How Old Should Baby Be to Have Pacifier
Risks and Benefits of Pacifiers
Am Fam Doc. 2009 Apr fifteen;79(8):681-685.
Patient information: See related handout on pacifier use in infants, written by the authors of this article.
Article Sections
- Abstract
- Benefits
- Complications
- Arroyo to the Patient
- References
Physicians are often asked for guidance almost 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 risk of sudden baby death syndrome. Pacifiers have been studied and recommended for pain relief in newborns and infants undergoing common, minor procedures in the emergency department (e.1000., heel sticks, immunizations, venipuncture). The American Academy of Pediatrics recommends that parents consider offering pacifiers to infants one month and older at the onset of sleep to reduce the risk of sudden infant expiry syndrome. Potential complications of pacifier utilise, particularly with prolonged use, include a negative effect on breastfeeding, dental malocclusion, and otitis media. Adverse dental effects tin be evident later on two years of age, just mainly after 4 years. The American University of Family unit Physicians recommends that mothers be educated about pacifier use in the immediate postpartum period to avoid difficulties with breastfeeding. The American Academy of Pediatrics and the American Academy of Family Physicians recommend weaning children from pacifiers in the second six months of life to prevent otitis media. Pacifier use should not be actively discouraged and may exist especially beneficial in the first six months of life.
Nonnutritive sucking is a natural reflex for a fetus and newborn, commonly manifested by sucking the hands and fingers. The pacifier, as well referred to every bit a "dummy," has been used every bit a method for fulfilling this innate want.1 Historically, pacifiers were viewed every bit beneficial until the early on 1900s, when an anti-pacifier movement spread concerns that their apply led to poor hygiene and indulgent behavior.two At present, at that place are mixed opinions as to whether pacifier utilize is beneficial, yet roughly 75 to 85 percent of children in Western countries apply a pacifier.3 Table 1 summarizes the risks, benefits, and recommendations for pacifier use at diverse ages.4–11
SORT: Fundamental RECOMMENDATIONS FOR Do
| Clinical recommendation | Show rating | References | Comments |
|---|---|---|---|
| Pacifiers may be used to help relieve pain from minor procedures. | B | 4, 12–xix | About studies are small randomized controlled trials. |
| Pacifiers may be offered at the onset of sleep to reduce the take chances of sudden infant death syndrome. | B | half-dozen, 22 | Reference 22 is a meta-analysis of 7 case-controlled studies. |
| Pacifier use may be associated with early breast weaning or may exist a marker of breastfeeding difficulties; therefore, information technology should exist avoided until breastfeeding is well established. | B | 5, seven, 21, 23–26 | References 21 and 26 are randomized trials. |
| Although adverse dental effects may occur after 24 months of pacifier use, the effects are more significant after 48 months. Therefore, pacifier use should be discouraged after four years of historic period. | B | 10, xi, 30–32 | Reference 30 is a meta-analysis. |
| Pacifier use should exist stopped or limited in the 2d six months of life to reduce the run a risk of otitis media. | B | three, 8, ix | Reference iii is a randomized trial. |
Tabular array 1
Recommendations for Pacifier Use
| Age | Potential benefits | Potential complications | Recommendations |
|---|---|---|---|
| Preterm infants | Analgesia Decreased hospital stay, earlier transition to bottle feeding from enteral feeding, improved bottle feeding performance | — | AAP recommends pacifier use in infants up to six months of age to help prevent pain from minor procedures in the emergency department.4 AAP guideline on breastfeeding does not contradict pacifier use for oral preparation in preterm infants.five |
| Up to six months | Analgesia Reduced SIDS take chances | Early on breast weaning | AAP recommends pacifier utilize in infants up to 6 months of historic period for pain relief from minor procedures in the emergency section.4 AAP suggests offering pacifiers to infants at the onset of slumber to reduce the adventure of SIDS.6 AAP recommends avoiding pacifier apply until breastfeeding is well established (ordinarily past one month of age).5 AAFP recommends educating mothers near the effect of pacifier use on breastfeeding in the firsthand postpartum flow.7 |
| Six months to 2 years | — | Otitis media | AAFP/AAP joint guidelines recommend reducing or stopping pacifier use in the 2d six months of life to reduce the take chances of otitis media.8 ICSI recommends avoiding pacifier use subsequently 10 months of age.9 |
| Two years and older | — | Dental malocclusion (misalignment of the teeth, such as open bite, crossbite, or overjet) | ADA and AAPD recommend actively discouraging pacifier apply subsequently 4 years of age.10,xi |
Benefits
- Abstruse
- Benefits
- Complications
- Approach to the Patient
- References
ANALGESIA
Pacifiers provide a calming upshot and have been used for pain and anxiety prevention. A subgroup of the American University of Pediatrics (AAP) lists pacifiers as one of the key methods for pain relief in newborns and infants younger than six months undergoing minor procedures in the emergency department.4 A pocket-size corporeality of sucrose solution (ii mL) can exist given within two minutes of a procedure, lone or in combination with a nipple or pacifier; the combination appears to be more effective.12,13 Several studies of full-term and preterm newborns showed that pacifiers were superior to various sweet solutions,14–xvi whereas a study of very preterm newborns showed that pacifiers in combination with sweet solutions were no ameliorate than sugariness solutions lone.17 A more recent study confirmed that pacifier utilize reduces crying time in infants undergoing venipuncture in the emergency section, especially in those younger than three months.18 Pacifiers accept been studied or recommended by the AAP for utilise with the following procedures: catheterization, circumcision, heel sticks, immunizations, insertion of an intravenous line, lumbar puncture, screening for retinopathy of prematurity, and venipuncture.4,xiii,15,18,xix
PRETERM INFANTS
A Cochrane review found that nonnutritive sucking is associated with shorter hospital stays, earlier transition to bottle feeding from enteral feeding, and improved bottle feeding.xx Although the review did not show that pacifiers take a meaning impact on weight proceeds, behavior, energy intake, heart rate, oxygen saturation, intestinal transit time, or historic period at full oral feeds, none of the studies reported harmful effects from pacifier use. Overall, pacifier use appears to be a reasonable and inexpensive option for preterm infants.
SUDDEN Infant DEATH SYNDROME
AAP guidelines suggest offering pacifiers to infants at the onset of sleep to reduce the chance of sudden infant decease syndrome (SIDS).six The guidelines recommend not introducing pacifiers to breastfeeding infants until one month of age because after onset of pacifier use appears to have fewer negative effects on breastfeeding.21 Pacifiers should not be forced on the infant or reinserted during slumber if the infant spits it out. The verbal mechanism of benefit for reducing rates of SIDS is not fully understood, but pacifier apply may decrease the likelihood of rolling into the decumbent position, increase arousal, maintain airway patency, decrease gastroesophageal reflux and resultant sleep apnea, or increment respiratory bulldoze with carbon dioxide retention.22 A meta-analysis22 of 7 case-control studies demonstrated a strong association betwixt pacifier apply and a reduction in the risk of SIDS, estimating a number needed to care for of 2,733.
Complications
- Abstract
- Benefits
- Complications
- Approach to the Patient
- References
BREASTFEEDING
Observational studies23–25 and a randomized controlled trial (RCT)21 showing that pacifier use is associated with early on breast weaning have led to concerns. All the same, an RCT that studied the result of pacifier use on chest-feeding in 281 mother-baby pairs for three months postpartum had a dissimilar conclusion.26 Although an observational association was noted between pacifier utilise and early weaning, when the data were analyzed further, the intervention (communication to avert pacifier utilise) did not significantly reduce weaning at three months. The authors concluded that pacifier use may be a mark of breast-feeding difficulties, but does not appear to be the crusade of early weaning. The intervention group used pacifiers less often, but had no meaning deviation in crying or fussing, suggesting that other soothing methods are equally effective as pacifier utilize. A more contempo RCT on preterm infants did not demonstrate a meaning event of pacifier utilize on early weaning.27
Considering there is alien show most whether early utilise 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 well-nigh 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 use in preterm infants for oral training.5
DENTAL HEALTH
A systematic review plant inconsistent results regarding the effect of pacifier use on early childhood caries, suggesting that in that location is no proven correlation.29 A meta-analysis ended that pacifier apply after iii years of age is associated with a higher incidence of malocclusion.thirty In one study, 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 pct in those who ceased sucking betwixt 36 and 48 months, and 14 percent in those who ceased sucking before 24 months.31 The about significant malocclusions occurred in children who continued sucking habits beyond 48 months, simply there were notable changes in children who continued beyond 24 months. A more recent study confirms these negative dental effects with pacifier employ after two years of historic period.32
Studies comparing orthodontic and conventional pacifiers institute minor differences in malocclusion.33,34 The American Dental Clan and the American Academy of Pediatric Dentistry recommend that pacifier use exist discouraged later four years of age.10,xi
INFECTION
Several studies take shown that pacifiers are often colonized with Candida and bacterial organisms (typically nonpathogenic).35–37 One study institute 21 of twoscore pacifiers to take a positive civilisation finding, with none containing the common pathogens of otitis media.38 Latex pacifiers are more than significantly colonized with Candida and Staphylococcus than silicone pacifiers.36,39
A population-based written report of more than than 10,000 infants in the United Kingdom evaluated pacifier apply and finger sucking at xv months of age and their association with infection at 18 months of historic period.40 The 36 percent of infants who used a pacifier had a college incidence of earache and colic compared with the twoscore percent of infants who did non suck and the 21 percent of infants who sucked fingers. The two.seven percentage of infants who sucked both a pacifier and fingers had more than wheezing and earaches and poorer health in the month earlier the study. One explanation for the association between pacifier apply and illness may exist that pacifiers were used to at-home sick infants. A directly link between disease and blazon of sucking habit could not be determined from this study; more research is needed before recommendations can be made.40
A systematic review of epidemiologic studies found three studies that showed an association between pacifier use and infection, such equally otitis media, dental infection, and respiratory and gastrointestinal symptoms.41 These studies are too too limited to depict conclusions. Although some evidence exists for pacifier colonization with microorganisms, the direct clan betwixt these organisms and infection has not been proven.
OTITIS MEDIA
There are two proposed mechanisms for how pacifier apply could cause otitis media: reflux of nasopharyngeal secretions into the middle ear from sucking, and eustachian tube dysfunction from contradistinct dental structure.42 A meta-assay, including 22 studies from various countries, showed that pacifier apply increased the risk of developing otitis media, with a risk ratio (RR) of 1.24.43 Infants in mean solar day care exterior the home had an RR of two.45, those in family twenty-four hours intendance had an RR of 1.59, and those with a parent who smoked had an RR of 1.66. Breastfeeding reduced the chance of otitis media, with an RR of 0.87.
Ane widely cited, open, controlled cohort study of more than 400 patients evaluated the incidence of otitis media in infants whose parents were counseled to restrict pacifier use to when the infant was falling asleep. This counseling reduced continuous pacifier use by 21 per centum and led to 29 percent fewer episodes of otitis media in the intervention group.3 A more recent prospective cohort study from the Netherlands found that 35 percent of 216 children using pacifiers and 32 per centum of 260 children in the command group developed at to the lowest degree 1 episode of otitis media.42 However, rates of recurrent otitis media were college in the pacifier group (xvi versus 11 pct), leading the authors to conclude that pacifier utilize may increase the risk of recurrent otitis media.
AAFP/AAP joint guidelines on otitis media, which are based on evidence from cohort studies, recommend that physicians abet for little to no employ of pacifiers in the 2d six months of life to prevent otitis media.8 The Institute for Clinical Systems Improvement makes a similar recommendation, but suggests avoiding use by 10 months of age.9
Approach to the Patient
- Abstract
- Benefits
- Complications
- Approach to the Patient
- References
In addition to reviewing the risks and benefits of pacifiers, physicians should also counsel parents almost the safe use of pacifiers.44 Parents or caregivers should not put sweet substances on pacifiers to entice the infant. Pacifiers should be cleaned and replaced regularly to maintain good hygiene and avert mechanical hazards.6,45 Manufacturing standards from the U.Due south. Consumer Product Prophylactic Commission are bachelor at http://www.cpsc.gov/businfo/regsumpacifier.pdf, and pacifier recalls are available at http://www.cpsc.gov/cpscpub/prerel/prerel.html.
Pacifier use should no longer be actively discouraged and may be especially beneficial in the offset 6 months of life. However, the risks begin to outweigh the benefits around 6 to 10 months of age and announced to increase afterwards two years of age. Considering research suggests that limiting pacifier use does not significantly bear upon crying or fussing, physicians should be prepared to counsel parents about soothing alternatives and pacifier weaning. Physicians should be mindful that after vi months of age, pacifiers transform from a means of nonnutritive sucking to objects of affection that give the child a sense of security.3 Removing the pacifier can be a corking source of anxiety for children and parents. Cardinal 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 physician 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 evidence reports, Bandolier, Clinical Bear witness, the Cochrane database, Database of Abstracts of Reviews of Furnishings, the Institute for Clinical Systems Comeback, the National Guideline Clearinghouse database, the Trip database, and UpToDate were also searched.
REFERENCES
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14. Carbajal R, Chauvet X, Couderc Due south, Olivier-Martin M. Randomised trial of analgesic effects of sucrose, glucose, and pacifiers in term neonates. BMJ. 1999;319(7222):1393–1397.
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18. Curtis SJ, Jou H, Ali S, Vandermeer B, Klassen T. A randomized controlled trial of sucrose and/or pacifier as analgesia for infants receiving venipuncture in a pediatric emergency department. BMC Pediatr. 2007;seven:27.
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37. Mattos-Graner RO, de Moraes AB, Rontani RM, Birman EG. Relation of oral yeast infection in Brazilian infants and use of a pacifier ASDC J Dent Kid. 2001;68(1):33–3610.
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40. North Stone Yard, Fleming P, Golding J. Socio-demographic associations with digit and pacifier sucking at 15 months of age and possible associations with infant infection. Early Hum Dev. 2000;lx(2):137–148.
41. Joanna Briggs Institute. Early babyhood pacifier apply in relation to breastfeeding, SIDS, infection and dental malocclusion. Nurs Stand. 2006;20(38):52–55.
42. Rovers MM, Numans ME, Langenbach E, Grobbee DE, Verheij TJ, Schilder AG. Is pacifier apply a risk factor for acute otitis media? A dynamic cohort report. Fam Pract. 2008;25(4):233–236.
43. Uhari M, Mäntysaari Chiliad, Niemelä 1000. A meta-analytic review of the chance factors for acute otitis media. Clin Infect Dis. 1996;22(6):1079–1083.
44. Schwartz RH, Guthrie KL. Infant pacifiers: an overview. Clin Pediatr (Phila). 2008;47(4):327–331.
45. Neville HL, Huaco J, Vigoda M, Sola JE. Pacifier-induced bowel obstruction—non so soothing. J Pediatr Surg. 2008;43(2):e13–e15.
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