Influence of potentially harmful sucking habits on otitis media in children: a systematic review and meta-analysis

This study aimed to evaluate the influence of pacifier use, bottle feeding, and finger/thumb sucking on the occurrence of otitis media in children. Searches were conducted in grey literature and six databases: Web of Science, Cochrane Library, LILACS, Scopus, MEDLINE/PubMed, and EMBASE, from inception through May 2025. Observational studies investigating the association between harmful sucking habits and otitis media in newborns, infants, preschoolers, and older children were included. Risk of bias was assessed using the Joanna Briggs Institute tool. Meta-analysis results were reported as odds ratios (ORs) with 95% confidence intervals (CIs), and the certainty of evidence was also evaluated. A total of 36 studies were included, most of which were cohort studies (n = 14), with sample sizes ranging from 46 to 35,613. Eleven studies were incorporated into meta-analyses. Children who used a pacifier were 1.17 times more likely to develop otitis media (95%CI: 1.00-1.33) and 1.54 times more likely to develop acute otitis media (95%CI: 1.01-2.36) compared to those who did not use a pacifier. No significant association was found between bottle feeding and otitis media (OR = 0.83; 95%CI: 0.59-1.17). Most studies did not report a significant association between finger or thumb sucking and otitis media. The certainty of evidence was rated as very low. These findings suggest that pacifier use may increase the likelihood of developing otitis media, particularly acute otitis media, with potentially relevant implications.