Review: Harmful and beneficial effects of pacifier use in newborns, infants

The new research establishes recommendations based on the critical analysis of nearly 2,000 scientific articles.

Researchers at the Universitat Jaume I Desirée Mena and Jennifer Sánchez, from the Predepartmental Unit of Nursing, have reviewed 1,897 scientific articles on the harmful and beneficial effects of pacifier use in newborns and infants. The conclusions of the study, published in the journal Rol de Enfermería, propose a series of recommendations based on evidence aimed at facilitating decision-making when choosing pacifiers in order to provide parents and carers with the most appropriate information to decide freely.

The use of pacifiers has been related to the appearance of oral malformations, with an early abandonment of breastfeeding, the appearance of otitis media, the maintenance of the habit of digital suction and a decrease in the production of speech sounds, as well as the establishment of smoking habit in adolescence and adulthood. As for the beneficial effects associated with its use, there is the protective factor against the syndrome of sudden death of the infant during sleep and the appearance of overweight and obesity in adolescence, analgesia produced during stressful procedures or situations and stimulation of the sucking reflex in situations in which it is underdeveloped.

For the development of the study, an integrative review of the literature developed through a filter of scientific quality was carried out. The obtained articles were submitted to an analysis centred on the design of the study, population, sample, follow-up period, evaluation, results, conclusions, etc., depending on the design. Likewise, a descriptive analysis of the variables was carried out, classifying them as favourable, unfavourable or non-influential effects.

From an analysis based on scientific evidence, "a series of recommendations are established with the aim of providing mothers, fathers and carers with the best information that allows them to freely deliberate and choose what best suits their needs, beliefs, expectations…", as lecturer Desirée Mena explains. If breastfeeding is chosen, it is suggested not to use the pacifier, as it is related to the difficulty in its establishment and early weaning. In case of using it, to avoid dentition problems, specifically, oral malformations, its use is recommended from the six months of age. However, its use is related, especially after this age, to the appearance of otitis media. Another reason why it is discouraged is that its use appears to be related to persistent digital suction in childhood, the onset of smoking habit in adolescence and adulthood and a decrease in the production of speech sound.

The research indicates that the use of the pacifier is recommended in the case that the baby has not developed the nutritive sucking reflex, as it can be used to stimulate it. It is also recommended to soothe the baby in stressful or painful situations. To this end, explains Jennifer Sanchez that "we do not discourage the joint use of sucrose, although for nutritional reasons it is not recommended; however, breastfeeding would always be better as a first option if it is available. In addition, the use of the pacifier during sleep is recommended to avoid the appearance of sudden infant death syndrome.

In the case of pacifier use, the recommendation is to wash it with a 0.12% aqueous chlorhexidine solution or immerse it in boiling water. In addition, periodic dental check-ups are recommended to monitor the growth of the temporary dentition and detect the appearance of malformations. In the case of breastfeeding, the study indicates that it is advisable to make periodic visits with the midwife or paediatric nurse to supervise it in order to detect early possible problems arising from the use of the pacifier.

Finally, the researchers at the UJI point out that the study has also made it possible to detect potential future lines of research aimed at having strong evidence on the use of pacifiers, the prevention of sudden infant death syndrome and the appearance of otitis media.

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