How Long Can a Baby Use a Pacifier
Risks and Benefits of Pacifiers
Am Fam Physician. 2009 Apr 15;79(8):681-685.
Patient data: See related handout on pacifier employ in infants, written past the authors of this article.
Commodity Sections
- Abstract
- Benefits
- Complications
- Approach to the Patient
- References
Physicians are oft asked for guidance about pacifier use in children, especially regarding the benefits and risks, and when to appropriately wean a child. The benefits of pacifier use include analgesic effects, shorter hospital stays for preterm infants, and a reduction in the adventure of sudden infant death syndrome. Pacifiers have been studied and recommended for pain relief in newborns and infants undergoing common, modest procedures in the emergency department (e.chiliad., heel sticks, immunizations, venipuncture). The American Academy of Pediatrics recommends that parents consider offering pacifiers to infants 1 month and older at the onset of sleep to reduce the take chances of sudden infant decease syndrome. Potential complications of pacifier use, particularly with prolonged use, include a negative effect on breastfeeding, dental malocclusion, and otitis media. Adverse dental effects tin can be evident after two years of age, but mainly later on 4 years. The American Academy of Family Physicians recommends that mothers be educated almost pacifier utilise in the immediate postpartum flow to avoid difficulties with breastfeeding. The American Academy of Pediatrics and the American University of Family unit Physicians recommend weaning children from pacifiers in the second half-dozen months of life to forestall otitis media. Pacifier utilise should not be actively discouraged and may be especially beneficial in the first vi months of life.
Nonnutritive sucking is a natural reflex for a fetus and newborn, usually manifested by sucking the easily and fingers. The pacifier, too referred to every bit a "dummy," has been used as a method for fulfilling this innate want.1 Historically, pacifiers were viewed every bit benign until the early on 1900s, when an anti-pacifier movement spread concerns that their employ led to poor hygiene and indulgent behavior.two Now, there are mixed opinions as to whether pacifier use is beneficial, yet roughly 75 to 85 percent of children in Western countries utilise a pacifier.3 Table 1 summarizes the risks, benefits, and recommendations for pacifier use at various ages.4–11
SORT: KEY RECOMMENDATIONS FOR Practice
| Clinical recommendation | Bear witness rating | References | Comments |
|---|---|---|---|
| Pacifiers may be used to help relieve pain from minor procedures. | B | 4, 12–xix | Well-nigh studies are small randomized controlled trials. |
| Pacifiers may be offered at the onset of sleep to reduce the risk of sudden babe death syndrome. | B | 6, 22 | Reference 22 is a meta-analysis of seven instance-controlled studies. |
| Pacifier use may be associated with early breast weaning or may be a marker of breastfeeding difficulties; therefore, it should be avoided until breastfeeding is well established. | B | five, seven, 21, 23–26 | References 21 and 26 are randomized trials. |
| Although adverse dental effects may occur after 24 months of pacifier utilize, the effects are more than pregnant later 48 months. Therefore, pacifier use should exist discouraged subsequently 4 years of age. | B | 10, 11, 30–32 | Reference xxx is a meta-assay. |
| Pacifier use should be stopped or limited in the second 6 months of life to reduce the adventure of otitis media. | B | 3, 8, 9 | Reference 3 is a randomized trial. |
Table 1
Recommendations for Pacifier Use
| Age | Potential benefits | Potential complications | Recommendations |
|---|---|---|---|
| Preterm infants | Analgesia Decreased hospital stay, before transition to bottle feeding from enteral feeding, improved bottle feeding performance | — | AAP recommends pacifier utilize in infants up to six months of age to help prevent hurting from small-scale procedures in the emergency department.4 AAP guideline on breastfeeding does not contradict pacifier use for oral training in preterm infants.five |
| Up to half-dozen months | Analgesia Reduced SIDS take chances | Early chest weaning | AAP recommends pacifier use in infants up to six months of age for hurting relief from minor procedures in the emergency department.iv AAP suggests offering pacifiers to infants at the onset of sleep to reduce the chance of SIDS.6 AAP recommends avoiding pacifier use until breastfeeding is well established (usually by i month of age).5 AAFP recommends educating mothers nearly the upshot of pacifier utilize on breastfeeding in the immediate postpartum period.7 |
| Six months to two years | — | Otitis media | AAFP/AAP joint guidelines recommend reducing or stopping pacifier use in the second 6 months of life to reduce the risk of otitis media.8 ICSI recommends fugitive pacifier utilise after 10 months of age.9 |
| Two years and older | — | Dental malocclusion (misalignment of the teeth, such equally open seize with teeth, crossbite, or overjet) | ADA and AAPD recommend actively discouraging pacifier employ after four years of historic period.ten,xi |
Benefits
- Abstract
- Benefits
- Complications
- Approach to the Patient
- References
ANALGESIA
Pacifiers provide a calming effect and have been used for pain and anxiety prevention. A subgroup of the American Academy of Pediatrics (AAP) lists pacifiers as one of the primal methods for pain relief in newborns and infants younger than six months undergoing pocket-sized procedures in the emergency department.4 A small amount of sucrose solution (2 mL) can be given within two minutes of a process, solitary or in combination with a nipple or pacifier; the combination appears to be more than effective.12,xiii Several studies of full-term and preterm newborns showed that pacifiers were superior to various sugariness solutions,fourteen–16 whereas a study of very preterm newborns showed that pacifiers in combination with sweet solutions were no improve than sweet solutions alone.17 A more recent written report confirmed that pacifier use reduces crying time in infants undergoing venipuncture in the emergency department, particularly in those younger than iii months.eighteen Pacifiers take been studied or recommended by the AAP for utilize with the following procedures: catheterization, circumcision, heel sticks, immunizations, insertion of an intravenous line, lumbar puncture, screening for retinopathy of prematurity, and venipuncture.4,13,15,18,19
PRETERM INFANTS
A Cochrane review plant that nonnutritive sucking is associated with shorter infirmary stays, earlier transition to bottle feeding from enteral feeding, and improved bottle feeding.20 Although the review did not show that pacifiers accept a significant affect on weight proceeds, behavior, energy intake, heart rate, oxygen saturation, abdominal transit time, or age at full oral feeds, none of the studies reported harmful effects from pacifier apply. Overall, pacifier utilize appears to be a reasonable and inexpensive option for preterm infants.
SUDDEN INFANT Expiry SYNDROME
AAP guidelines suggest offering pacifiers to infants at the onset of sleep to reduce the take a chance of sudden infant death syndrome (SIDS).6 The guidelines recommend non introducing pacifiers to breastfeeding infants until one month of historic period because later onset of pacifier use appears to take fewer negative effects on breastfeeding.21 Pacifiers should not exist forced on the infant or reinserted during sleep if the baby spits it out. The verbal mechanism of do good for reducing rates of SIDS is not fully understood, but pacifier use may decrease the likelihood of rolling into the prone position, increase arousal, maintain airway patency, decrease gastroesophageal reflux and resultant sleep apnea, or increment respiratory drive with carbon dioxide retention.22 A meta-analysis22 of 7 case-command studies demonstrated a strong clan between pacifier use and a reduction in the risk of SIDS, estimating a number needed to treat of 2,733.
Complications
- Abstruse
- Benefits
- Complications
- Arroyo to the Patient
- References
BREASTFEEDING
Observational studies23–25 and a randomized controlled trial (RCT)21 showing that pacifier use is associated with early breast weaning have led to concerns. Yet, an RCT that studied the effect of pacifier utilize on breast-feeding in 281 mother-babe pairs for three months postpartum had a unlike conclusion.26 Although an observational association was noted between pacifier use and early weaning, when the data were analyzed farther, the intervention (advice to avoid pacifier use) did not significantly reduce weaning at three months. The authors concluded that pacifier use may be a marker of breast-feeding difficulties, only does not appear to be the crusade of early weaning. The intervention group used pacifiers less oftentimes, but had no significant deviation in crying or fussing, suggesting that other soothing methods are as effective as pacifier utilise. A more recent RCT on preterm infants did not demonstrate a significant effect of pacifier use on early on weaning.27
Because there is conflicting evidence about whether early on apply of a pacifier disrupts breastfeeding or merely indicates other breastfeeding difficulties, guidelines are cautionary.28 The American Academy of Family Physicians (AAFP) recommends educating mothers about the risks of pacifier use in the immediate postpartum period.seven The AAP recommends postponing pacifier use until breastfeeding habits are well established; this recommendation does not contradict utilise in preterm infants for oral training.five
DENTAL HEALTH
A systematic review found inconsistent results regarding the consequence of pacifier employ on early childhood caries, suggesting that there is no proven correlation.29 A meta-analysis ended that pacifier utilize after three years of historic period is associated with a higher incidence of malocclusion.30 In one written report, the prevalence of malocclusion was roughly 71 percent in children who used a pacifier or sucked a digit for more than 48 months, compared with 32 per centum in those who ceased sucking between 36 and 48 months, and xiv percent in those who ceased sucking before 24 months.31 The nigh significant malocclusions occurred in children who continued sucking habits across 48 months, simply in that location were notable changes in children who continued beyond 24 months. A more recent study confirms these negative dental furnishings with pacifier use after two years of age.32
Studies comparing orthodontic and conventional pacifiers found minor differences in malocclusion.33,34 The American Dental Association and the American Academy of Pediatric Dentistry recommend that pacifier use exist discouraged after four years of age.10,11
INFECTION
Several studies have shown that pacifiers are often colonized with Candida and bacterial organisms (typically nonpathogenic).35–37 One study constitute 21 of 40 pacifiers to take a positive culture finding, with none containing the common pathogens of otitis media.38 Latex pacifiers are more significantly colonized with Candida and Staphylococcus than silicone pacifiers.36,39
A population-based study of more than 10,000 infants in the Great britain evaluated pacifier use and finger sucking at 15 months of historic period and their association with infection at 18 months of age.forty The 36 percent of infants who used a pacifier had a college incidence of earache and colic compared with the 40 percentage of infants who did not suck and the 21 percent of infants who sucked fingers. The 2.7 percent of infants who sucked both a pacifier and fingers had more wheezing and earaches and poorer wellness in the month before the written report. Ane explanation for the association betwixt pacifier employ and illness may exist that pacifiers were used to calm sick infants. A straight link between illness and type of sucking habit could not exist determined from this written report; more inquiry is needed before recommendations can exist fabricated.40
A systematic review of epidemiologic studies found 3 studies that showed an clan betwixt pacifier use and infection, such as otitis media, dental infection, and respiratory and gastrointestinal symptoms.41 These studies are likewise too limited to draw conclusions. Although some bear witness exists for pacifier colonization with microorganisms, the directly association between these organisms and infection has non been proven.
OTITIS MEDIA
There are two proposed mechanisms for how pacifier use could cause otitis media: reflux of nasopharyngeal secretions into the middle ear from sucking, and eustachian tube dysfunction from altered dental structure.42 A meta-analysis, including 22 studies from various countries, showed that pacifier use increased the risk of developing otitis media, with a run a risk ratio (RR) of 1.24.43 Infants in twenty-four hour period intendance exterior the home had an RR of 2.45, those in family unit twenty-four hour period care had an RR of 1.59, and those with a parent who smoked had an RR of one.66. Breastfeeding reduced the chance of otitis media, with an RR of 0.87.
One widely cited, open up, controlled cohort study of more than 400 patients evaluated the incidence of otitis media in infants whose parents were counseled to restrict pacifier employ to when the baby was falling asleep. This counseling reduced continuous pacifier utilize past 21 percent and led to 29 percentage fewer episodes of otitis media in the intervention group.three A more than recent prospective cohort report from the Netherlands plant that 35 percent of 216 children using pacifiers and 32 pct of 260 children in the control grouping developed at least one episode of otitis media.42 However, rates of recurrent otitis media were higher in the pacifier group (16 versus xi percent), leading the authors to conclude that pacifier use may increase the risk of recurrent otitis media.
AAFP/AAP articulation guidelines on otitis media, which are based on evidence from accomplice studies, recommend that physicians abet for little to no use of pacifiers in the 2d six months of life to forestall otitis media.viii The Establish for Clinical Systems Improvement makes a similar recommendation, just suggests avoiding utilize by ten months of age.9
Approach to the Patient
- Abstract
- Benefits
- Complications
- Arroyo to the Patient
- References
In add-on to reviewing the risks and benefits of pacifiers, physicians should likewise counsel parents about the prophylactic use of pacifiers.44 Parents or caregivers should not put sweet substances on pacifiers to entice the infant. Pacifiers should exist cleaned and replaced regularly to maintain skillful hygiene and avoid mechanical hazards.half dozen,45 Manufacturing standards from the U.S. Consumer Production Rubber Committee are available at http://www.cpsc.gov/businfo/regsumpacifier.pdf, and pacifier recalls are available at http://world wide web.cpsc.gov/cpscpub/prerel/prerel.html.
Pacifier apply should no longer exist actively discouraged and may be peculiarly benign in the first six months of life. Nonetheless, the risks begin to outweigh the benefits around six to 10 months of age and appear to increase afterward ii years of age. Considering inquiry suggests that limiting pacifier utilize does not significantly affect crying or fussing, physicians should be prepared to counsel parents about soothing alternatives and pacifier weaning. Physicians should be mindful that afterwards six months of historic period, pacifiers transform from a ways of nonnutritive sucking to objects of amore that give the child a sense of security.3 Removing the pacifier tin can be a neat source of anxiety for children and parents. Central alternatives to pacifier use in younger infants include swaddling, rocking, soft music, singing, and infant massage.46 Older infants or toddlers may be distracted from pacifiers with activities, toys, or other objects of affection. Some weaning methods that have been studied include doc or parent encouragement, putting unpalatable substances on the pacifier, and stopping the addiction abruptly.47
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Data Sources: A Medline search was completed using the key terms "pacifier," "dummy," and "soother." The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Agency for Healthcare Research and Quality testify reports, Bandolier, Clinical Evidence, the Cochrane database, Database of Abstracts of Reviews of Furnishings, the Constitute for Clinical Systems Comeback, the National Guideline Clearinghouse database, the Trip database, and UpToDate were also searched.
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4. Zempsky WT, Cravero JP, for the American Academy of Pediatrics. Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics. 2004;114(5):1348–1356.
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17. Carbajal R, Lenclen R, Gajdos V, Jugie 1000, Paupe A. Crossover trial of analgesic efficacy of glucose and pacifier in very preterm neonates during subcutaneous injections. Pediatrics. 2002;110(ii pt 1):389–393.
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How Long Can a Baby Use a Pacifier
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