Pacifiers and the risk of middle ear infections

Acute otitis media (middle ear infection) is a common childhood infection, leading to doctor visits, antibiotics, and even surgery.

Researchers from the University Medical Center Utrecht in the Netherlands studied if pacifier use might increase the risk.

First, the details.

  • 495 children, 0 and 4 years old were monitored for 5 years.
  • Their parents filled out a questionnaire regarding pacifier use and potential.
  • Middle ear infections were diagnosed by physicians according to the International Classification of Primary Care coding system.

And, the results.

  • Among 216 children that used a pacifier, 35% developed at least one episode of middle ear infection.
  • Of the 260 children that did not, 32% developed at least one middle ear infection.
  • For recurrent infections, these figures were 16% vs 11%, respectively.
  • All differences were significant when adjusted for potential confounding factors.

The bottom line?
The researchers recommend that parents be told of the risk.

It’s easy to find recommendations pro and con for pacifiers. Certainly, we want to minimize the risk of ear infections. Just ask any parent who has awakened during the night to the cries of their child from the pain.

But the decision to hold back on pacifiers conflicts with the recommendation by the American Academy of Pediatrics Task Force on sudden infant death syndrome (SIDS), which suggests using pacifiers in children less than one year of age because it lowers the risk.

Unfortunately, the authors confine their discussion to the issue of middle ear infection risk, but avoid broader recommendations for the overall risk to benefit ratio for children.

I understand the rationale (the study was about infection), but it doesn’t help in clinical decision-making.

8/17/08 11:16 JR

Hi, I’m JR

John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at, a complementary and alternative medicine website.