Is pacifier use a risk factor for acute otitis media? A dynamic cohort study.

Background: 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.

Objective: To study whether pacifier use increases the risk of AOM.

Methods: 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.

Results: 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.

Conclusion: 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.