Pacifier use: another possible cause of ear infections-Ask Dr. Paul Library

DEAR DR.PAUL: I just read that a recent study suggested that children who use pacifiers get more ear infections. Is this true? Can anything else cause ear infections?

PEDIATRICIAN DR.PAUL Answers: A very timely question indeed. You're right - a recent study has suggested that pacifier use in babies may lead to ear infections. Why might this finding be important? Well, as you may know, more than 70% of all children will have at least one ear infection during their childhood and about one third will have at least three infections.

The cause of middle ear infection, or Otitis Media, is bacteria. We think children are at risk for ear infections because their Eustachian tube - the connection between the nose and the ear - does not work very well, causing a fluid back-up and subsequent infection. There are children who are at risk for having repeated ear infections. We usually refer to them as ear infection-prone children. We have identified certain factors that can contribute to this susceptibility to ear infections.

These risk factors include:

  • First ear infection before age six months
  • Facial or mouth anomalies, such as a cleft palate or Down's syndrome
  • Not being breastfed
  • Exposure to cigarette smoke
  • Exposure to allergens in allergic children (such as dust mites)
  • Day care attendance
  • Putting baby to bed with a bottle

Looking at this list of risk factors, it is easy to see that parents have no control over the first two. However, the rest of these factors can be addressed, specifically in terms of trying to prevent or reduce the number of ear infections.

For example, breast feeding a child can protect from Otitis Media as can avoiding exposure to cigarette smoke and other allergens. Delaying (if possible) day care attendance, and not putting baby to bed with the bottle can also be helpful in staving off an infection.

Now, let's address the recent pacifier study. This study suggests that pacifier or "soother" use (at night) may also be a contributing factor. In a sense, this is a logical deduction because, as with the bottle, a baby makes a sucking motion while lying down and it is thought that this interferes more with the Eustachian tube function. That may make a child more susceptible to getting an ear infection. Sucking on a pacifier, I assume, would have a similar effect as the bottle, which might explain the findings of this study. I think this study brings out an important issue, namely that there are things parents do which can potentially cause ear infections. By recognizing and avoiding these habits, we can try to reduce the risk of ear infections.

So now, thanks to this recent study we add pacifier use to the list of risk factors. Although this is the first study, and I am sure more will follow, knowing the relationship between sucking motion in bed and ear infections (from studies of bottle feeding in bed) I think it is prudent to try to decrease pacifier use at night, if not in all babies, at least in those who are prone to ear infections.

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