baby clinics in Finland to determine if counseling parents about pacifier use was associated with a decrease in episodes of acute otitis media in infants.

Nurses who staffed the well-baby clinics were instructed about the harmful effects of pacifier use and asked to share this information with the parents of children 18 months or younger (see the accompanying table). Parents were also given a leaflet summarizing this information. The counseling sessions occurred at each well-baby visit. Parents of children in the control group (whose nurses received information about the epidemiology of infectious diseases) did not receive counseling about pacifier use. All parents were asked to complete a daily symptom sheet to record symptoms consistent with acute otitis media.

The children enrolled in the trial were followed for three to six months, depending on the date of recruitment. Information about previous episodes of acute otitis media, type of day care and signs and symptoms of allergies was also collected. Based on previous studies of the prevalence of pacifier use, the authors surmised that one half of the children in the intervention (counseling) group would develop acute otitis media; they hypothesized that the counseling would decrease this occurrence by one quarter. The use of pacifiers was classified as follows: none, only when falling asleep or continuously.

There were 272 children in the counseling group and 212 in the control group. The mean age of the children was eight months. About one third of the children had a history of acute otitis media. Pacifier use occurred in 79.0 percent of the intervention group and in 74.7 percent of the control group. At the end of the study, pacifiers were still being used by 68.0 percent of children in the intervention group and 66.5 percent of children in the control group. However, children in the intervention group were significantly less likely to be using the pacifier continuously than were those in the control group (35 percent versus 48 percent). Among children seven to 18 months of age, this represented a 21 percent decrease in the continuous use of a pacifier.

The incidence of acute otitis media was reduced by 29 percent in the group that received counseling. Continuous use of the pacifier was associated with a 33 percent higher rate of acute otitis media. Most of the parents seemed to appreciate the counseling about pacifier use, although 11 percent felt anxiety because they had not known of the adverse effects of pacifier use, 9 percent felt guilty and 7 percent were angry about the counseling.

Counseling Parents About Pacifier Use*

The use of a pacifier

Increases the incidence of acute otitis media

Increases the incidence of candidiasis of the mouth

Increases the incidence of caries

Increases the incidence of malocclusion

Thus, pacifier use

Can be free until six months of age

Should be limited to the moments when the child is falling asleep after six months of age

Should be terminated after 10 months of age


*—This information was given in a leaflet and in discussions with the clinical nurse during the prescheduled visit to the well-baby clinics.

Reprinted with permission from Niemelä M, Pihakari O, Pokka T, Uhari M, Uhari M. Pacifier as a risk factor for acute otitis media: a randomized, controlled trial of parental counseling. Pediatrics 2000;106:484.

Counseling Parents About Pacifier Use*

View Table

Counseling Parents About Pacifier Use*

The use of a pacifier

Increases the incidence of acute otitis media

Increases the incidence of candidiasis of the mouth

Increases the incidence of caries

Increases the incidence of malocclusion

Thus, pacifier use

Can be free until six months of age

Should be limited to the moments when the child is falling asleep after six months of age

Should be terminated after 10 months of age


*—This information was given in a leaflet and in discussions with the clinical nurse during the prescheduled visit to the well-baby clinics.

Reprinted with permission from Niemelä M, Pihakari O, Pokka T, Uhari M, Uhari M. Pacifier as a risk factor for acute otitis media: a randomized, controlled trial of parental counseling. Pediatrics 2000;106:484.

The authors conclude that offering supportive and encouraging recommendations about the use of pacifiers can reduce the occurrence of acute otitis media. Pacifier use is one of the easily modifiable risk factors for acute otitis media (as opposed to anatomic considerations or mode of day care), and anticipatory guidance of parents about pacifier use should occur.

Niemelä M, et al. Pacifier as a risk factor for acute otitis media: a randomized, controlled trial of parental counseling. Pediatrics. September 2000;106:483–8.


Copyright © 2001 by the American Academy of Family Physicians.
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