Ear Infections and Pacifiers

Dr. Greene's Answer

University researchers from Finland have published a study of 845 children attending day care. They followed the children for fifteen months, keeping track of behaviors which might influence the number of ear infections. These included breast feeding, parental smoking, thumb sucking, bottle use, and social class.

The strongest association was with pacifier use, which increased the frequency of ear infections by 50%. In children less than two years of age, pacifier use increased the average number of annual ear infections from 3.6 to 5.4 episodes. In children between two and three years of age, pacifier use increased the number from 1.9 to 2.7 ear infections per year. Presumably, either the sucking motion associated with pacifier use hinders proper eustachian tube function (which normally keeps the middle ear open and clean), or – particularly in day care – the pacifiers act as fomites (germ covered objects that spread infection). The authors suggest that pacifiers be used only during the first ten months of life when the need for sucking is strongest and episodes of ear infections are relatively uncommon.

A more recent study in children less than 2 years old demonstrated a similar association between pacifier use and ear infections. Researchers found a 33% reduction in the rate of ear infections when pacifier use was limited. The authors recommend that pacifier use be reduced to moments when falling asleep after 6 months of age and discontinued altogether after 10 months of age.

I believe that sucking is an important comfort measure for many babies. Moreover, sucking objects of various types have been used by most cultures throughout history. In my opinion, these studies suggest two take-home lessons:

1. If your child is plagued by frequent ear infections, stopping or reducing the use of a pacifier is worth a try – certainly before prophylactic antibiotics or surgery.
2. For any child, it is prudent to wean the pacifier as soon as it is no longer something that the child actively needs.

Too often pacifier use persists into middle childhood either out of habit, or because the pacifier has become the child’s “lovey” – and not out of any true sucking need. They might just as easily have found comfort from something else.

If this is the case for your child, here are some tips that will help you wean him or her from pacifier use in a constructive way. First, restrict pacifier use to sleep time and stressful situations (getting shots), since most children will become less attached as they experience more of the day without the pacifier. Then, make the pacifiers less attractive while at the same time introducing a new comfort object. To make the pacifiers less attractive, you might put on one drop of ‘bitter apple’ (found in pet stores), giving the pacifier a mildly unpleasant taste. Combination teddy bear-blankets, such as those made by Dakin, make a nice comforting alternative. For older children, you might try gathering up all the pacifiers and taking them to the toy store for the child to trade in for the toy of their choice. For most kids it will be easier to deal with the pacifier issue now rather than waiting until they become more attached and the habit becomes more ingrained.