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Pacifier as a risk factor for acute otitis media: A randomized, controlled trial of parental counseling
M Niemelä1, O Pihakari, T Pokka
1Department of Pediatrics, Division of Phoniatrics, University of Oulu, Oulu, Finland. marjon@cc.oulu.fi
Insights
Reducing pacifier use in infants under 18 months can significantly lower the incidence of acute otitis media (AOM). This intervention trial demonstrated that limiting pacifier use is a preventable strategy for reducing AOM episodes in children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Pacifier use is common in infants and young children.
- Acute otitis media (AOM) is a frequent childhood infection.
- The link between pacifier use and AOM requires further investigation.
Purpose of the Study:
- To evaluate the association between pacifier use and acute otitis media (AOM) occurrence.
- To assess the effectiveness of an intervention aimed at reducing pacifier use in young children.
- To determine if limiting pacifier use can prevent AOM episodes.
Main Methods:
- An open, controlled cohort study was conducted across fourteen well-baby clinics.
- Clinics were paired and randomly assigned to either an intervention or control group.
- Intervention involved instructing parents of children under 18 months to limit pacifier use.
Main Results:
- Continuous pacifier use decreased by 21% in the intervention group (P =.0001).
- The occurrence of AOM was 29% lower among children in the intervention clinics.
- Children not using pacifiers continuously experienced 33% fewer AOM episodes.
Conclusions:
- Pacifier use is identified as a preventable risk factor for AOM in children.
- Restricting pacifier use, particularly to sleep times, effectively prevented AOM episodes.
- Interventions to reduce pacifier use show promise in managing childhood ear infections.
Objectives:
To evaluate the association between pacifier use and the increased occurrence of acute otitis media (AOM) in an intervention trial.
Methods:
Fourteen well-baby clinics were selected to participate in an open, controlled cohort study. These clinics were paired according to the number of children and the social classes of the parents they served. One clinic in each pair was randomly allocated for an intervention, while the other served as a control. The nurses at the intervention clinics were trained to instruct the parents of children <18 months old to limit pacifier use during their prescheduled visits to the clinic. The intervention consisted of a leaflet explaining the harmful effects of pacifier use and instructions to restrict its use. Two hundred seventy-two children were successfully recruited from the intervention clinics and 212 from the control clinics. The data about pacifier use and the occurrence of respiratory infections and AOM were collected similarly in both groups.
Results:
After the intervention, a 21% decrease was achieved in continuous pacifier use at the age of 7 to 18 months (P =.0001), and the occurrence of AOM per person-months at risk was 29% lower among children at the intervention clinics. The children who did not use a pacifier continuously in either of the clinics had 33% fewer AOM episodes than the children who did.
Conclusion:
Pacifier use appeared to be a preventable risk factor for AOM in children. Its restriction to the moments when the child was falling asleep effectively prevented episodes of AOM.