ArticleLiterature Review

Risks and Benefits of Pacifiers

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Abstract

Physicians are often 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 risk of sudden infant death syndrome. Pacifiers have been studied and recommended for pain relief in newborns and infants undergoing common, minor procedures in the emergency department (e.g., 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 death syndrome. Potential complications of pacifier use, particularly with prolonged use, include a negative effect on breastfeeding, dental malocclusion, and otitis media. Adverse dental effects can be evident after two years of age, but mainly after four years. The American Academy of Family 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 be especially beneficial in the first six months of life.

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... Non-nutritive breastfeeding is stimulated with a gloved finger, a pacifier, or a nipple that is not producing milk. It is used during tube feeding and transition from tube feeding to oral feeding and is only recommended in the first 6 months of life [8]. It is defined as any "blind" repetitive activity on the nipple or nursing by the infant with a nipple that does not yield a wet stimulus [9]. ...
... Median length of hospital stay (days) was 20 in the intervention group and 32 (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) in the control group (p=0.210), time to complete oral feeding was 4 (3)(4)(5)(6)(7)(8)(9)(10)(11) in the intervention group and 8 (7)(8)(9)(10)(11)(12)(13) in the control group (p=0.003). Full breastfeeding at discharge was achieved in 33 neonates (89.2%) in the intervention group and in 34 neonates (91.9%) in the control group (p=1.000), with no statistically significant differences between groups. ...
... Median length of hospital stay (days) was 20 in the intervention group and 32 (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) in the control group (p=0.210), time to complete oral feeding was 4 (3)(4)(5)(6)(7)(8)(9)(10)(11) in the intervention group and 8 (7)(8)(9)(10)(11)(12)(13) in the control group (p=0.003). Full breastfeeding at discharge was achieved in 33 neonates (89.2%) in the intervention group and in 34 neonates (91.9%) in the control group (p=1.000), with no statistically significant differences between groups. ...
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Introduction: Preterm infants are necessary to acquire safe and effective feeding skills as they are born without developed suck-swallow-respiration coordination skills. Various methods are used in premature infants in order to improve sucking skills and transit from gavage feeding to full oral feeding or breastfeeding safer and faster. Aim: To research and evaluate all methods by which a premature infant will transit to oral feeding, as well as to report problems that is going to happen during the transition. Methodology: A review of the literature was conducted in PubMed database from January 2022 to March 2022. The criteria for entering the review were the following: primary research studies, the language should be either English or Greek, the article should be published between 01/01/2012 to 31/12/2021 and studies that refer to preterm infants. The sort was done using the PRISMA 2009 method. Results: A search in electronic database PubMed, applying specific eligibility criteria, resulted in 159 articles. Through identification, screening and eligibility procedures, resulted in 20 articles. The methods that identified were nonnutritive sucking with either a pacifier, the mother’s breast, or a pacifier connected to a music player that heard the mother’s voice, oro-motor stimulation, a combination of nonnutritive sucking oro-motor stimulation, responsive feeding to neonatal signs, cup and probiotics. Conclusions: All these methods lead to earlier full oral feeding, reduce the length of hospital stay, and cause fewer side effects.
... Pacifiers (also known as dummies or soothers), commonly used in infancy and recommended in the United States, 9,10 are another source of microbial exposure in early life. [9][10][11] A Swedish birth cohort found potential benefits of shared microbial exposure as infants whose parents sucked their pacifier (ie, used their own mouth to clean it) had reduced food sensitization, asthma, and eczema at 18 months compared with infants whose parents used other cleaning methods. ...
... Pacifiers (also known as dummies or soothers), commonly used in infancy and recommended in the United States, 9,10 are another source of microbial exposure in early life. [9][10][11] A Swedish birth cohort found potential benefits of shared microbial exposure as infants whose parents sucked their pacifier (ie, used their own mouth to clean it) had reduced food sensitization, asthma, and eczema at 18 months compared with infants whose parents used other cleaning methods. 12 Another cohort study identified lower total IgE levels in children from 10 to 18 months if mothers reported sucking the infants' pacifier (n 5 9 of 74) at 6 months compared with not sucking their pacifier. ...
... In Australia, pacifier use is not actively encouraged or discouraged; rather, it is suggested each family does what suits it best; however, its use is recommended in the United States from 1 month onward to prevent sudden infant death syndrome. 10,11,31,32 Importantly, pacifier use has not been shown to affect breast-feeding duration. 33 Although maintaining appropriate sterilization of pacifiers (technique unspecified) is recommended by Raising Children's Network in Australia until 6 months to protect infants from infection, 32 we believe guidelines on pacifier use should consider the evidence on associated sterilization techniques, including the findings from this report. ...
Article
Background Environmental microbial exposure plays a role in immune system development and susceptibility to food allergy. Objective We sought to investigate whether infant pacifier use during the first postnatal year, with further consideration of sanitization, alters the risk of food allergy by age 1 year. Methods The birth cohort recruited pregnant mothers at under 28 weeks’ gestation in southeast Australia, with 894 families followed up when infants turned 1 year. Infants were excluded if born under 32 weeks, with a serious illness, major congenital malformation, or genetic disease. Questionnaire data, collected at recruitment and infant ages 1, 6, and 12 months, included pacifier use and pacifier sanitization (defined as the joint exposure of a pacifier and cleaning methods). Challenge-proven food allergy was assessed at 12 months. Results Any pacifier use at 6 months was associated with food allergy (adjusted odds ratio, 1.94; 95% CI, 1.04-3.61), but not pacifier use at other ages. This overall association was driven by the joint exposure of pacifier-antiseptic use (adjusted odds ratio, 4.83; 95% CI, 1.10-21.18) compared with no pacifier use. Using pacifiers without antiseptic at 6 months was not associated with food allergy. Among pacifier users, antiseptic cleaning was still associated with food allergy (adjusted odds ratio, 3.56; 95% CI, 1.18-10.77) compared with no antiseptic use. Furthermore, persistent and repeated antiseptic use over the first 6 months was associated with higher food allergy risk (P = .029). Conclusions This is the first report of a pacifier-antiseptic combination being associated with a higher risk of subsequent food allergy. Future work should investigate underlying biological pathways.
... They are commonly used across the globe for their various perceived benefits, while avoided in other parts for their risks and negative associations. The use of 1 2 3 1 1 pacifiers is widespread in various communities as a means of soothing and relaxing the baby, relieving pain by functioning as an analgesic, and satisfying the baby's innate non-nutritive suckling (NNS) response [2]. In addition, a meta-analysis has revealed the beneficial effect of pacifiers in shortening the duration of hospital stay in preterm infants [3]. ...
... These include increasing the risk for the development of otitis media, possible disruption of breastfeeding, and the development of nipple confusion and teeth malocclusion in certain cases [6]. It has been suggested that pacifier use can cause otitis media through Eustachian tube dysfunction and the reflux of nasopharyngeal secretions into the middle ear [2,6]. In one study, it was demonstrated that pacifier use resulted in a reduced frequency of breastfeeding by 26% [7]. ...
... Cases of latex allergy have also been reported with the use of pacifiers [8]. Furthermore, they are also an important source of infection as they are home to many microorganisms [2]. ...
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Background Pacifier use has been popular for ages. They are prevalent all over the world because of their various perceived benefits. On the other hand, there is a common belief that they do carry health risks as well. Due to these contradicting belief systems, the frequency of their use, and the factors that determine them, need to be thoroughly evaluated. Since Pakistan is a developing country with a low literacy rate, it can be implied that a vast majority of the country’s population may lack awareness regarding the advantages and disadvantages of pacifier use, making them incapable of weighing associated risks versus benefits. The data evaluating these factors in this region are however scarce in the published literature. We, therefore, aimed to highlight the frequency and predictors of pacifier use in the low socioeconomic group of Karachi, Pakistan. Materials and methods A descriptive, cross-sectional study was conducted on a sample of 300 mothers visiting a tertiary care hospital in Karachi, Pakistan. We included mothers who had at least one child under the age of two years, and whose child did not have any oro-nasal anomaly that could prevent them from sucking a pacifier. Data were collected using pre-tested questionnaires and analyzed using the Statistical Package for Social Sciences (SPSS version 23.0, IBM Corp., Armonk, NY, US). Frequencies were calculated and presented in the form of tables. The chi-square test was used to determine the significance of all categorical variables. A P-value of <0.05 was considered to be statistically significant. Results Almost half of our respondents (49%) gave pacifiers to their children. A significant number (59%) of these mothers were uneducated. Almost all (97%) of the users had annual household income less than 15,000 Pakistani rupees (PKR); 34% were primiparous and more than two-thirds (71%) had a normal vaginal delivery. Out of all the factors, maternal age less than 20, annual household income less than 15,000 PKR, and primiparity were significantly associated with pacifier use in mothers (P<0.05). Only a half of the users (51%) cleaned the pacifiers by boiling; one-fourth (25%) washed it with water only; while 18% washed it with soap and water. The majority (84%) of the mothers used the pacifier to soothe the baby when upset. Among mothers who did not use a pacifier, about a third (30%) did not do so as they believed it’s a bad practice. About one-fourth (27%) believed it was unhygienic. Conclusions Our study highlights the gap in the awareness of mothers regarding pacifier use. Using this data, we can target to disseminate specific information to this population to integrate safe and healthy child care habits in society.
... Los hábitos pueden alterar el normal desarrollo del sistema estomatognático produciendo un desequilibrio entre las fuerzas musculares externas y las internas lo que trae como consecuencia una deformación ósea. (1)(2)(3)(4) La succión digital se ha descrito como un hábito común en la infancia que se considera como normal hasta la edad de los 3 o 4 años. (4) Aunque la mayoría de los niños que succionan el pulgar interrumpen esta costumbre hacia los 2,5-3 años, en algunos casos este hábito permanece hasta edades entre los 6 y 12 años. ...
... (1)(2)(3)(4) La succión digital se ha descrito como un hábito común en la infancia que se considera como normal hasta la edad de los 3 o 4 años. (4) Aunque la mayoría de los niños que succionan el pulgar interrumpen esta costumbre hacia los 2,5-3 años, en algunos casos este hábito permanece hasta edades entre los 6 y 12 años. La presencia del mismo después de los 4 años genera cambios en la tonicidad muscular de labios y bucinadores, dificulta la deglución normal y crea mecanismos nocivos que llevan a desarrollar una actividad muscular de compensación para lograr la deglución, lo cual también puede afectar otras funciones como la fonación y la respiración entre otras. ...
... La presencia del mismo después de los 4 años genera cambios en la tonicidad muscular de labios y bucinadores, dificulta la deglución normal y crea mecanismos nocivos que llevan a desarrollar una actividad muscular de compensación para lograr la deglución, lo cual también puede afectar otras funciones como la fonación y la respiración entre otras. (1,(4)(5)(6) El hábito de succión digital, afecta tanto la estética como la función, provocando desplazamientos de los dientes superiores hacia delante, los inferiores hacia atrás y en muchos casos origina mordida abierta que, pueden llegar hasta colapso maxilar y en consecuencia mordida cruzada posterior. (5) Es importante eliminar el hábito de forma eficaz y temprana, de manera que las alteraciones que se hayan podido producir como consecuencia del mismo tiendan a desaparecer espontáneamente; pero además identificar la causa de ese hábito para prevenir una recidiva. ...
Article
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Introduction: buccal habits may alter the stomatognathic system normal development; provoke disequilibrium among the muscular forces and cause deformation. These habits modify teeth position, the relation and form the dental arches keep between them, interfering in the normal grow and function of the buccal-facial muscles. The purpose of this term is identifying children affected by non-nutritive habits practices and their relation with dental malocclusion presence. Method: we carried out a cross sectional descriptive research in children aged 5-11 years, assisting to primary schools located in the health area of the Milanes policlinic, in Matanzas. The universe was formed by 2 300 children from which we selected an age-stratified, non-randomized sample of 506 male and female students assisting to Jose A. Echeverría and Manuel Ascunce Domenech primary schools, 2005-2006 school years, treated at the Teaching Stomatologic Clinic “III Congreso del PCC”. We identified the following habits: buccal breathing, digital suction and atypical swallowing, and we determined their relation with dental malocclusions. Results: 58,7 % of the children practiced deforming buccal habits. Atypical swallowing showed the highest prevalence (25,3 %), followed by buccal breathing (19, 4 %) and digital suction (14,0 %). Class II, division 1 malocclusions predominated in the children identified with deforming habits, and their values were: 34,7 %. 39,4 % and 32 % in those practicing buccal breathing, digital suction and atypical swallowing, in that order. There it was a progressive habit decrease proportional to age increase. Conclusions: most of the children identified with buccal deforming habits were related with the presence of dental malocclusions. In them, the anomalies increased with age. Class II, division 1 malocclusions prevailed over the rest of the studied clinical entities. This fact warns us about the necessity of preventing these harmful practices in early ages, and demanding the fulfillment of the dental-facial anomalies prevention and interception program at the primary health care level.
... Otro reporte es la reducción de la estancia hospitalaria y por ende los costos de hospitalización. [8][9][10] Por las razones antes expuestas, el personal médico debe tener conocimiento sobre el beneficio de utilizar la succión no nutritiva como parte del programa de estimulación temprana y además involucrar a la familia, de tal manera que se les oriente e informe sobre el papel que juega el uso de succión no nutritiva. ...
... Finalmente, reduce la estancia hospitalaria y sus costos. [8][9][10]12,13 Fase faríngea Ésta consiste en la deglución de la leche y sucede cuando hay suficiente cantidad en la cavidad oral y se activa el centro de la deglución. El líquido es empujado hacia atrás cuando la lengua se contrae y sube hacia el paladar forzándolo hacia la orofaringe; este proceso estimula los corpúsculos sensoriales en las fauces y en la pared faríngea. ...
... Por otro lado, se menciona que el recién nacido puede modular experiencias agresivas por sí mismo y de manera eficaz, a través de conductas de autoconsuelo, tales como la succión. 8,9,22 El chupón se menciona por primera vez en la literatura médica a finales del siglo XV por Metlinger (1473), sin embargo su historia se remonta a miles de años atrás, ya que en los textos antiguos de Sorano (siglo II) y Oribasio (siglo IV), se menciona que los objetos con azúcar o miel servían para calmar a los recién nacidos. 13 La técnica utilizada para ofrecer al recién nacido succión no nutritiva es mediante el estímulo de reflejo de búsqueda, al introducir el pezón o el chupón conjuntamente con la sonda, manteniendo la posición de semisentado con la cabeza en la línea media y brazos flexionados. ...
Article
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A literature review was conducted to determine the effectiveness of non-nutritive sucking in preterm infants as part of daily care in order to improve the quality of life, thereby avoiding possible motor impairment, cognitive and social future stages of development and assisting in the speedy recovery of the hospitalized infant. Also establish and define the intervention of medical personnel and to inform and educate parents about the usefulness of using non-nutritive sucking. Search was conducted in MEDLINE and EMBASE, including those articles published in the last 6 years. Based on available evidence, non nutritive sucking preterm infants have clinical benefit (significantly reducing the duration of hospital stay in preterm infants and quick transition orogastric tube to bottle feeds and better performance bottle-feeding) and seem to have no negative effect in the short term.
... We discuss the literature dealing with the development of sucking during the fetal period; background to the BFHI; and the expansion of the Ten Steps as presented by Nyqvist et al [8]. We also discuss the value of NNS and presumed risks associated with pacifier use, and we conclude with recommendations for pacifier use as presented by Sexton and Natale [11] and the AAP [12]. Our paper adds to the knowledge base by providing arguments and evidence that allow clinicians to make informed decisions on appropriate circumstances for the use of pacifiers, and by outlining a scientific and evidence-based clinical guide for pacifier use. ...
... Accelerated maturation and improved pain management can be classified as neurological benefits. The use of NNS in conjunction with a sweet substance, such as expressed breast milk or sucrose, for managing pain during painful procedures and interventions such as immunizations [19,22], and heel pricks [23] are often underutilized, especially in preterm infants and full term infants up to six months [11]. In addition, the benefits of NNS specifically for immature preterm infants are even more far reaching. ...
... It protects the infant against aspiration, since suck inhibits swallowing, and in tube-fed infants it contributes to accelerated maturation, which in turn contributes to faster transition from tube to oral feeds [4,24]. All these benefits lead to greater weight gain and, in the hospitalized infant, to earlier discharge [11,19,24]. ...
Article
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Background: The use of pacifiers is an ancient practice, but often becomes a point of debate when parents and professionals aim to protect and promote breastfeeding as most appropriately for nurturing infants. We discuss the current literature available on pacifier use to enable critical decision-making regarding justifiable use of pacifiers, especially in the Baby-Friendly Hospital Initiative context, and we provide practical guidelines for clinicians. Discussion: Suck-swallow-breathe coordination is an important skill that every newborn must acquire for feeding success. In most cases the development and maintenance of the sucking reflex is not a problem, but sometimes the skill may be compromised due to factors such as mother–infant separation or medical conditions. In such situations the use of pacifiers can be considered therapeutic and even provide medical benefits to infants, including reducing the risk of sudden infant death syndrome. The argument opposing pacifier use, however, is based on potential risks such as nipple confusion and early cessation of breastfeeding. The Ten Steps to Successful Breastfeeding as embedded in the Baby-Friendly Hospital Initiative initially prohibited the use of pacifiers in a breastfeeding friendly environment to prevent potential associated risks. This article provides a summary of the evidence on the benefits of non-nutritive sucking, risks associated with pacifier use, an identification of the implications regarded as ‘justifiable’ in the clinical use of pacifiers and a comprehensive discussion to support the recommendations for safe pacifier use in healthy, full-term, and ill and preterm infants. Summary: The use of pacifiers is justifiable in certain situations and will support breastfeeding rather than interfere with it. Justifiable conditions have been identified as: low-birth weight and premature infants; infants at risk for hypoglyceamia; infants in need of oral stimulation to develop, maintain and mature the sucking reflex in preterm infants; and the achievement of neurobehavioural organisation. Medical benefits associated with the use of pacifiers include providing comfort, contributing towards neurobehavioural organisation, and reducing the risk of sudden infant death syndrome. Guidelines are presented for assessing and guiding safe pacifier use, for specific design to ensure safety, and for cessation of use to ensure normal childhood development. Keywords: Breastfeeding, Pacifier, Baby-friendly hospital initiative, Clinician’s guide, Neonatal intensive care unit, Pacifierrisks, Justifiable pacifier use, Recommendations for pacifier use
... Yapılan çalışmalarda parafonksiyonel oral alışkanlıkların çocuklarda yaygın olarak görüldüğü, bazılarının yetişkinlik döneminde de devam ettiği, ağız sağlığı ile ilgili sorunlar, diş gıcırdatma ve sigara içme gibi durumlarla ilişkisinin olduğu bildirilmektedir (9,10). Küçük çocuklarda parafonksiyonel oral davranışların, örneğin emzik emmenin sakinleştirici etkisine benzeyen etkilerle sigaraya başlama ya da içmeye katkı sağladığı, anlık olarak rahatlama ve stresi azaltma etkisinin olduğu bildirilmiştir (11). ...
... Uzun süreli emzik kullanımı (24 aydan fazla) ile sigara içme arasında anlamlı bir ilişki olduğu, emzik kullanımın yerine yeterli emzirmenin sigaraya karşı koruyucu bir faktör olduğu bulunmuştur (24). Küçük çocuklarda emzik emmenin sakinleştirici etkisine benzer bir etki ile sigara içmenin ergenlerde rahatlama ve stres atma ile ilişkili etkiler sağladığı bildirilmiştir (10,11). Oral parafonksiyonel davranışlar çocuklar ve gençler arasında yaygınlık gösterse de gündelik hayat içinde varlığı pek dikkat çekmemektedir. ...
Article
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Amaç: Bu araştırma ile bir devlet üniversitesinin hemşirelik öğrencilerinin parafonksiyonel oral alışkanlıkları ve bağımlı kişilik özelliğinin sigara içme durumlarına etkisini incelemek amaçlanmıştır. Gereç ve Yöntem: Karşılaştırmalı tanımlayıcı tipte olan araştırmaya hemşirelik bölümünde okuyan 360 gönüllü öğrenci katılmıştır. Veriler sosyodemografik bilgileri, parafonksiyonel oral alışkanlıkları ve sigara içme ile ilgili özellikleri içeren Tanıtıcı Anket Formu ve Kişilik İnancı Ölçeği Kısa Formunun bağımlı kişilik için olan bölümü kullanılarak, Kasım-Aralık 2020’de toplanmıştır. Verilerin analizinde tanımlayıcı istatistikler, ki-kare testleri ve lojistik regresyon analizi kullanılmıştır. Bulgular: Araştırmada öğrencilerin %18,1’nin sigara içtiği; erkek, 20 yaş üstü, dördüncü sınıf, ilçede yaşama ve zayıf-normal kilolu olmanın sigara içmeyi etkilediği; dudak ısırma, kürdanı ağızda tutma, tırnak yeme, tırnak etlerini koparma ve kalemi ağıza alma alışkanlıklarının sigara içenlerde anlamlı düzeyde yüksek olduğu; bağımlı kişilik özelliği ve parafonksiyonel oral alışkanlıkların sigara içmenin %13’ünü açıkladığı ve tırnak yemenin sigara içmeyi 2,68 kat arttırdığı saptanmıştır. Sonuç: Bu alışkanlıklar, kişilik özellikleri ve sigara içme arasındaki ilişkiyi inceleyen kontrollü boylamsal çalışmalar önerilmektedir.
... Non-nutritive sucking habits (NNSB), such as pacifier use and thumb-sucking, are generally engaged by infants in response to frustration and to satisfy their urge and need for contact (1). It has been suggested positive effects of the use of pacifier as a nonpharmacological intervention in the management of acutely painful procedures in infants (2,3). Research has also demonstrated that pacifiers are associated with protection of sudden infant death syndrome (4). ...
... Research has also demonstrated that pacifiers are associated with protection of sudden infant death syndrome (4). However, potential complications of non-nutritive sucking habits include early weaning, increase the likeliness of otitis media, malocclusion and undesirable dental arch traits at the end of the primary dentition (2,5,6). Many studies showed that persistence of these habits beyond 2 or 3 years of age considerably increases the probability of developing orthodontic problems, including anterior open bite, increased overjet, posterior crossbite and long facial height (7). ...
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It is well recognized that pacifier habit leads to occlusal and orofacial functional changes in children. However, the effects of the interruption of prolonged pacifier habit on the development of the dento-facial complex has not yet been fully characterized. Thus, the aim of this study was to investigate the influence of pacifier removal on aspects of oro-dentofacial morphology and function in preschool children. For that, a pacifier group ( n = 28) and a control group ( n = 32) of 4-year-old children with and without pacifier habit, respectively, were followed up by a group of dentists and speech therapists at baseline, 6 and 12 months after habit removal. Bite force and lip pressure were assessed using digital systems, and the evaluation of breathing and speech functions was performed using validated protocols, together with the measurements of dental casts and facial anthropometry. The Two-way mixed model ANOVA was used in data analysis. After 12 months, a decrease in malocclusion frequency was observed in pacifier group. Additionally, a change over time was observed in facial, intermolar and palate depth measurements, as well in bite and lip forces and speech function scores, increasing in both groups ( p < 0.01). The upper and lower intercanine widths and breathing scores differed between groups at baseline and changed over time reducing the differences. The presence of speech distortions was more frequent in the pacifier group at baseline and decreased over time ( p < 0.05). The interruption of pacifier habit improved the maxillary and mandibular intercanine widths, as well as the breathing and speech functions, overcoming the oro-dentofacial changes found. Trial Registration: This clinical trial was registered in the Brazilian Clinical Trials Registry (ReBEC; http://www.ensaiosclinicos.gov.br/ ), protocol no. RBR-728MJ2.
... Non-nutritive sucking evidences to enhance an infant's preparedness to initiate oral feeding (2) . Thumb sucking and pacifier are two distinct forms of non-nutritive sucking patterns in which no food supply is introduced (3) . Pacifiers are non-nutritive sucking tools that are recommended to calm newborns and infants who subjected to common minor painful procedures like immunization, heel sticks and venipuncture. ...
... Mothers who have difficulties in breastfeeding use pacifiers as an effective weaning technique (5) . Prolonged use of pacifier has a negative impact on breast feeding, dental occlusion and may predispose to otitis media (6,3,7) . Thumb sucking is a habit that is expected to occur in a large percentage of infants. ...
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Background: Non-nutritive sucking habit (NNSH) is the main environmental causative factor that disturbs normal orofacial development. In spite of the harmful effect of pacifier as a NNSH, mothers aware from the other types of NNSH like thumb sucking far more than pacifier use. Open bite is one of the most challenging malocclusions in orthodontics due to the high prevalence of relapse after treatment, so preventing the causative factor of its occurrence is essential at early age of child life. This study aims to assess the impact of two non-nutritive patterns on the development of anterior open bite in primary dentition and to compare which of these habits mostly affect open bite development. Materials and Methods: The sample consisted of 313 Iraqi children (135 boys, 178 girls), aged 3-5 years, enrolled at two public kindergartens in Baghdad city, the Capital of Iraq. A pre-tested questionnaire with clinical examination were used to obtain data regarding thumb sucking, pacifier and the presence of open bite. Excel sheets were used for data processing, and Chi square test was used in data analysis. Results: There was a significant association between NNSH and the development of open bite (p value = 0.01). No gender differences in open bite prevalence were observed. The prevalence of non-nutritive sucking habits and open bite was 63.11% and 52.9% respectively with no gender difference. There was no significant differences between the effect of pacifier and thumb sucking habits on the development of an anterior open bite. Conclusion: Both pacifier and thumb sucking at preschool age are significant causative factors that lead to development of open bite in primary dentition. Encouraging mothers to ban and discontinue pacifier and thumb sucking habits as early as possible in the child's life is a crucial factor to prevent open bite development. On the other hand if general health of the child indicates the use of pacifier, mothers should use an orthodontic pacifier and for short time
... 4 The benefits of its use are also documented in preterm infants regarding an improved earlier transition from enteral to bottle feeding. 7 The American Academy of Pediatrics guidelines suggest offering infants pacifiers at the onset of sleep to reduce SIDS risk. 6 Although the exact mechanism underlying reduction in SIDS rates is not fully understood, pacifier use may decrease the likelihood of rolling into prone position, increase arousal, and maintain airway patency. ...
... 16 The joint recommendations of the American Academy of Family Physicians/American Academy of Pediatrics are based on the previous studies by Niemela, Uhari, and Rovers. 3,18,20 These guidelines recommend reducing or stopping pacifier use in the second six months of life to reduce otitis media risk (SORT B). 7,25 In 2014, the Portuguese Health Authority (DGS) issued recommendations about AOM diagnosis and treatment in pediatric age, with pacifier use identified as one of the risk factors for AOM in healthy children. 26 ...
Article
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Introduction: Sucking reflex is acknowledged as a comforting mechanism for infants. When used for short periods of time, it is considered a healthy habit. Acute otitis media is one of the most frequent infections in pediatric age and has been associated with pacifier misuse. Objectives: To review available evidence regarding the association between pacifier use in the first years of life and otitis media risk. Methods: A literature search was conducted on several databases using MeSH terms “otitis” and “pacifiers” for guidelines, systematic reviews, randomized controlled trials, and observational studies over the last 20 years. SORT scale of the American Family Physician was used to evaluate evidence levels. Results: A total of 56 articles were retrieved, of which four guidelines, one systematic review, and one original article were selected. According to guidelines, there is no reason to discourage pacifier use, as it can be particularly beneficial in the first six months of life. Afterwards, pacifier use should be limited to moments of falling asleep. Its use should also be avoided in infants with chronic or recurrent otitis media. The systematic review stablished pacifier use as a risk factor for recurrent acute otitis media (RAOM) which is susceptible to intervention. In the observational study, a statistically significant association was found between pacifier use and RAOM risk. Conclusions: Pacifier use should not be actively discouraged in the first semester of life, as it can have beneficial effects for children (SORT A). Afterwards, its use should be discontinued due to increased otitis risk (SORT A).
... do sistema estomatognático como a oclusão, respiração e fala 23 . A maior persistência nos hábitos de sução não nutritivos está associada à má oclusão 24 . O uso de chupeta ortodôntica é preferível ao hábito de sucção do dedo, pois este é mais difícil de ser controlado pelos pais 18 . ...
... O uso de chupeta ortodôntica é preferível ao hábito de sucção do dedo, pois este é mais difícil de ser controlado pelos pais 18 . Portanto, a chupeta deve ser desencorajada e, a idade limite seria de quatro anos 24 . Na nossa amostra o hábito de utilizar a chupeta persistiu em quase metade das crianças após quatro anos. ...
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Introdução: A má oclusão dentária tem origem multifatorial, logo é difícil definir estratégicas específicas de como preveni-la. A respiração bucal e certos hábitos de sucção, se persistir por mais de 36 meses, podem influenciar de forma negativa. Objetivo: Identificar fatores de risco à oclusão dentária como: respiração bucal e hábitos de sucção em escolares de 8 a 10 anos de idade em Petrópolis, RJ. Métodos: Estudo observacional, transversal, de caráter descritivo. Incluídos escolares de ambos os sexos, 8 a 10 anos, matriculados em sete escolas municipais de Petrópolis. Distribuído aos escolares o protocolo para a identificação da criança respiradora bucal e o questionário sobre hábitos de sucção (mamadeira, chupeta e dedo). Resultados: Foram avaliados 377 protocolos para a identificação de criança respiradora bucal e 377 questionários sobre hábitos de sucção. Nos protocolos foram referidos sintomas como: dormir de boca aberta em 193 (51,2%), babar no travesseiro em 172 (45,6%), roncos em 131 (34,7%) e obstrução nasal diária em 118 (31,2%). Ao aplicar os critérios de Abreu, constatou-se uma frequência de 243 (64%) respiradores bucais e 134 (36%) respiradores nasais. Ao avaliar os 377 questionários sobre os hábitos de sucção encontraram-se: 276 (73%) crianças com hábitos de sucção e 101 (27%) sem tais hábitos. Dos 276 escolares que tiveram hábitos de sucção, houve persistência destes hábitos acima de três anos e 11 meses em 149 crianças (54%). Conclusão: Encontrada uma alta frequência de respiradores bucais e de crianças com hábitos de sucção.
... Non-nutritive sucking is a natural reflex for infants; it can be an important first step in the infant's development of self-regulation and ability to control emotion (Adair et al. 1992;Casamassimo 1996;Pinkham et al. 1999;Ponti et al. 2003). The use of a pacifier is a common habit existent in children, and it is supported by American Academy of Pediatrics (AAP 2015) due to beneficial effects during the first 6 months of life (Sexton and Natale 2009). Pacifiers have a tranquilising effect, and promote pain relief (Nelson 2012). ...
... Although the literature has supported that pacifier use interferes with the occlusion in children (Martins et al. 2003;Góis et al. 2008;Melink et al. 2010;Ize-Iyamu and Isiekwe 2012;Dimberg et al. 2013;Germa et al. 2016), there is no indication for prohibiting its use (Sexton and Natale 2009). Besides being of great value to cherish the infant and helping the parents to calm the crying it could possibly act as an analgesic (Nelson 2012). ...
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Aim: This was to investigate the occurrence of malocclusion traits among children who were users of orthodontic or conventional pacifier by means of a systematic review. Methods: Search for articles involved five electronic databases: Latin American and Caribbean Health Sciences (LILACS), PsycINFO, PubMed (including MedLine), Scopus and Web of Science. Grey literature was partially assessed. Observational studies with children aged 6–60 months who had used orthodontic or conventional pacifier were included. The risk of bias among included studies was assessed through the Joanna Briggs Institute Tool. Results: From the 607 initially-identified papers only three were included after the selection process. All presented moderate risk of bias. Although an anterior open bite and accentuated overjet were identified among conventional users of pacifier in one study, no differences were identified in the other two selected studies. Posterior crossbite frequency was not different in any of the included studies. There was also no difference regarding frequency and duration of use, except in the study that showed higher occurrence of open bite malocclusion in conventional pacifier users. Conclusions: The currently available evidence is insufficient to support the concept that the usage of orthodontic pacifiers is able to prevent malocclusion traits when compared to the usage of conventional pacifiers.
... There are evidences that their precursors have been used since the Neolithic Period 1 . Until now, there are controversial data on the benefits and potential risks of their use 2,3 . Nipples can be composed by different materials such as latex or silicone. ...
... Nipples can be composed by different materials such as latex or silicone. Nowadays, the use of silicone nipples is preferred due to their lower roughness and lower microbial adhesion 2,4 . As they are in direct contact with the oral microflora, microbial biofilms may grow on their surfaces [4][5][6] . ...
... Nonnutritive sucking (NNS) is common and the prevalence of NNS in children varies from 60 to more than 80% (1,2). A pacifier is used for comforting; as a sleeping aid; and to ameliorate uncomfortable, stressful or painful episodes (3)(4)(5). Use of a pacifier is considered socially normal in most cultures, and weaning may be difficult (1,5). Ideally, NNS habits should be discontinued by 24-36 months of age to reduce the risk of developing malocclusion (4,6). ...
... Numerous studies have examined the effects of NNS habits on occlusal characteristics and found that NNS beyond age 3 may have detrimental consequences for dento-and maxillofacial development (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Anterior open bite (AOB), increased overjet, posterior crossbite, narrow intercuspid width of the maxillary arch and a high narrow palate are the most notable changes in the developing dentition (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). ...
Article
Ziel Evaluierung der Auswirkungen eines Schnullers mit besonders dünnem Saugerhals auf die Okklusion im Milchgebiss bei Kindern mit zuvor diagnostiziertem frontal offenen Biss (FOB) und vergrößertem Overjet (horizontalem Überbiss). Methoden Durchführung einer prospektiven randomisierten klinischen Studie in der Abteilung für Präventive Zahnheilkunde und Kinderzahnheilkunde am Universitätsklinikum Jena, Deutschland. 86 Kleinkinder (Durchschnittsalter 20,3 Monate) mit Schnuller-assoziiertem offenen Biss oder Overjet von ≥2 mm wurden randomisiert einer von 3 Gruppen zugewiesen: Gruppe I (n=28), Interventionsgruppe, Umstellung auf Schnuller mit besonders dünnem Saugerhals; Gruppe II (n=30), Kontrollgruppe, Weiterverwendung des bisherigen Schnullers (konventioneller oder physiologischer Schnuller); und Gruppe III (n=28), Interventionsgruppe, Gold Standard, Abgewöhnung des Schnullers. Die Kinder wurden über einen Zeitraum von 12 Monaten beobachtet. Ergebnisse Nach 12 Monaten wurden die Daten von 63 Kindern (mit einem Durchschnittsalter von 33,1 Monaten) analysiert (I: n=24; II: n=22; III: n=17). Dabei zeigte sich zwischen den Gruppen ein signifikanter Unterschied in Bezug auf Overjet und Overbite. Kinder, die den Schnuller mit besonders dünnem Saugerhals verwendeten, hatten signifikant bessere Ergebnisse bezüglich Overjet und Overbite als Kinder mit konventionellem oder physiologischem Schnuller. Kinder, denen der Schnuller abgewöhnt worden war, wiesen die besten Messergebnisse auf. Schlussfolgerung Die Verwendung eines Schnullers mit besonders dünnem Saugerhals resultierte im Vergleich zur weiterführenden Benutzung eines konventionellen oder physiologischen Schnullers in besseren klinischen Messergebnissen für Overjet und Overbite.
... Onychophagia, which affects 20-30% of the population regardless of age, can lead to psychosocial issues and adverse effects on oral health [27]. While pacifier use can have analgesic benefits and may reduce the risk of sudden infant death syndrome, prolonged use beyond two years can result in malocclusions [28]. Thumb sucking, if persistent beyond the age of four and during the eruption of permanent teeth, often causes significant dentomaxillary anomalies [29]. ...
Article
Aim and Objectives: This study aimed to investigate the knowledge and attitudes of parents in Oradea, Romania, regarding common bad oral habits among children, which are critical for dentofacial development. Material and Methods: A cross-sectional study was conducted using an online questionnaire distributed via Google Forms, comprising 20 items across three sections: socio-demographic data, presence of bad oral habits, and parental attitudes. The study included parents or guardians of children under 18. Results: Out of 121 respondents, 82.6% were female, and the majority were aged 18-30 years. Most parents (74%) were aware of the negative effects of bad oral habits, but uncertainties remained, particularly regarding habits like thumb sucking (36%) and nail biting (42%). Furthermore, 45% of all parents lacked knowledge about the appropriate age to intervene, and 52% were unsure about effective methods to discourage these habits. This indicates a need for targeted information and support strategies. Conclusions: The findings highlight the need for enhanced parental education on the impact of bad oral habits on children's dentofacial development. Targeted educational initiatives and early interventions are crucial.
... For example, we added "pacifiers" since young children often place in their mouth, and "electronics" which have become more commonplace for children to touch in their younger years. Pacifier use has been associated with risks of certain bacterial colonies and illness for an infant or child, especially when not sanitized (76), and may also have higher levels of dust if dropped on floors routinely. The addition of the "electronics" category can benefit children and health studies interested in time spent with electronics in today's modern world. ...
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Background Heavy metals, pesticides and a host of contaminants found in dust and soil pose a health risk to young children through ingestion. Dust/soil ingestion rates for young children can be estimated using micro-level activity time series (MLATS) as model inputs. MLATS allow for the generation of frequency and duration of children’s contact activities, along with sequential contact patterns. Models using MLATS consider contact types, and transfer dynamics to assign mechanisms of contact and appropriate exposure factors for cumulative estimates of ingestion rates. Objective The objective of this study is to describe field implementation, data needs, advanced field collection, laboratory methodologies, and challenges for integrating into and updating a previously validated physical-stochastic MLATS-based model framework called the Child-Specific Aggregate Cumulative Human Exposure and Dose (CACHED) model. The manuscript focuses on describing the methods implemented in the current study. Methods This current multidisciplinary study (Dust Ingestion childRen sTudy [DIRT]) was implemented across three US regions: Tucson, Arizona; Miami, Florida and Greensboro, North Carolina. Four hundred and fifty participants were recruited between August 2021 to June 2023 to complete a 4-part household survey, of which 100 also participated in a field study. Discussion The field study focused on videotaping children’s natural play using advanced unattended 360° cameras mounted for participants’ tracking and ultimately conversion to MLATS. Additionally, children’s hand rinses were collected before and after recording, along with indoor dust and outdoor soil, followed by advanced mass analysis. The gathered data will be used to quantify dust/soil ingestion by region, sociodemographic variables, age groups (from 6 months to 6 years), and other variables for indoor/outdoor settings within an adapted version of the CACHED model framework. Significance New innovative approaches for the estimation of dust/soil ingestion rates can potentially improve modeling and quantification of children’s risks to contaminants from dust exposure.
... The protection mechanism of a pacifier concerning SIDS is not yet well understood. The main hypotheses include the lower likelihood of the infant rolling into the prone position [29], reductions in the occurrence of sleep apnea and gastroesophageal reflux [30], and better autonomic control of respiration [31]. Moreover, a systematic review states that pacifier use during sleep may improve clearance of the airways due to the lower position adopted by the tongue. ...
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Objective To identify online recommendations from pediatric and pediatric dentistry associations of the Americas regarding the pacifier habit. Material and Methods A search was conducted on the associations' website (November/2021 to March/2023) to the questions: (1) Recommend using a pacifier?, (2) What care?, (3) Advantages and (4) disadvantages, (5) Ideal age, and (6) methods for habit removal. Results Among the 36 American countries, 21 were represented on websites, social media, and official guides. The most significant portion of pediatric dentistry associations (23.81%) does not recommend the use of a pacifier if the infant is exclusively breastfeeding, and recommends avoiding the offer of a pacifier in the first days of life to facilitate the establishment of breastfeeding. Some pediatric (29.63%) associations suggested that use reduces the risk of sudden infant death syndrome. Most pediatric dentistry associations (85.71%) and some pediatric associations (22.22%) linked pacifier use to breastfeeding difficulties and the occurrence of orthodontics. Most of the 20 pediatric dentistry associations stated that the habit should be removed by a maximum of three years of age (90.48%). The most reported recommendations were behavior modification techniques and positive reinforcement. Conclusion Most pediatric dentistry associations recommend the care and disadvantages of pacifiers and the ideal age to remove them. The few pediatric associations that provide information address indications, care, advantages and disadvantages of pacifiers, age, and methods for removing them. Keywords: Pediatric Dentistry; Child; Sucking Behavior; Pacifiers; Counseling
... We found that pacifier usage lowers the frequency of SRNC in the 3-5-month age group. Pacifier usage has been reported to be protective against Sudden Infant Death Syndrome but is also associated with reducing the duration of breastfeeding and may cause problems with dental and middle ear health (19). The studies on the effects of pacifiers on sleep are relatively limited and the results are controversial (20,21). ...
... Pacifiers are extensively used in today's world due to their calming and relaxing effect, improving the sleep quality and decreasing the risk of sudden death syndrome in infants during their first 6 months of life. [1][2][3] The pacifier tip is in constant contact with the oral normal flora and saliva, and can become contaminated and serve as a route of infection transmission to infants. [4,5] In older children, bacteria can lead to biofilm formation and subsequent development of dental plaque, which can lead to dental caries. ...
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Background: This study aimed to compare the antimicrobial effects of green tea, microwaving, cold boiled water, and chlorhexidine (CHX) on Streptococcus mutans and Candida albicans on silicone pacifiers. Materials and methods: In this in vitro experimental study, 60 equal-size samples of silicone pacifiers were cut, ultraviolet sterilized, and randomly divided into two groups (n = 30) for immersion in 0.5 McFarland standard suspension of S. mutans and C. albicans. The samples in each group were then randomly divided into five subgroups (n = 6) for disinfection with 0.12% CHX, cold boiled water, green tea, microwaving for 7 min, and distilled water. The sample suspensions were cultured on blood agar (for S. mutans) and Sabouraud dextrose agar (for C. albicans) and incubated. The number of colonies was counted after 24 and 48 h. Data were analyzed using the Kruskal-Wallis and Mann-Whitney tests (P < 0.05). Results: At 24 and 48 h, the S. mutans colony count was the lowest in CHX and green tea subgroups followed by microwave, cold boiled water, and distilled water subgroups (P < 0.05). Conclusion: CHX and green tea can significantly decrease the S. mutans and C. albicans colony count on silicone pacifiers.
... Prolonged NNSHs have been associated with maxillofacial growth anomalies in children, including high-arched palate and posterior crossbite (14)(15)(16)(42)(43)(44)(45). The habit of a thumb or a pacifier in the mouth accustoms the tongue to be in a low position where it cannot exert pressure on the palate, which potentially results in a high-arched palate. ...
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Introduction Children born very preterm have an immature sucking reflex at birth and are exposed to neonatal care that can impede proper palate growth. Objectives We aimed to describe the frequency of high-arched palate and posterior crossbite at the age of 5 in children born very preterm and to identify their respective risk factors. Methods Our study was based on the data from EPIPAGE-2, a French national prospective cohort study, and included 2,594 children born between 24- and 31-week gestation. Outcomes were high-arched palate and posterior crossbite. Multivariable models estimated by generalized estimation equations with multiple imputation were used to study the association between the potential risk factors studied and each outcome. Results Overall, 8% of children born very preterm had a high-arched palate and 15% posterior crossbite. The odds of high-arched palate were increased for children with low gestational age (24–29 vs. 30–31 weeks of gestation) [adjusted odds ratio (aOR) 1.76, 95% confidence interval (CI) 1.17, 2.66], thumb-sucking habits at the age of 2 (aOR 1.53, 95% CI 1.03, 2.28), and cerebral palsy (aOR 2.18, 95% CI 1.28, 3.69). The odds of posterior crossbite were increased for children with pacifier-sucking habits at the age of 2 (aOR 1.75, 95% CI 1.30, 2.36). Conclusions Among very preterm children, low gestational age and cerebral palsy are the specific risk factors for a high-arched palate. High-arched palate and posterior crossbite share non-nutritive sucking habits as a common risk factor. The oro-facial growth of these children should be monitored.
... It is important that pacifiers be used sparingly until breastfeeding has started; if there is a decrease in the availability of breast milk, the use of pacifiers should be reduced to facilitate physiological breastfeeding [11,33,34]. In order to reduce the risk of SIDS, a pacifier should be used during the first year of life for both day and night sleep [13,35,36]. In order to prevent pain and lesions, it is very important that pacifiers should never be used with sweeteners [37][38][39]. ...
Article
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We studied the variations in peripheral capillary oxygen saturation (SpO2) during wake time in relation to pacifier use and to the following different positions: supine at 0°, supine at 30° (in babies under one year) vs. sitting (in babies between 1 and 3 years of age). We observed 54 patients under the age of three years, weighing over 1.800 g. Peripheral oxygen saturation was recorded for at least 40 min per patient in the following positions: 20 min lying supine at 0° (10 min with a pacifier and 10 min without); 20 min lying supine at 30° inclination or in a sitting position if the baby was older than one year (10 min with a pacifier and 10 min without). Pacifier use improved the peripheral oxygen saturation both in the 0° supine position, and at 30° in a sitting position. No significant differences were observed in the SpO2 levels comparing the different positions. In conclusion a pacifier thus seems to have a positive effect on respiration.
... The majority (62.3 %) of analyzedmothers introduced pacifier during the first week of lifewhich is similar to the findingof other study (21,22) .About three quarter (76.3 %) of studied breast-fed pacifier user infants converted to artificial feeding pattern prior to 6 months age. Breast-feeding was negatively correlated with pacifier use (4,5,23) . ...
... In a review study on 34 papers from PubMed database, the relationship between feeding methods and maxillofacial development was investigated and the results showed that in some studies feeding methods had some effects on nonnutritive sucking habits and in other there was no effect. They also found that based on the studies from 1999 to 2011, prolonged breast-feeding diminishes the risk of acquiring non-nutritive sucking habits (14). ...
... WHO is well aware that bottles, teats and pacifiers have more risks than benefits (Sexton & Natale, 2009), particularly in locations where access to clean water is difficult. If the health care worker does not counsel on their use, eventually mothers will find information from outside, probably from incompetent sources and/or from companies that violate the WHO Code. ...
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In 2018, the World Health Organization (WHO) issued the first revision of the 1989 WHO/UNICEF Ten Steps to Successful Breastfeeding. While there is evidence of the effectiveness of those Ten Steps in increasing breastfeeding rates, there has been no published analysis of the key differences between both versions. We aim to summarise the key changes in each of the Ten Steps and explores the benefits and cost implications. We first review the background to recent changes, and then compare the evolution of each of the Ten Steps since 1989. Thirdly, we explore the implications of new implementation guidelines in terms of the cost and benefits from different perspectives. Revisions are subtle, yet meaningful for implementation. A major change made by WHO is subdividing the Ten Steps into 1) critical management procedures, and 2) key clinical practices. Lessons have been learned on how the change has shifted the focus from health care staff to parents and families, and shifted the responsibility for some elements of care from hospitals to the communityto implement BFHI more cost effectively and how to motivate policies and practices by ensuring better incentives. Exploring the costs and benefits of the Ten Steps, and who has responsibility for implementation, may increase understanding of how BFHI can be implemented to make it more universal, cost-effective and sustainable. Commitment is needed from policymakers to integrate the BFHI into health systems and health financing. Future research will examine this at the country level.
... 30 Authors of this study concluded that pacifier use may be an indicator of breastfeeding difficulties rather than a cause of early weaning. 31 This reasoning may explain the increased risk of weaning <2 versus ‡2 months postpartum among women in our study who reported that hospital staff helped them learn how to breastfeed. Reverse causation is a likely explanation for the significant link found between hospital support of breastfeeding and early weaning-women who are having difficulties breastfeeding are more likely to terminate early and are simultaneously more likely to be receiving breastfeeding support. ...
Article
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Introduction: Hospitals are in a unique position to promote, protect, and support breastfeeding. However, the association between in-hospital events and breastfeeding success within population-based samples has not been well studied. Materials and methods: A stratified (by education and birth weight) systematic sample of 5,770 mothers taking part in the Utah Pregnancy Risk Assessment Monitoring System, 2012-2015, were included. Mothers, 2-4 months postpartum, completed the 82-item questionnaire, including if they had ever breastfed their new baby, and if so, current breastfeeding status. Relationships between in-hospital experiences and breastfeeding termination and duration were evaluated via Poisson and Cox proportional hazard regression models, respectively, adjusting for other in-hospital experiences, maternal age, race/ethnicity, maternal education, marital status, smoking, physical activity, delivery method, pregnancy complications, and length of hospital stay. Results: Of all, 94.4% of mothers self-reported breastfeeding initiation, of whom 18.8% had breastfed <2 months, having breastfed on average 3.2 weeks (standard error: 0.07). In fully adjusted models, mothers who reported receiving a pacifier, receiving formula, or had staff help them learn how to breastfeed had a higher prevalence of terminating breastfeeding before 2 months (adjusted prevalence ratio [aPR] = 1.13, 95% confidence interval [CI]: 0.97-1.32; aPR = 1.20, 95% CI: 1.07-1.36; and aPR = 1.25, 95% CI: 1.08-1.34). Conversely, mothers who reported starting and feeding only breast milk in the hospital and receiving a phone number to call for help with breastfeeding had a lower prevalence of breastfeeding termination before 2 months (aPR = 0.72, 95% CI: 0.61-0.86; aPR = 0.57, 95% CI: 0.51-0.64; and aPR = 0.91, 95% CI: 0.80-1.03). Adjusted Cox models showed similar direction of associations. Conclusions: Encouraging mothers to exclusively breastfeed in the hospital, and reducing gift packs containing pacifiers and formula, may be key areas United States hospitals can focus on to increase breastfeeding success. Prospective assessment in other geographical regions is needed to corroborate these findings.
... Hábitos de sucção não nutritiva (HSNN) são comuns na infância e podem determinar impacto negativo no crescimento e desenvolvimento cranio- facial [1][2][3] . Desde a vida intrauterina, o bebê apresen- ta o reflexo natural de sucção não nutritiva e, ao nascimento, a função está completamente desenvol- vida 4 . Esse tipo de sucção supre carências psicológi- cas e afetivas, promovendo sensações de bem-estar, prazer emocional, conforto e proteção 5 . ...
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Objetivo: investigar a prevalência e os fatores asso­ciados ao uso de chupeta em pré-escolares. Sujeitos e método: estudo transversal foi realizado com 1.316 crianças de 0 até 5 anos de idade no município de Ca­noas, no Rio Grande do Sul. O instrumento de pesquisa foi um questionário semiestruturado respondido pelos responsáveis sobre características sociodemográficas (sexo, cor da pele, idade da criança e materna, esco­laridade materna, estrutura e renda familiar) e compor­tamentais (uso da mamadeira e aleitamento materno). O desfecho foi presença/ausência de uso de chupeta. A análise estatística compreendeu regressão de Poisson com variância robusta bruta e ajustada. Resultados: a prevalência de uso de chupeta em algum momento da vida foi de 68,1%. A análise multivariável ajustada mostrou que crianças que usaram mamadeira tiveram três vezes maior prevalência do desfecho (RP: 3,21; IC95% 2,25-4,59; p<0,001) se comparadas àquelas que nunca usaram mamadeira. Além disso, a análise adicio­nal encontrou que crianças mais novas ainda usam a chupeta quando comparadas às mais velhas. Conclu­são: conclui-se que a prevalência do uso de chupeta é alta e está associada com hábitos de nutrição. Assim, entender a associação de aspectos biopsicossociais e sua rede de causalidade torna-se essencial para o es­tabelecimento de estratégias de promoção de saúde na primeira infância.
... If pacifiers are given to infants when they are learning to suck from their mothers' breasts in the early postpartum period, the use of pacifiers may interfere with proper sucking and cause nipple confusion [18]. Studies have found pacifier use to be associated with an increased prevalence of oral candidiasis, a type of fungal infection [19][20][21][22]. Several studies also show that non-nutritive sucking habits are associated with the development of malocclusion in the primary dentition [1,12,18]. ...
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Background: The development of primary dentition can be affected by oral sucking habits. Therefore, this study aims to investigate the association of nutritive and non-nutritive sucking habits with primary dentition development. Methods: One thousand one hundred and fourteen children aged 2 to 5 years old in Hong Kong were recruited in a cross-sectional study. Information on their nutritive (e.g. breastfeeding and bottle feeding) and non-nutritive sucking habits (e.g. pacifier use and thumb/digit sucking) was collected via questionnaires. The children's primary occlusions were examined in three dimensions. Results: Children who were breastfed for more than 6 months had a lower proportion of daily pacifier use (p < 0.05). Children who used pacifiers daily had a higher proportion of thumb/digit sucking (p < 0.05). Children who used pacifiers daily for more than one year had higher chances of developing an anterior open bite (p < 0.05) and a reduced overbite (p < 0.05). Those exhibiting daily thumb/digit sucking for more than one year had higher chances of developing Class II incisor and Class II canine relationships, an increased overjet and anterior open bite (p < 0.05). Conclusion: Pure breastfeeding for more than 6 months is inversely associated with daily pacifier use and daily pacifier use is positively associated with daily thumb/digit sucking. Children with more than one year of daily pacifier use and thumb/digit sucking have higher chances of developing abnormal dental relationships in the sagittal (i.e. Class II incisor and Class II canine relationships and increased overjet) and vertical (i.e. anterior open bite) dimensions, respectively.
... [5] Also, it has been found that prolonged use of a pacifier (children aged 6 months-2 years) results in an increased risk of otitis media or malocclusion. [6] Other studies show that sucking a pacifier may cause choking, food poisoning, development of allergies, increased risk of tooth decay as well as intestinal parasitic infection. [5] Latest studies, however, indicate that the use of a bottle teat is a sign of mothers' difficulties breastfeeding or lowered motivation for this mode of feeding rather than the root cause of early weaning. ...
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Rationale: Existing research into the effects of teat application has mainly focused on its negative and positive influence on the development of the oral cavity. Our work demonstrates that apart from changing the setting of the articulatory organs, the teat can also affect the quality of breathing, eating and sleeping. Patients concerns: We described the cases of 2 children: a 19-month-old girl and a 2.5-month-old boy, who had breathing disorders due to withdrawal of the tongue and impaired food intake. Intervention: The babies were bottled fed with a special teat for cleft lip patients to observe the influence of the teat on the setting of the articulatory organs and breathing. Diagnosis: We suspected that the specific construction of the teat-the wide outer part and the short internal part-would affect children's reflexes and articulatory organs so as to force the frontal position of the tongue, which was meant to facilitate breathing and eating. Outcomes: It was found that feeding with the cleft lip teat stimulates the gyro-linguistic muscle, which results in the proper position of the tongue and consequently better breathing and improved quality of sleep. Lessons: A specialist bottle teat designed for babies with cleft lips can constitute an effective tool in the therapy of nonspecific respiratory disorders resulting from improper position of the tongue and other articulatory organs.
... 18,27 The reason could be the fact that infants satisfy their sucking need with the pacifier which is added to the other disadvantages of the pacifier. 28 However, it was shown that pacifier could help in increasing EBF rate in infants whose mothers were at risk of postpartum depression. 20 In addition, we came to this point that mother's perception of breast milk adequacy was a determinant factor on EBF duration, which has previously been reported by other studies. ...
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Background Exclusive breastfeeding (EBF) in the first six months of the life can significantly improve maternal and children health, and it is especially important in low- and middle-income countries. We aimed to determine the factors affecting EBF duration in a sample of Iranian infants. Methods This prospective study was conducted between April 2012 and October 2014 in Fars, Iran. Women (N=2640), who had given birth to healthy term infants were categorized into EBF versus non-EBF groups. Demographic information from mothers and infants, medical and drug history, and pregnancy related factors were compared between the two groups. Multivariable analysis was performed using Adaptive Lasso regression. P<0.05 was considered significant. Results The mean duration of EBF was 4.63±1.99 months. There was an inverse association between the mother’s educational level and duration of EBF (P<0.001). Also, we found that mothers who were housewives had a significantly longer duration of EBF (4.68±1.97) compared to mothers with either part-time (4.21±2.01) or full-time jobs (4.02±2.12) (P<0.001). By eliminating the redundant factors, the proposed multivariable model showed the infant’s weight gain during EBF, singleton/multiple pregnancies, maternal perception of quantity of breast milk, post-partum infection, use of pacifier, neonate’s irritability, birth place and mother’s full-time job as the most important factors affecting the duration of EBF. Twin pregnancies, post-partum infection, cesarean section by maternal request, use of a pacifier and irritability in the neonatal period significantly reduced the duration of EBF. Conclusion Health policy-makers should promote EBF programs among the educated as well as working mothers in order to positively affect the community’s health status.
... En la literatura se reconoce el origen multifactorial en el desencadenamiento de las maloclusiones dentarias, en el que intervienen factores hereditarios, factores estructurales como el tamaño de los huesos, los dientes, la dirección eruptiva de estos últimos y la dirección de crecimiento de los huesos. Así como otros factores ambientales, dentro de estos, los más frecuentes son los hábitos bucales deformantes, como la succión digital, el uso de chupo o biberón, la respiración bucal y la deglución atípica hasta edades avanzadas (2,3). ...
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Objetivo: establecer la frecuencia de maloclusiones dentales y alteraciones esqueléticas relacionadas con hábitos orales en sujetos de 6 a 11 años de edad. Métodos: estudio analítico de prevalencia. Con 50 participantes aleatorios que ingresaron en el período de Mayo a Septiembre de 2015 al centro de prácticas "Juan Manuel Méndez Bechara” para tratamientos de ortopedia maxilar, con historias clínicas, anexos de ortodoncia completos, con radiografía de perfil, examen clínico y análisis cefalométrico de Steiner, estadísticamente se utilizó la prueba de Shapiro-Wilk para conocer la hipótesis nula de normalidad, luego de conocer la hipótesis nula se utilizó el Test de la t de Student para evaluar si es razonable mantener la Hipótesis. Resultados: se encontró que el hábito oral de mayor frecuencia fue la onicofagia (24,4 %), la succión de objetos (23,1%) y la succión de carrillos (13,6 %). El tipo de mordida de mayor frecuencia fue la mordida abierta anterior (64 %) y los ángulos SNA, SNB y ANB alterados, demostrando que existe una relación entre en los hábitos orales, las oclusiones y las alteraciones en los ángulos cefalómetros analizados. Conclusión: se encontró la relación entre los hábitos bucales y la presencia de mal oclusiones dentarias y alteraciones esqueléticas en los sujetos de6 a 11 años de edad que participaron en el estudio.
... Avoiding pacifiers and artificial teats is one of the guidelines in the Baby Friendly Hospital Initiative's (BFHI) document The Ten Steps to Successful Breastfeeding (14,15). However, avoiding pacifiers has stirred up controversy within the medical community (16,17). Pacifiers are non-nutritive sucking devices that are used to calm infants and have become a cultural norm in the majority of countries (18)(19)(20). ...
Article
Aim: Mothers are often advised not to use pacifiers until breastfeeding has been well-established. This study determined the infant and social factors that were related to pacifier use during the first few days of life and whether it led to alterations in feeding performance. Methods: We enrolled 42 full-term infants and their mothers at Barnes-Jewish Hospital in urban St Louis, USA, in 2015. Before they were discharged the mothers completed a questionnaire, and infant feeding was assessed using a standardised assessment. Results: There were 24 (57%) infants who used a pacifier during the first few days of life and seven (29%) of these were exclusively breastfed. Pacifier use was less common among mothers who exclusively breastfed (p=0.04). Pacifier use was more common among mothers whose income was less than 25,000 US dollars (p=0.02), who were single (p=0.002) and who did not have a college education (p=0.03). No associations between pacifier use and feeding performance were observed. Conclusion: While lower socioeconomic status was related to pacifier use, feeding performance in the first few days of life was no different between those infants who did and did not use pacifiers after a full-term birth. This article is protected by copyright. All rights reserved.
... The effects of sucking habits on the development of the occlusion were under investigation for decades and several studies demonstrated their association with different types of malocclusion (4,(16)(17)(18)(19)(20). The main question arising from these studies is whether genetic factors are a risk or a protective factor for AOB. ...
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Anterior open bite (AOB) has a multifactorial etiology caused by the interaction of sucking habits and genetic factors. The aim of this study was to evaluate the association between AOB and polymorphisms in genes that encode Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs). Four hundred and seventy-two children that presented at least one sucking habit were evaluated. Children were examined clinically for the presence of AOB. Genomic DNA was extracted from saliva. Genotyping of the selected polymorphisms in MMP2, MMP3, MMP9, TIMP1 and TIMP2 was carried out by real-time PCR using the TaqMan method. Allele and genotype frequencies were compared between the groups with and without AOB using the PLINK® software in a free and in a recessive model using a chi-square test. Logistic regression analysis was implemented (p≤0.05). Two hundred nineteen children had AOB while 253 did not. The polymorphism rs17576 in MMP9 was significantly associated with AOB (p=0.009). In a recessive model GG genotype was a protective factor for AOB (p=0.014; OR 4.6, 95%CI 1.3-16.2). In the logistic regression analysis, none of the genes was associated with AOB. In conclusion, the polymorphism rs17576 (glutamine for arginine substitution) in MMP9 was a protective factor for AOB.
... Quizá en algunos neonatos con factores de riesgo pueda aconsejarse su uso. 28,29 8. Circuncisión. La discusión ha sido prolongada. ...
... While researchers have suggested that pacifier use might interfere with the establishment breastfeeding (Neifert, Lawrence, & Seacat, 1995;Righard, 1998;Kronborg & Vaeth, 2009) others have suggested that pacifier use is simply a marker of breastfeeding problems (Victora et al., 1997;Kramer et al., 2001). Consequently, the recommendations for pacifier use vary worldwide (Eidelman et al., 2012;Sexton & Natale, 2009 & Fein, 2008). On the other hand, the American Academy of Pediatrics recommends using pacifiers to prevent sudden infant death syndrome (SIDS) and there is a general recommendation that pacifiers can be introduced after breastfeeding is well established, at approximately 3 to 4 weeks of age (Eidelman et al., 2012). ...
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Identifying modifiable risk factor for exclusive breastfeeding (EBF) interruption is key for improving child health globally. There is no consensus about the effect of pacifier use on EBF interruption. Thus, the aim of this systematic review was to investigate the association between pacifier use and EBF interruption during the first six month. A search of CINAHL, Scopus, Web of Science, LILACS and Medline; from inception through 30 December 2014 without restriction of language yielded 1,866 publications (PROSPERO protocol CRD42014014527). Predetermined inclusion/exclusion criteria peer reviewed yielded 46 studies: two clinical trials, 20 longitudinal, and 24 cross-sectional studies. Meta-analysis was performed and meta-regression explored heterogeneity across studies. The pooled effect of the association between pacifier use and EBF interruption was 2.48 OR (95% CI = 2.16-2.85). Heterogeneity was explained by the study design (40.2%), followed by differences in the measurement and categorization of pacifier use, the methodological quality of the studies and the socio-economic context. Two RCT's with very limited external validity found a null association, but 44 observational studies, including 20 prospective cohort studies, did find a consistent association between pacifier use and risk of EBF interruption (OR = 2.28; 95% CI = 1.78-2.93). Our findings support the current WHO recommendation on pacifier use as it focuses on the risk of poor breastfeeding outcomes as a result of pacifier use. Future studies that take into account the risks and benefits of pacifier use are needed to clarify this recommendation.
... Thumb-sucking and/or pacifier use is still a controversial and inconclusive issue, and there is some evidence that socioeconomic status and lifestyle may influence the prevalence of malocclusion. [13][14][15] Considering the importance of this issue 16 and that the social class and economic conditions remain potent discriminators of health inequalities, [17][18][19] the aim of this study was to verify the relationship between nonnutritive habits and malocclusions in children using day nurseries' facilities. ...
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Introduction: This study evaluated the expression of nonnutritive sucking habits and the presence of malocclusion in children using day nurseries' facilities. Materials and methods: The 195 children (7-40 months) attending 18 public day nurseries were evaluated clinically in Ponta Grossa, Brazil. Statistical package software was used for descriptive, univariate, bivariate, and multiple logistic regressions of the data about the socioeconomic condition, educational family status, malocclusions, and prevalence of nonnutritive sucking habits among the children. Results: The pacifier users had a statistically significant, explanatory association with open bite [odds ratio (OR) = 10.97; 95% confidence interval (CI): 4.95, 24.31; p < 0.0001]. The children older than 25 months had more open bite than younger children (OR = 6.07; 95% CI: 2.81, 13.11; p < 0.0001). Of the children examined, 35.4% had an anterior open bite, 0.51% had posterior cross-bite, and 1.03% showed finger-sucking habits. A high frequency of pacifier-sucking habits was found (52%), with a significant association between this habit and anterior open bite (p < 0.0001, OR = 7.49; 95% CI: 3.71, 15.15). The 126 children without open bite (36.5%) were pacifier users. There was suggestive, though nonsignificant, evidence of a difference in pacifier use by gender (males, 34%; females, 46%; p = 0.07). The 69 children with open bite (81.16%) were pacifier users and (18.84%) nonusers. The boys showed a slightly greater association with open bite (OR = 21.33; 95% CI: 6.12, 74.40; p < 0.0001) than girls (OR = 5.03; 95% CI: 1.26, 20.00; p = 0.02) in the age group of 25 to 40 months; however, it was not observed in younger children. Conclusion: Pacifier use is a predictor for open bite in children from the lower socioeconomic classes using day nurseries' facilities. Clinical significance: The parents, guardians, and caregivers working in public day nurseries should be advised to monitor nonnutritive sucking habits in order to avoid or minimize the occurrence of malocclusion. It demonstrates that the permanence of the children in day nurseries may be linked with deleterious oral habits, and it discusses strategies to minimize the occurrence of alterations in the normal occlusion.
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A chupeta é parte integrante dos lares de todo o mundo, aquando da existência de um recém-nascido. O seu uso tornou-se um hábito culturalmente enraizado, seguido pela maioria dos pais/tutores, mas foi surgindo receio de que a utilização deste objeto tenha influência negativa no sucesso da amamentação.Neste artigo de revisão, são apresentados os resultados mais recentes da literatura sobre a influência da chupeta na amamentação, abordando a importância da amamentação e as principais vantagens e desvantagens do uso de chupeta.Estudos observacionais apontam uma possível correlação entre o uso de chupeta e o insucesso da amamentação, mas essa associação não se confirmou em estudos de maior robustez como em ensaios clínicos randomizados.Face à evidência científica apresentada, os autores consideram que a chupeta deve ser oferecida, se essa for a vontade dos pais, tomando uma decisão partilhada e informada.
Article
Objective This study aimed to investigate the effect of white noise on pain response, heart rate, and oxygen saturation during heel puncture in premature infants. Methods A randomized, controlled, pretest-posttest design was used. The participants were premature infants admitted to the neonatal intensive care unit of a university hospital in Gyeonggi Province. Sixty premature infants were assigned to either an experimental ( n = 30) or control ( n = 30) group. The experimental group was exposed to white noise during heel puncture, and the measured variables were pain response, heart rate, and oxygen saturation. The data were analyzed using the independent t test, chi-squared test, and analysis of covariance. Results Premature infants in the experimental group had a lower pain response and heart rate than the control group ( F = 81.26, P < .01; F = 7.05, P = .01), and higher oxygen saturation than the control group ( F = 4.76, P = .03). Conclusion These results demonstrated that the white noise intervention is an effective nursing intervention to reduce the pain response and stabilize heart rate and oxygen saturation in premature infants during heel puncture.
Chapter
Das erste Lebensjahr gehört zu den wohl dynamischsten Entwicklungsphasen: Nach der Geburt muss sich das Kind rasch an die neuen Lebensbedingungen anpassen. Seine Atmung und sein Kreislauf bewältigen diese Umstellung innerhalb von wenigen Minuten. Verdauung, Stoffwechsel und Ausscheidung kommen langsam über Stunden und Tage in Gang. Der Säugling braucht schließlich einige Wochen und Monate, um seinen Schlaf-Wach-Rhythmus dem Tag-Nacht-Wechsel anzugleichen. Außerdem muss er sich im ersten Lebensjahr auch an die Schwerkraft und den Raum anpassen. Für diese komplexen Entwicklungsaufgaben im Bereich des körperlichen Wachstums, der Motorik, der Wahrnehmung sowie des Schlaf- und Ernährungsverhaltens benötigt das Neugeborene bzw. der Säugling die Unterstützung der engsten Bezugspersonen, die ihm den Einstieg in die Welt ermöglichen. Dieses Kapitel beschreibt diese Entwicklungsschritte im Detail und erklärt ebenso die frühe kognitive, sprachliche und soziale Entwicklung des Säuglings.
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Background The current literature suggests a link between dummy (or pacifier) use and a number of both positive and detrimental consequences. Positive consequences include soothing effect and protection from sudden infant death syndrome (SIDS), while negative ones include increased risk of otitis media and dental malformation. However, there is little research surrounding the impact of dummy use on the development of speech sounds. Aims To investigate whether duration (in number of months) and frequency per day of dummy use have an individual or combined effect on the development of a child's speech, and if so, in what way. Methods & Procedures A total of 100 British‐English children aged 24–61 months and growing up in the UK were recruited through nurseries, playgroups and by word of mouth. Their parents were asked to complete a questionnaire about the duration and frequency of dummy use and factors known to influence the development of speech. Following this, the children's speech was assessed using the phonology section of the Diagnostic Evaluation of Articulation and Phonology (DEAP). Analysis of the DEAP was conducted to determine the percentage of consonants correct, number of age‐appropriate, delayed and atypical errors. Dummy use and speech outcome measures were then analysed qualitatively and quantitatively using mean and median group comparisons alongside multivariate generalized least squares and generalized negative binomial modelling approaches to test for significant associations. Outcomes & Results The results showed that the majority of speech outcomes are not significantly associated with dummy use, however measured, in bivariate or multivariate analyses. However, there is a significant association between increased atypical errors and greater frequency of daytime dummy use. This association is strengthened by restricted sampling within the younger members of the sample, with this association not observable within children older than 38 months, the median sample age. Conclusions & Implications The evidence base for any effects of dummy use on speech is very small. Dummy use may increase the number of atypical speech errors a young child makes. However, only the frequency of daytime use seems relevant, not the duration or night‐time use, and these errors may resolve over time. What this paper adds What is already known on this subject • The use of a dummy with infants in Western countries is comparatively high (between 36‐85%). A number of positive and detrimental consequences of dummy use have been documented in the literature; however, research on the effect of dummy use on speech development is significantly lacking. Past studies have included small sample sizes or used single measures of speech outcomes, which may not be specific enough to reveal how speech may be affected. Many speech and language therapists speculate that the use of a dummy could be contributing to many of the conditions they treat, yet this claim remains largely unsubstantiated. Clinical implications of this study • The study suggests that only prolonged use of a dummy over several hours and during the day may start to show any impact on speech; even then, professionals need to be aware that the evidence base for any speech effects is very small. Clinicians and other professionals who parents consult on dummy use should make sure to provide both the pros and cons of dummy use, in order to enable parents to make an informed decision.
Chapter
The management of pain in children requires a thorough knowledge of pain mechanisms, analgesic pharmacology, pain responses and treatment modalities that change across the spectrum of childhood. Challenges regarding pain assessment and diagnosis related to communication in children are common, and appropriate dosing must take into account the changes in drug metabolism and side effects that occur at different ages. Regional anaesthesia can be an excellent option for perioperative pain management in pediatrics but demands a specialised knowledge of childhood anatomy and regional techniques. Although pain management in children presents unique challenges, when it is provided effectively, it results in better subjective and objective outcomes for patients and their caregivers.
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Background: The association between prolonged non-nutritive sucking habits (NNSHs, ie, sucking pacifiers or fingers) and maxillofacial growth anomalies in the general population has been widely described. Because maturation of sucking abilities is not fully achieved in very preterm infants (<32 weeks' gestation), neonatal services worldwide rely on the use of pacifiers to promote the development of adequate sucking reflexes, possibly prolonging NNSHs during infancy. Objective: We aimed to describe the frequency and to identify factors associated with NNSHs at age 2 years in very preterm children. Methods: The study was based on data from EPIPAGE-2, a French national prospective cohort study of preterm births during 2011 that included 2593 children born between 24 and 31 weeks' gestation. The primary outcome was NNSHs at 2 years. Multivariable log-linear regression models with generalized estimation equations were used to study the association between the characteristics studied and NNSHs. Multiple imputations were used to take into account missing data. Results: The frequency of NNSHs was 69% in the overall sample but higher among girls (adjusted risk ratio [RR] 1.12, 95% confidence interval [CI] 1.05, 1.17), children born from multiple pregnancies (eg, twins/triplets) (RR 1.07, 95% CI 1.00, 1.11), children who were fed by nasogastric tube (RR 1.07, 95% CI 1.01, 1.13), or those who benefitted from developmental care programmes (RR 1.10, 95% CI 1.02, 1.19). The NNSHs frequency was lower if mothers were not born in France (RR 0.70, 95% CI 0.64, 0.77), children had 2 or more older siblings (RR 0.88, 95% CI 0.82, 0.96), or children were breast-fed at discharge (RR 0.90, 95% CI 0.85, 0.95). Conclusions: NNSHs at 2 years seemed associated with cultural background, development care programmes, and breast feeding. Whether NNSHs at 2 years among very preterm children are associated with future maxillofacial growth anomalies deserves further attention.
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Pacifier is a nipple given to infant or child to suck upon. It's still common user in our locality. Infants have an intense need to suck that is separate from their need to eat. Some newborns begin to suck immediately. Infants suck when they are tired, bored, or in need of comfort. Some babies have a stronger need to suck than others and-next to eating and being held-sucking may provide the most comfort to an infant. Babies who do not suck their thumbs or fingers often rely on pacifiers. Most infants cry because they do not yet have methods for soothing themselves. Some newborns do not have the coordination to suck their fingers or thumb. Although breastfeeding is the most effective way to calm infants, and their hands or thumbs can be placed in their mouths, pacifiers can be very helpful for discontented babies who cannot or will not suck their thumbs or fingers. The aims of this study to decrease problem that occurs with using of pacifier by evaluate the association between pacifier use and the increased occurrence of acute otitis media, diarrhea , oral thrush, and teething problems. The current work represented a case control study which was conducted during the period extending from the first of the July 2015 to the end of October of 2015. A simple random sampling technique had been used to collect a (200) kids (100kids use pacifier and 100 not use pacifier) from different locations in Kirkuk province and their age from birth to 5years. The 100 children that used a pacifier at baseline. 56% of children using pacifier had otitis media (OM) versus 40% of non-pacifier using.66% of children using pacifier had oral thrush versus 49% of non-pacifier use. Use of pacifier appears to be a risk factor for recurrent acute OM and oral thrush. Parents should be informed about the possible negative effect of using a pacifier once there has been diagnosed with acute OM or oral thrush to avoid recurrent OM and oral thrush.
Article
Background Divergent opinions are found in the literature regarding the use of a pacifier. During the longitudinal follow‐up of children, health professionals must take a position on this issue and offer clear information regarding the pros and cons of pacifier use so that parents/caregivers can feel comfortable enough to make their own decision. Aim Evaluate the beneficial effects of pacifier use on the sleep quality of infants. Design A cross‐sectional study was conducted at public day care centres in the city of Recife, Brazil. Interviews were held with 157 mothers of infants aged five to 13 months. Data were collected on the mother's and child's profiles. Child's sleep quality was determined using the Brief Infant Sleep Questionnaire. Results The results demonstrated no statistically significant differences between the group that used a pacifier and the group that did not use a pacifier with regard to sleep variables of the child. Conclusions When deciding whether or not to permit pacifier use, the infant's sleep quality should not be considered a critical factor.
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Purpose: to identify the prevalence of pacifier use as well as the reasons for introducing a pacifier and to analyze factors associated with this practice among children of working women with childcare in the workplace. Methods: a cross-sectional study was conducted with 46 women working at a higher education institution that offered childcare in the workplace; the children were in the age range 2.6 years. Data collection was carried out using a self-report questionnaire filled at home. Reasons for introducing a pacifier were analyzed descriptively; Poisson regression was used in the multiple analysis. Results: the prevalence of pacifier use was 63%. Most women offered the pacifier after the infant's 16th day of life, in order to calm the baby. In the multiple analysis, higher maternal education was associated with pacifier use. Conclusion: a high prevalence of pacifier use was observed, as well as early pacifier introduction, among children of working women with childcare in the workplace. With regard to the factors associated with pacifier use in this population, lower maternal education acted as a protective factor against pacifier use.
Article
The article deals with the infant's need to suck not only for the reason of feeding but also for the reason of self-pacification, self-satisfaction or pain relief. This can be achieved by giving the baby a pacifier, the advantages and disadvantages of which are documented in the article on the basis of earlier foreign research. It could lead to a conclusion that the problem whether to give a pacifier to an infant or not has already been resolved in western countries, but in our country, we are still at the beginning of the solution. So far, the opinion not to give the pacifier is prevailing, the main reason being the fear that the infant will not learn to suck from the breast. Therefore the article deals also with other advantages and disadvantages of giving the baby a pacifier, including the recommendations published by American associations of paediatricians, paediatric dentists and family physicians.
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Context The World Health Organization and the United Nations Children's Fund strongly discourage use of pacifiers because of their perceived interference with breastfeeding. Observational studies have reported a strong association between pacifier use and early weaning, but such studies are unable to determine whether the association is causal.Objectives To test whether regular pacifier use is causally related to weaning by 3 months postpartum and to examine differences in results according to randomized intervention allocation vs observational use or nonuse of pacifiers.Design Double-blind, randomized controlled trial conducted from January 1998 to August 1999.Setting Postpartum unit of a university teaching hospital in Montreal, Quebec.Participants A total of 281 healthy, breastfeeding women and their healthy, term singleton infants.Interventions Participants were randomly allocated to 1 of 2 counseling interventions provided by a research nurse trained in location counseling. The experimental intervention (n = 140) differed from the control (n = 141) by recommending avoidance of pacifier use and suggesting alternative ways to comfort a crying or fussing infant.Main Outcome Measures Early weaning, defined as weaning within the first 3 months, compared between groups; 24-hour infant behavior logs detailing frequency and duration of crying, fussing, and pacifier use at 4, 6, and 9 weeks.Results A total of 258 mother-infant pairs (91.8%) completed follow-up. The experimental intervention increased total avoidance of pacifier use (38.6% vs 16.0% in the control group), reduced daily use (40.8% vs 55.7%), and decreased the mean number of pacifier insertions per day (0.8 vs 2.4 at 4 weeks [P<.001]; 0.8 vs 3.0 at 6 weeks [P<.001]; and 1.3 vs 3.0 at 9 weeks [P = .004]). In the analysis based on randomized intervention allocation, the experimental intervention had no discernible effect on weaning at 3 months (18.9% vs 18.3% in the experimental vs control group; relative risk [RR], 1.0; 95% confidence interval [CI], 0.6-1.7), and no effect was observed on cry/fuss behavior (in the experimental vs control groups, respectively, total daily duration, 143 vs 151 minutes at 4 weeks [P = .49]; 128 vs 131 minutes at 6 weeks [P = .81]; and 110 vs 104 minutes at 9 weeks [P = .58]). When randomized allocation was ignored, however, we observed a strong observational association between exposure to daily pacifier use and weaning by 3 months (25.0% vs 12.9% of the exposed vs unexposed groups; RR, 1.9; 95% CI, 1.1-3.3).Conclusions We found a strong observational association between pacifier use and early weaning. No such association was observed, however, when our data were analyzed by randomized allocation, strongly suggesting that pacifier use is a marker of breastfeeding difficulties or reduced motivation to breastfeed, rather than a true cause of early weaning. Figures in this Article Pacifiers have been around for a very long time. Small clay pacifiers have been found in Cypriot graves dating back to about 1000 BC, and breast-shaped pottery nipples have been recovered from Roman graves dating from around AD 100.1- 2 In the early 1900s, however, pacifiers began to be condemned by the infant welfare movement. Various reformers referred to the pacifier as a product of "perverted American ingenuity,"3 an "instrument of torture,"4 and a "curse of babyhood."5 More recently, clinicians and public health practitioners have raised concerns that the pacifier causes "nipple confusion" and thereby leads to early weaning.6 In fact, avoidance of pacifiers constitutes step 9 of the World Health Organization/United Nations Children's Fund Baby-Friendly Hospital Initiative.7 What is the evidence of actual benefit or harm associated with pacifier use? Several observational studies published since the Baby-Friendly Hospital Initiative was developed, including studies from Brazil,8- 10 Sweden,11- 12 England,13- 14 New Zealand,15 and the United States,16 have reported a significant association between pacifier use and early weaning. The question is whether such an association is causal, or whether pacifier use is a marker of breastfeeding difficulties or a mother's reduced motivation to continue breastfeeding. No physiological evidence has validated the concept of nipple confusion; an infant can apparently distinguish nutritive from nonnutritive sucking.17- 20 It is clear that pacifiers reduce crying in the short term21- 25 but no studies have assessed whether the regular use of pacifiers reduces the overall duration or frequency of crying and fussing. Such studies are important, because proscription of pacifier use could conceivably increase infant distress and thereby impair infant-parent relationships. The major objectives of our study were to assess whether advice to avoid pacifier use and to use other modes of calming a crying or fussing infant reduces the risk of early weaning (before age 3 months) and increases the frequency or duration of crying and fussing. We also wished to assess the bias that occurs in using an observational vs an experimental design to study the effect of pacifier use on breastfeeding duration.
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Oral candida in subjects who sucked dummies was almost double that of controls. Although the carriage of Candida albicans on silicone dummies was significantly reduced compared with latex dummies, oral colonisation was unaffected, suggesting that dummy carriage is not the cause of the observed increase.
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To evaluate the effects of pacifier use and the timing of pacifier introduction on breastfeeding duration, problems, and frequency. A cohort of 265 breastfeeding mother-infant dyads was followed prospectively. Maternal interviews were conducted at delivery, 2, 6, 12, and 24 weeks, and thereafter every 90 days until breastfeeding ended. Information was obtained regarding pacifier use, infant feeding, use of supplemental foods and breastfeeding frequency, duration, and problems. The effect of pacifier introduction by 6 weeks of age on breastfeeding duration was evaluated with Kaplan-Meier and Cox proportional hazards models. The effect of the timing of pacifier introduction (</=2 weeks and </=6 weeks) on breastfeeding duration at 2 and 3 months was evaluated using logistic regression modeling. A total of 181 mothers (68%) introduced a pacifier before 6 weeks. In adjusted analyses, pacifier introduction by 6 weeks was associated with a significantly increased risk for shortened duration of full (hazard ratio, 1.53; 95% confidence interval: 1.15, 2.05) and overall (hazard ratio, 1.61; 95% confidence interval: 1.19,2.19) breastfeeding. Women who introduced pacifiers tended to breastfeed their infants fewer times per day, with significant differences noted at 2 (8.1 +/- 2.6 vs 9.0 +/- 2.3) and 12 weeks' (6.3 +/- 2.0 vs 7.4 +/- 1.6) postpartum. At 12 weeks postpartum, women who introduced pacifiers also were more likely to report that breastfeeding was inconvenient and that they had insufficient milk supplies. Pacifier use begun either before 2 weeks or before 6 weeks' postpartum was not significantly associated with breastfeeding duration at 2 and 3 months. Pacifier use was independently associated with significant declines in the duration of full and overall breastfeeding. Breastfeeding duration in the first 3 months' postpartum, however, was unaffected by pacifier use. Women who introduced pacifiers tended to breastfeed their infants less frequently and experienced breastfeeding problems consistent with infrequent feeding. Findings from this study suggest that the decreases in breastfeeding duration associated with pacifier use may be a consequence of less frequent breastfeeding among women who introduce pacifiers to their infants.
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To analyze the influence of thumb sucking and pacifier use on breastfeeding patterns in exclusively breastfed infants, on the duration of exclusive breastfeeding, and on the total breastfeeding duration. Descriptive, longitudinal, prospective study. The subjects were recruited from a population of 15 189 infants born in the maternity ward at the University Hospital, Uppsala, Sweden between May 1989 and December 1992. 506 mother-infant pairs. Daily recordings by the mothers on infant feeding from the first week after delivery through the duration of the study. Fortnightly home visits with structured interviews by a research assistant. Pacifier use was associated with fewer feeds and shorter suckling duration per 24 hours, shorter duration of exclusive breastfeeding, and shorter total breastfeeding duration compared with no pacifier use. These associations were not found for thumb sucking. The possible negative effects of pacifiers on breastfeeding seemed to be related to the frequency of their use. Maternal age and education only slightly modified the association between pacifier use and breastfeeding duration. More frequent use of a pacifier was associated with shorter breastfeeding duration, even among a group of mothers who were highly motivated to breastfeed. breastfeeding duration, breastfeeding pattern, exclusive breastfeeding, pacifier use, thumb sucking.
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To assess and compare the analgesic effects of orally administered glucose and sucrose and pacifiers. To determine the synergistic analgesic effect of sucrose and pacifiers. Randomised prospective study with validated behavioural acute pain rating scale. Maternity ward. 150 term newborns undergoing venepuncture randomly assigned to one of six treatment groups: no treatment; placebo (2 ml sterile water); 2 ml 30% glucose; 2 ml 30% sucrose; a pacifier; and 2 ml 30% sucrose followed by a pacifier. Median (interquartile) pain scores during venepuncture were 7 (5-10) for no treatment; 7 (6-10) for placebo (sterile water); 5 (3-7) for 30% glucose; 5 (2-8) for 30% sucrose; 2 (1-4) for pacifier; and 1 (1-2) for 30% sucrose plus pacifier. Mann-Whitney U test P values for comparisons of 30% glucose, 30% sucrose, pacifier, and 30% sucrose plus pacifier versus placebo (sterile water) were 0.005, 0.01, <0.0001, and <0.0001, respectively. Differences between group median pain scores for these comparisons were 2 (95% confidence interval 1 to 4), 2 (0 to 4), 5 (4 to 7), and 6 (5 to 8), respectively. P values for comparisons of 30% glucose, 30% sucrose, and 30% sucrose plus pacifier versus pacifier were 0.0001, 0.001, and 0.06, respectively. Differences between group medians for these comparisons were 3 (2 to 5), 3 (1 to 5), and 1 (0 to 2), respectively. The analgesic effects of concentrated sucrose and glucose and pacifiers are clinically apparent in newborns, pacifiers being more effective than sweet solutions. The association of sucrose and pacifier showed a trend towards lower scores compared with pacifiers alone. These simple and safe interventions should be widely used for minor procedures in neonates.
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Very preterm newborns undergo multiple invasive procedures. Nonpharmacological interventions are valuable alternatives for pain relief during minor procedures in neonates. Oral sucrose analgesia has been widely studied in term and preterm neonates during painful procedures. The analgesic effect of oral glucose in very preterm infants has not yet been reported. The objectives of this study were to assess the analgesic effect of orally administered glucose and to determine the synergetic analgesic effect of glucose and pacifiers during subcutaneous injections in very preterm neonates using a validated behavioral acute pain rating scale. Two crossover trials. One neonatal intensive care unit in a community-based general hospital. A prospective study was conducted in 40 very preterm neonates. Each infant received 2 treatments in a crossover manner during 2 consecutive subcutaneous injections of erythropoietin. The first trial (25 infants) was intended to compare oral 30% glucose (0.3 mL) versus placebo (0.3 mL of sterile water); the second trial (15 infants) compared oral 30% glucose (0.3 mL) versus oral 30% glucose (0.3 mL) followed by sucking a pacifier. The primary outcome measure was the evaluation of pain induced by a subcutaneous injection of erythropoietin, using Douleur Aiguë Nouveau-né scale (0 no pain, 10 maximum pain). Twenty-four infants completed the study in the first trial and 15 in the second one. Mean (95% confidence interval [CI]) gestational age, birth weight, postnatal age, and weight at inclusion for neonates in the first and second trial were, respectively, 28.1 (95% CI: 27.3-29.0) and 29.1 (95% CI: 27.8-30.4) weeks, 1036 (95% CI: 944-1128) and 995 (95% CI: 848-1141) g, 26.4 (95% CI: 22.4-30.3) and 26 (95% CI: 22.0-29.9) days, and 1234 (95% CI: 1120-1348) and 1209 (95% CI: 1059-1359) g. In the first trial, median (interquartile) pain scores for placebo and 30% glucose, respectively, were 7 (2.5-9.75) and 4.5 (1-6). In the second trial, median (interquartile) pain scores for 30% glucose and for 30% glucose plus pacifier, respectively, were 4 (2-7) and 4 (1-6). A small dose of 0.3 mL of 30% oral glucose has an analgesic effect in very preterm neonates during subcutaneous injections. This effect is clinically evident because it can be detected by a behavioral pain rating scale. The synergetic analgesic effect of glucose plus sucking a pacifier is less obvious in very preterm neonates as opposed to what other studies have showed in full-term infants.
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The aim of this study was to evaluate the characteristics of the dental arches and some oral myofunctional structures in 36- to 60-month-old children who sucked a pacifier or did not have this habit. Sixty-one children were divided into 3 groups: (1) those who never sucked a pacifier, (2) those who exclusively sucked a physiological pacifier, and (3) those who exclusively sucked a conventional one. A clinical examination was performed on the children to observe the relationship between the arches and their width, as well as the following oral myofunctional structures: lips, tongue, cheeks, and hard palate. Statistical analysis showed that: (1) the use of both ytpes of pacifiers led to anterior open bite (prevalence of 50% in both groups; P = . 001), (2) posterior crossbite was present only on children who had a pacifier-sucking habit, (3) the mean oveqrjt was greater on children who sucked physiological (3.6 mm) or conventional (3.7 mm) pacifiers when compared to those with no sucking habits (1.3 mm; P = .001), (4) intercanine distance of the upper arch was significantly smalelr on children who sucked pacifiers (29.6 mm in the physiological group and 29.2 mm in the conventional pacifier group) than those who did not (31.2 mm), and (5) the children who never sucked on a pacifier showed a higher prevalence of normality of cheek mobility (74%; P = .022) and hard palate shape (78%; P = .042). Children who sucked pacifiers, both conventional and physiological ones, showed higher prevalence of alterations in the relationship of the dental arches and orla myofunctional structures, when compared to those who never sucked a pacifier.
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To determine the effect of artificial teats (bottle and dummy) and cups on breast feeding in preterm infants. Randomised controlled trial. Two large tertiary hospitals, 54 peripheral hospitals. 319 preterm infants (born at 23-33 weeks' gestation) randomly assigned to one of four groups: cup/no dummy (n = 89), cup/dummy (n = 72), bottle/no dummy (n = 73), bottle/dummy (n = 85). Women with singleton or twin infants < 34 weeks' gestation who wanted to breastfeed were eligible to participate. Cup or bottle feeding occurred when the mother was unable to be present to breast feed. Infants randomised to the dummy groups received a dummy on entry into the trial. Full breast feeding (compared with partial and none) and any breast feeding (compared with none) on discharge home. Secondary outcomes: prevalence of breast feeding at three and six months after discharge and length of hospital stay. 303 infants (and 278 mothers) were included in the intention to treat analysis. There were no significant differences for any of the study outcomes according to use of a dummy. Infants randomised to cup feeds were more likely to be fully breast fed on discharge home (odds ratio 1.73, 95% confidence interval 1.04 to 2.88, P = 0.03), but had a longer length of stay (hazard ratio 0.71, 0.55 to 0.92, P = 0.01). Dummies do not affect breast feeding in preterm infants. Cup feeding significantly increases the likelihood that the baby will be fully breast fed at discharge home, but has no effect on any breast feeding and increases the length of hospital stay.
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This Clinical Report was reaffirmed December 2020 Control of pain and stress for children is a vital component of emergency medical care. Timely administration of analgesia affects the entire emergency medical experience and can have a lasting effect on a child’s and family’s reaction to current and future medical care. A systematic approach to pain management and anxiolysis, including staff education and protocol development, can provide comfort to children in the emergency setting and improve staff and family satisfaction.
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The goal of this study was to verify the prevalence of nutritive (breast-feeding and bottle-feeding) and non-nutritive (pacifier) sucking habits, the methods used to eliminate them, and success of these methods. To collect the data, 502 questionnaires were distributed to parents of 0- to 6-year-old children. Bottle-feeding was used by 83% and pacifier by 63% of children. The professional's explanation, the use of substances on the pacifier, the abrupt interruption of the habit, and parents' explanations were efficient in 90%, 80%, 64%, and 38% of the cases, respectively. Sucking habits had a high prevalence in this sample. An indirect linear relationship between breast-feeding and pacifier use demonstrated that the more the child was breast-fed, the less the pacifier was used. The most efficient method to end the pacifier-sucking habit was professional explanation; however, it was used less often.
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To enhance breastfeeding practices, the World Health Organization discourages pacifiers and bottle-feeding. However, the effect of artificial nipples on breastfeeding duration is poorly defined. The effects of 2 types of artificial nipple exposure on breastfeeding duration were evaluated: 1) cupfeeding versus bottle-feeding for the provision of in-hospital supplements and 2) early (2-5 days) versus late (>4 weeks) pacifier introduction. A total of 700 breastfed newborns (36-42 weeks, birth weight >or=2200 g) were randomly assigned to 1 of 4 intervention groups: bottle/early pacifier (n = 169), bottle/late pacifier (n = 167), cup/early pacifier (n = 185), or cup/late pacifier (n = 179). The cup/bottle intervention was invoked for infants who received supplemental feedings: cup (n = 251), bottle (n = 230). Data were collected at delivery and at 2, 5, 10, 16, 24, 38, and 52 weeks' postpartum. Intervention effects on breastfeeding duration were evaluated with logistic regression and survival analyses. Supplemental feedings, regardless of method (cup or bottle), had a detrimental effect on breastfeeding duration. There were no differences in cup versus bottle groups for breastfeeding duration. Effects were modified by the number of supplements; exclusive and full breastfeeding duration were prolonged in cup-fed infants given >2 supplements. Among infants delivered by cesarean, cupfeeding significantly prolonged exclusive, full, and overall breastfeeding duration. Exclusive breastfeeding at 4 weeks was less likely among infants exposed to pacifiers (early pacifier group; odds ratio: 1.5; 95% confidence interval: 1.0-2.0). Early, as compared with late, pacifier use shortened overall duration (adjusted hazard ratio: 1.22; 95% confidence interval: 1.03-1.44) but did not affect exclusive or full duration. There was no advantage to cupfeeding for providing supplements to the general population of healthy breastfed infants, but it may have benefitted mother-infant dyads who required multiple supplements or were delivered by cesarean. Pacifier use in the neonatal period was detrimental to exclusive and overall breastfeeding. These findings support recommendations to avoid exposing breastfed infants to artificial nipples in the neonatal period.
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Screening is necessary for infants at risk of retinopathy of prematurity. Despite local anaesthetic drops, infants find eye examinations distressing, displaying behavioural and physiological changes indicating acute pain. Oral sucrose and non-nutritive sucking reduce pain responses associated with invasive procedures. To evaluate the use of oral sucrose and/or pacifier for reducing pain responses during eye examinations. Forty infants <32 weeks gestation or <1500 g birth weight, in two neonatal units, were randomised to one of four interventions administered two minutes before their first screening examination: 1 ml sterile water as placebo (group 1, n = 10), 1 ml 33% sucrose solution (group 2, n = 10), 1 ml sterile water with pacifier (group 3, n = 9), or 1 ml 33% sucrose solution with pacifier (group 4, n = 11). Examinations were videotaped. Two observers, blind to the intervention, assessed recordings. Pain responses were scored using the premature infant pain profile (PIPP). The groups were similar in gestation, birth weight, and age at examination. Mean PIPP scores were 15.3, 14.3, 12.3, and 12.1 for groups 1, 2, 3, and 4 respectively. Analysis of variance showed a significant difference in PIPP score between groups (p = 0.023). Infants randomised to pacifiers scored lower than those without pacifiers (p = 0.003). There was no difference between groups receiving sucrose and those receiving water (p = 0.321). Non-nutritive sucking reduced distress responses in infants undergoing screening for retinopathy of prematurity. The difference in response was large enough to be detected by a validated assessment tool. No synergistic effect of sucrose and pacifier was apparent in this group.
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A randomized study was done to compare non pharmacological methods to reduce the pain of heel pricks in 104 stable term neonates. Non-nutritive sucking (NNS), rocking, massage, sucrose (20 percent), distilled water (DW) and expressed breast milk (EBM) were used as pain reducing agents. Duration of cry and Douleur Aiguë du Nouveau né (DAN) score were used to assess pain. Physiological parameters were also recorded before and after the stimulus. At 30 seconds after the stimulus, the pain scores were lowest in the sucrose group but this was not sustained at 1, 2 and 4 minutes. At 2 and 4 minutes pain scores were lowest in the NNS and rocking groups as compared to sucrose, distilled water, expressed breast milk and massage. The total duration of crying was also lowest in the NNS and rocking groups. Physiological parameters were comparable in all groups. Babies who were in Prechtl State 1 and 2 (sleeping) at the time of stimulus showed significantly lesser response to pain compared to babies who were awake. This was seen in all the intervention groups. In conclusion, our study suggests that rocking or giving a baby a pacifier are more effective non-pharmacological analgesics than EBM, DW, sucrose or massage for the pain of heel pricks in neonates. A calm or sleeping state before a painful procedure also appears to decrease crying and pain scores.
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Although sucrose has been accepted as an effective analgesic agent for procedural pain in neonates, previous studies are largely in the NICU population using the procedure of heel lance. This is the first report of the effect of sucrose, pacifier or the combination thereof for the procedural pain of venipuncture in infants in the pediatric emergency department population. The study design was a double (sucrose) and single blind (pacifier), placebo-controlled randomized trial--factorial design carried out in a pediatric emergency department. The study population was infants, aged 0-6 months. Eighty-four patients were randomly assigned to one of four groups: a) sucrose b) sucrose & pacifier c) control d) control & pacifier. Each child received 2 ml of either 44% sucrose or sterile water, by mouth. The primary outcome measure: FLACC pain scale score change from baseline. Secondary outcome measures: crying time and heart rate change from baseline. Sucrose did not significantly reduce the FLACC score, crying time or heart rate. However sub-group analysis revealed that sucrose had a much greater effect in the younger groups. Pacifier use reduced FLACC score (not statistically significant), crying times (statistically significant) but not heart rate. Subgroup analysis revealed a mean crying time difference of 76.52 seconds (p < 0.0171) (0-1 month) and 123.9 seconds (p < 0.0029) (1-3 month). For subgroup age > 3 months pacifier did not have any significant effect on crying time. Age adjusted regression analysis revealed that both sucrose and pacifier had significant effects on crying time. Crying time increased with both increasing age and increasing gestational age. Pacifiers are inexpensive, effective analgesics and are easy to use in the PED for venipuncture in infants aged 0-3 months. The benefits of sucrose alone as an analgesic require further investigation in the older infant, but sucrose does appear to provide additional benefit when used with a pacifier in this age group. Current Controlled Trials ISRCTN15819627.
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To investigate the association of finger and pacifier-sucking habits, breathing pattern, and adenoid size with the development of malocclusion in primary dentition. A case-control study was carried out involving 300 preschool children, ages 3 to 6 years, randomly selected from 10 public and 10 private preschools from a large representative sample of 745 children. The study was developed to identify risk factors associated with the development of malocclusion. The case group (n = 150) was composed of individuals with at least one of the following malocclusions: anterior open bite, posterior crossbite, or overjet of more than 3 mm. The control group (n = 150) was made up of individuals without malocclusions. Other variables were assessed through questionnaires about oral habits, including the use of a dummy, finger sucking, duration of these habits; mouth-breathing analysis; and a lateral cephalometric radiograph to evaluate the airway obstruction related to the adenoids. Multiple logistic regression analyses were performed. Statistical significance was P < .05. The risk factors for the occurrence of malocclusion in preschool children were duration of pacifier-sucking after 2 years of age (OR = 14.7) and mouth-breathing pattern (OR = 10.9). No significant associations were found between hypertrophied adenoids or finger-sucking habits and the occurrence of malocclusion. The malocclusion in the primary dentition in preschool children was directly related to the duration of pacifier-sucking after 2 years of age and the mouth-breathing pattern.
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Recently, the use of a pacifier has been identified as a risk factor for acute otitis media (AOM). The studies performed so far, however, suffer from methodological limitations. To study whether pacifier use increases the risk of AOM. Four hundred and ninety-five children between the ages of 0 and 4 years followed from 2000 to 2005 in a dynamic population study in the Leidsche Rijn residential area in Utrecht, The Netherlands. At baseline, the parents of these children filled out a questionnaire regarding pacifier use and potential confounders. AOM was diagnosed by GPs according to the International Classification of Primary Care coding system. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Of the 216 children that used a pacifier at baseline, 76 (35%) developed at least one episode of AOM, and of the 260 children that did not use a pacifier, 82 (32%) developed at least one AOM episode; for recurrent AOM, these figures were 33 (16%) versus 27 (11%), respectively. The adjusted ORs for pacifier use and AOM and recurrent AOM were 1.3 (95% CI 0.9-1.9) and 1.9 (95% CI 1.1-3.2), respectively. Pacifier use appears to be a risk factor for recurrent AOM. Parents should be informed about the possible negative effects of using a pacifier once their child has been diagnosed with AOM to avoid recurrent episodes.
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There has been a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed down for sleep in a nonprone position. Although the SIDS rate continues to fall, some of the recent decrease of the last several years may be a result of coding shifts to other causes of unexpected infant deaths. Since the AAP published its last statement on SIDS in 2000, several issues have become relevant, including the significant risk of side sleeping position; the AAP no longer recognizes side sleeping as a reasonable alternative to fully supine sleeping. The AAP also stresses the need to avoid redundant soft bedding and soft objects in the infant's sleeping environment, the hazards of adults sleeping with an infant in the same bed, the SIDS risk reduction associated with having infants sleep in the same room as adults and with using pacifiers at the time of sleep, the importance of educating secondary caregivers and neonatology practitioners on the importance of "back to sleep," and strategies to reduce the incidence of positional plagiocephaly associated with supine positioning. This statement reviews the evidence associated with these and other SIDS-related issues and proposes new recommendations for further reducing SIDS risk.
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This Policy Statement was revised. See https://doi.org/10.1542/peds.2022-057988 This policy statement on breastfeeding replaces the previous policy statement of the American Academy of Pediatrics, reflecting the considerable advances that have occurred in recent years in the scientific knowledge of the benefits of breastfeeding, in the mechanisms underlying these benefits, and in the practice of breastfeeding. This document summarizes the benefits of breastfeeding to the infant, the mother, and the nation, and sets forth principles to guide the pediatrician and other health care providers in the initiation and maintenance of breastfeeding. The policy statement also delineates the various ways in which pediatricians can promote, protect, and support breastfeeding, not only in their individual practices but also in the hospital, medical school, community, and nation.
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Many medical and child-care experts in the early years of this century viewed the dummy as a serious hazard to the health and development of babies. With the growth of the infant welfare movement, these beliefs were incorporated into health visitors' advice to mothers. A unique set of records made by health visitors in Hertford-shire has been used to explore the determinants and consequences of dummy-use in infancy. These data show that the prevalence of dummy-use, as recorded by health visitors, nearly halved in the period 1911–30, indicating the power of the anti-dummy campaign. Babies in Hertfordshire were more likely to use dummies if they were boys, if their mother was young or had herself been born in the county. Although the incidence of infections and nutritional deficiencies was higher amongst dummy-users, the absolute size of the difference was very small. The intensity of feeling aroused by the dummy in medical and child-care experts is not justified by any evidence from these records concerning the consequences of dummy-use. Opposition to the dummy stemmed in part from the belief that it was a vector of germs and dirt. Diarrhoea was the largest single cause of post-neonatal death in the early twentieth century, and contemporary medical opinion held that ’dirt‘ was somehow responsible, though no association between dummy-use and diarrhoea was found in the Hertfordshire data. Perhaps part of the explanation for the antagonism towards the dummy lies in the conviction, common among child-care experts at this time, that indulging babies' desires for comfort and pleasure would be detrimental to their characters.
Article
Aims: To assess the prevalence of pacifier and digit sucking at 15 months of age and to investigate whether this habit adversely affects the health of 18 month old infants. Study Design: Data collected via self-completion questionnaires from mothers forming part of the prospective, population based Avon Longitudinal Study of Pregnancy and Childhood. Subjects and Methods: The mothers of 10 006 infants gave information on their child’s use of a pacifier and of digit sucking at 15 months of age and the presence of specific health symptoms at 18 months of age. Adjusted logistic regression was performed to identify any statistically significant associations between pacifier use, digit sucking or a combination of the two with possible infection. Results: 36.3% of infants sucked a pacifier, 21.3% their thumb or finger and 2.7% sucked both at 15 months. Statistically significant differences were observed among various socio-demographic variables. Mothers were more likely to give their child a pacifier if they were younger, had lower levels of education, experienced greater financial difficulties or lived in council housing (compared to owned/mortgaged). The opposite was apparent for digit suckers. After allowing for these possible confounding factors, pacifier users had a higher incidence of earache and colic compared to children with no sucking habit, however digit suckers had a lower incidence of these symptoms. Children who sucked both were significantly more likely to have reported wheezing, earache, and poor health in the past month. Conclusions: Significantly different sociodemographic characteristics were observed with pacifier suckers compared to those who sucked their thumb or finger. It is almost impossible to attribute the direction of causality between infection and a sucking habit. Further and more detailed studies are needed before any recommendations can be made based on the statistically significant associations found as they are unlikely to be of major clinical significance.
Article
This study was designed to compare the occlusions of 24- to 59-month-old children who used orthodontic or conventional pacifiers to the occlusions of a group of controls who had no sucking habits. Information on the habits was collected by parental questionnaires. Ninety-five children were examined for malocclusions involving overbite, overjet, canine, and molar relationships, and posterior crossbites. Users of orthodontic pacifiers had statistically significantly greater overjets, and there was a significantly higher proportion of subjects with open bite in the conventional pacifier group. There was a trend toward a greater number of subjects in the control and orthodontic pacifier group with overbites less than or equal to 50%. These differences were not clinically significant, however. There appeared to be only minor differences between the occlusions of the two pacifier groups.
Article
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The occurrence of acute otitis media (AOM) has increased steadily during the last 15 years. The possible environmental risks associated with AOM should be well identified to prevent any further increase in its occurrence. A meta-analysis of the studies evaluating the risk factors for AOM was performed. A MEDLINE search of the medical literature from 1966 to 1994 with the key words children, risk, acute otitis media, and recurrent acute otitis media was performed, and the references of the articles that were found served as the sources for the studies used in the meta-analysis. Sixtyone studies were identified. Twenty-two (36%) of these studies were accepted for the meta-analysis. Depending on the risk factor, there were two to seven different studies from which risk ratios (RRs) could be pooled. The studies were performed in six different countries. If any other member of the family had had AOM, the risk increased (RR, 2.63; 95% confidence interval [CI], 1.86–3.72; P = .00001). The risk of AOM increased with day care outside the home (RR, 2.45; 95% CI, 1.51–3.98; P = .0003) and family day care (RR, 1.59; 95% CI, 1.19–2.13; P = .002). The risk of AOM increased with parental smoking (RR, 1.66; 95% CI, 1.33–2.06; P < .00001). Breast-feeding for at least 3 months reduced the risk of AOM (RR, 0.87; 95% CI, 0.79–0.95; P = .003). The use of a pacifier increased the risk of AOM (RR, 1.24; 95% CI, 1.06–1.46; P = .008). Child care outside the home and parental smoking were the factors that most significantly increased the occurrence of AOM.
Article
We analyzed the occurrence of salivary lactobacilli and Candida in a sample of 166 children aged 1-4 years (mean, 2.5 years) in relation to possible risk factors for colonization of the microbes. The risk factors examined were sucking habits, feeding habits, symptoms of respiratory infections, and antibiotic therapy at the time of sampling. Lactobacilli occurred in 18% of the children's saliva, and Candida in 24%. In the logistic modeling the variables most strongly associated with the occurrence of lactobacilli were pacifier-sucking (relative risk (RR), 2.9; 95% confidence interval (CI), 1.1-7.0; P = 0.01) and antibiotic therapy (RR, 4.6; CI, 1.2-16.9; P = 0.01). The association between positive Candida test and use of a pacifier was also significant (RR, 4.8; CI, 2.1-10.7; P = 0.0001). The results of the study suggest that the use of a pacifier increases the occurrence of both salivary lactobacilli and Candida. It could therefore be a factor influencing caries susceptibility and activity in children.
Article
The presence of aerobic and facultative anaerobic bacteria on the surface of pacifiers used by children with acute otitis media was investigated. The surface of 40 recently used pacifiers was swabbed after they were allowed to dry for five to six minutes. The swabs were processed quantitatively for the presence of aerobic bacteria. The antibacterial activity of the pacifier material was tested in vitro. Microorganisms were isolated from 21 (52.5 per cent) pacifiers. The number of colonies per pacifier varied between one and 35 (average six). The isolates included eight alpha-haemolytic streptococci, six Staphylococcus epidermis, five Candida albicans, five alpha-haemolytic streptococci, three Neisseria spp. and two Staphylococcus aureus. The pacifier material was shown to be inhibitory against S. aureus. This study illustrated that pacifiers do not contain high numbers of organisms and therefore are not likely to serve as a source of persistence of transfer of organisms.
Article
To evaluate the association between pacifier use and the increased occurrence of acute otitis media (AOM) in an intervention trial. 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. 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. 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.
Article
To determine the predictors of pacifier use during the first year of life and to assess the influence of pacifier use on the duration of breastfeeding. A prospective cohort study was conducted. Three hundred and fifty mother-infant pairs were followed to 1 year of age to determine the impact of the use of a pacifier on the duration of breastfeeding. A cohort of 441 mothers were enrolled and 79% participated. Ninety four per cent were followed up to 1 year. Daily pacifier use was associated with early cessation of breastfeeding (risk ratio (RR) 1.71; 95% confidence interval (95%CI) 1.29, 2.28) and a reduced duration of full breastfeeding (adjusted (adj.) RR 1.35; 95%CI 1.05, 1.74). Finger sucking was not associated with a reduced duration of breastfeeding (RR 1.05; 95%CI 0.81, 1.37). Pacifier use less than daily was not associated with a change in duration of breastfeeding (RR 1.02; 95%CI 0.75, 1.39). Most mothers commenced the use of a pacifier within the first month. Multiple logistic regression analysis found that the use of a pacifier was associated with male gender (adj. RR 1.97; 95%CI 1.23, 3.13), maternal smoking in pregnancy (adj. RR 2.23; 95%CI 1.01, 4.95), and low maternal confidence with breastfeeding (adj. RR 2.70; 95%CI 1.48, 4.93). Daily pacifier use is associated with a reduced duration of breastfeeding. Less frequent pacifier use does not reduce the duration of breastfeeding.
Article
The frequency of oral yeast ingestion and its relationship with sucking and feeding habits was described in children from one to 18 months of age. Yeasts were detected in 58.3 percent of children and the most prevalent species were Candida parapsilosis and Candida albicans. The use of a pacifier was positively associated with the frequency of yeast infection and with the levels of these microorganisms in the mouth. No relationship was detected between the prevalence of yeast and breast-feeding or bottle-feeding habits. The results suggest that use of a pacifier is an important local factor in the colonization and proliferation of yeast in the oral cavity.
Article
Studies dating to the 1870s have demonstrated that long-term nonnutritive sucking habits may lead to occlusal abnormalities, including open bite and posterior crossbite. However, little is known as to whether habits of shorter durations have lasting effects. The authors collected longitudinal data on nonnutritive sucking among children through a series of questionnaires regularly completed by parents. Researchers examined the children at ages 4 to 5 years and obtained study models. The models were measured for dental arch parameters (including arch width, arch length and arch depth) and assessed for overjet, overbite and posterior crossbite. The authors compared the dental arch and occlusal conditions among groups of children with nonnutritive sucking habits of different durations. Children with nonnutritive sucking habits that continued to 48 months of age or beyond demonstrated many significant differences from children with habits of shorter durations: narrower maxillary arch widths, greater overjet and greater prevalence of open bite and posterior crossbite. In addition, compared with those who ceased their habit by 12 months of age, those with habits at 36 months of age had significantly greater mandibular canine arch widths, maxillary canine arch depths and overjet, while those with habits at 24 months and 36 months had significantly smaller palatal depths. Prevalence of anterior open bite, posterior crossbite and excessive overjet (> 4 millimeters) increased with duration of habits. While continuous nonnutritive sucking habits of 48 months or longer produced the greatest changes in dental arch and occlusal characteristics, children with shorter sucking durations also had detectable differences from those with minimal habit durations. It may be prudent to revisit suggestions that sucking habits continued to as late as 5 to 8 years of age are of little concern.
Article
The purpose of this study was to identify the least painful circumcision method. The infants were circumcised with either the Mogen or the Gomco procedure and were given a sweetened pacifier or a pacifier dipped in water. All infants had a eutectic mixture of local anesthetic cream applied before circumcision. The duration of the crying and grimacing were measured. The Gomco procedure took 1.9 times longer to complete. Infants who were circumcised with the Mogen procedure cried and grimaced far less than infants who were circumcised with the Gomco procedure (P =.0001). Sucrose on a pacifier was far more analgesic than water on a pacifier for infants in the Gomco group. On the basis of these and other findings on pain prevention and amelioration, we recommend that a local anesthetic be administered in advance of circumcision and that the Mogen procedure be used, unless contraindicated. We also recommend that infants be given a sweetened pacifier before, during, and after circumcision if the Gomco method is used.
Article
To examine the efficacy of pacifiers and sugar, alone and in combination, for pain management in neonates. An experimental design examined pain responses of 84 newborns undergoing heelstick. They were randomly assigned to one of four groups: (a) water-moistened pacifier, (b) sugar-coated pacifier, (c) 2 cc of a 12% oral sucrose solution, or (d) control. Pain measures were duration of cry, vagal tone, and salivary cortisol. Multivariate analysis of variance (MANOVA) revealed that the sugar-coated pacifier group cried significantly less than the water-moistened pacifier and control groups. Repeated measures analysis of variance (ANOVA) revealed that the sugar-coated pacifier group demonstrated significantly lower vagal tone during heelstick than the oral sucrose solution and control groups. This difference between the sugar-coated pacifier and control groups persevered for 15 minutes after heelstick. Offering a sugar coated pacifier during heelstick in healthy neonates reduces pain behaviors more effectively than a water-moistened pacifier, 2 cc of a 12% sucrose solution, or no intervention.
Article
This evidence-based study of the literature investigated the relationship between pacifier use (with and without sweetening and prolonged or short-term) and early childhood caries (ECC). The review was based on evidence from 3 main sources: a search of several electronic bibliographic databases, a review of the references from relevant studies for additional potentially relevant articles and a review of several dental textbooks. A total of 74 articles were reviewed. Of these, 8 were deemed relevant and were critically appraised according to a "causation checklist" of 13 items. The 8 studies assessed were methodologically inconsistent in terms of definitions of ECC, diagnostic criteria for identifying carious lesions, dental examination procedures, interviewing methods, and descriptions of pacifier use. None of the studies achieved a score greater than 6 and hence none was considered to present strong evidence. Six studies did not control for confounding variables, and the conclusions they generated were inconsistent. The evidence from the other 2 studies, which did control for confounding factors, presented slightly stronger evidence, but they indicated no statistical difference in pacifier use between children with and those without ECC; furthermore, the reported odds ratios suggested that pacifier use might have had a mildly protective effect. Overall, the evidence does not suggest a strong or consistent association between pacifier use and ECC.