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Dummies and acute otitis media

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Dummies (pacifiers) are popular with the parents of young children but are they harmful? Fears of serious permanent malocclusion from their use seem largely to have subsided in recent decades but other problems have been mooted, such as increases in risk of otitis media, oral thrush, and dental caries. Researchers in Finland (Marjo Niemelä and colleagues.Pediatrics2000;106:483–8) have studied the effect on the occurrence of otitis media of counselling parents about dummy use.  Fourteen well baby clinics were paired by clinic size and social class of parents and one of each pair was randomised to intervention and the other to control. In the intervention clinics, parents were told of the possible harmful effects of dummies and advised to restrict their use after the age of 6 months to times when the child was about to go to sleep, and to stop using them altogether after the age of 10 months. There were 272 children in the intervention group and 212 controls. Use of a dummy in children aged 7–18 months fell by 20% in the intervention group and the prevalence of acute otitis media fell by almost 30%.  The mechanism by which use of a dummy might increase the risk of acute otitis media is unclear. It is suggested that it may be related to pressure changes in the nasopharynx and impaired function of the eustachian tube. Doctors are often accused of finding fault with many of the things that people do. Are dummies genuinely harmful or is this another example of the philosophy of “if you like it must be bad for you”?