Researchers in The Netherlands found that recurrent ear infections occurred nearly twice as frequently in babies and young children who used dummies or pacifiers as those who did not and advised doctors to tell parents about the risks.

The study is published in the 17 June advanced online issue of the Family Practice journal and is the work of lead author Dr Maroeska Rovers of the Julius Center for Health Science and Primary Care, University Medical Center Utrecht, and colleagues.

Rovers and colleagues did the study because although recent research has shown a link between increased risk of acute otitis media (AOM, middle ear infection) and use of a pacifier or dummy, it has not been very reliable because of methodological limitations.

They conducted a five-year dynamic population study on 495 children between 0 and 4 years old living in Utrecht in The Netherlands. The children’s parents filled in questionnaires at the start of the study (baseline) about use of dummies or pacifiers. AOM ear infection was diagnosed by GPs using the International Classification of Primary Care coding system.

The results showed that:

  • Of the 216 children who were using a dummy or pacifier at the start of the study, 76 (35 per cent) had at least one episode of AOM, while 33 (16 per cent) had recurrent AOM.
  • Of the 260 children who did not use a pacifier, 82 (32 per cent) had at least one episode of AOM, while 27 (11 per cent) had recurrent AOM.
  • The adjusted risk (odds ratio) for dummy/pacifier use for at least one episode of AOM was 1.3 (30 per cent more often), while for recurrent AOM it was 1.9 (nearly twice as often).

Rovers and colleagues concluded that:

“Pacifier use appears to be a risk factor for recurrent AOM.”

They suggested that doctors tell parents of children with recurring AOM about the likelihood of it recurring more often if they allow their child to use a dummy or pacifier.

In a press statement reported by the BBC, Rovers said:

“Paediatricians and GPs can use this information in their daily practice – they can dissuade parents from using a pacifier [dummy] once their child has been diagnosed with acute otitis media to avoid recurrent episodes.”

Ear infections are the most common illness in babies and young children, and three out of four will have had otitis media (middle ear infection) by the age of 3, according to information from the US National Institutes of Health.

There are two main types of otitis media, acute otitis media or AOM, as researched in this study, and otitis media with effusion (fluid), or OME. AOM is where parts of the middle ear are infected and swollen, with fluid and mucus trapped in the ear. It can be very painful. OME is where the fluid and mucus stay trapped in the ear after the infection has subsided. This condition makes it harder for the ear to fight new infections and can also affect the child’s hearing.

Ear infections usually result from viruses or bacteria getting inside the ear and causing an infection, often as a result of another illness such as a cold.

When the ears are infected it affects the eustachian tubes and the adenoids, with both becoming swollen. Eustachian tubes keep the ears supplied with fresh air and they also keep air pressure stable inside the ear. The adenoids are near the eustachian tubes and help to fight infection.

Eustachian tubes are smaller in children, making it harder for the fluid that arises in infection, say from a cold, to drain out, which is why children are more prone to ear infection than adults. Also in children, the adenoids are larger, and more likely to block to eustachian tube when swollen.

Some researchers believe that being around cigarette smoke can also increase the risk of ear infections in children.

“Is pacifier use a risk factor for acute otitis media? A dynamic cohort study.”
Maroeska M Rovers , Mattijs E Numans , Esther Langenbach , Diederick E Grobbee , Theo J M Verheij , and Anne G M Schilder.
Family Practice, Advance Access published on June 17, 2008.
DOI 10.1093/fampra/cmn030.

Click here for Abstract.

Sources: Journal abstract, NIH, BBC News.

Written by: Catharine Paddock, PhD