Influence of potentially harmful sucking habits on otitis media in children: a systematic review and meta-analysis

Abstract This study aimed to evaluate the influence of pacifier use, bottle feeding, and finger/thumb sucking on the occurrence of otitis media in children. Searches were conducted in grey literature and six databases: Web of Science, Cochrane Library, LILACS, Scopus, MEDLINE/PubMed, and EMBASE, from inception through May 2025. Observational studies investigating the association between harmful sucking habits and otitis media in newborns, infants, preschoolers, and older children were included. Risk of bias was assessed using the Joanna Briggs Institute tool. Meta-analysis results were reported as odds ratios (ORs) with 95% confidence intervals (CIs), and the certainty of evidence was also evaluated. A total of 36 studies were included, most of which were cohort studies (n = 14), with sample sizes ranging from 46 to 35,613. Eleven studies were incorporated into meta-analyses. Children who used a pacifier were 1.17 times more likely to develop otitis media (95%CI: 1.00–1.33) and 1.54 times more likely to develop acute otitis media (95%CI: 1.01–2.36) compared to those who did not use a pacifier. No significant association was found between bottle feeding and otitis media (OR = 0.83; 95%CI: 0.59–1.17). Most studies did not report a significant association between finger or thumb sucking and otitis media. The certainty of evidence was rated as very low. These findings suggest that pacifier use may increase the likelihood of developing otitis media, particularly acute otitis media, with potentially relevant implications.

• Publication year

  2025

• Venue

  Brazilian Oral Research

• Publication date

  2025-11-07

• Fields of study

  Medicine

• Identifiers
  DOI 10.1590/1807-3107bor-2025.vol39.115PMID 41221968PMCID 12594459
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• The difference between statistical significance and clinical relevance. The case of minimal important change, non-inferiority trials, and smallest worthwhile effect.

  2023cited by this paper
• Does the duration and frequency of dummy (pacifier) use affect the development of speech?

  2021influential reference
• Improving Delayed Antibiotic Prescribing for Acute Otitis Media

  2021cited by this paper
• Association of deleterious sucking habits with the occurrence of otitis in newborns, infants, preschool children, and children: a systematic review protocol.

  2021cited by this paper
• Risk Factors for Otitis Media in Children Referred to Abuzar Hospital in Ahvaz: A Case-Control Study

  2020cited by this paper
• Characterization of Models for Identifying Physical and Cognitive Frailty in Older Adults With Diabetes: Systematic Review and Meta-Analysis

  2020cited by this paper
• Chapter 7: Systematic Reviews of Etiology and Risk

  2020cited by this paper
• Panel 5: Impact of otitis media on quality of life and development.

  2019cited by this paper
• Otitis media related hearing loss in Indonesian school children.

  2019cited by this paper
• Risk of childhood otitis media with focus on potentially modifiable factors: A Danish follow-up cohort study.

  2018cited by this paper
• Risk factors for persistent otitis media with effusion in children: a case-control study

  2018cited by this paper
• The effect of pacifier sucking on orofacial structures: a systematic literature review

  2018cited by this paper
• Does Acute Otitis Media in the First Month of Life Increase the Risk for Recurrent Otitis?

  2018cited by this paper
• The association between nutritive, non-nutritive sucking habits and primary dental occlusion

  2018influential reference
• Acute Otitis Media During Infancy: Parent-reported Incidence and Modifiable Risk Factors

  2017cited by this paper
• Infant pacifiers for reduction in risk of sudden infant death syndrome.

  2017cited by this paper
• Association between pacifier use and bottle-feeding and unfavorable behaviors during breastfeeding.

  2017cited by this paper
• Risk factors for respiratory infections among children attending day care centres.

  2016cited by this paper
• Malocclusions and auditory tube dysfunction in children : an integrative review

  2016cited by this paper
• Pacifier-sucking habit duration and frequency on occlusal and myofunctional alterations in preschool children.

  2015cited by this paper
• The Role of Google Scholar in Evidence Reviews and Its Applicability to Grey Literature Searching

  2015cited by this paper
• Erratum to: Correlation between otitis media and dental malocclusion in children

  2014cited by this paper
• Using a pacifier to decrease sudden infant death syndrome: an emergency department educational intervention

  2014cited by this paper
• Incremental health care utilization and costs for acute otitis media in children

  2013cited by this paper
• Habitual use of push and pull plastic bottle caps is more prevalent among children with recurrent acute otitis media.

  2013cited by this paper
• Effect Sizes for 2×2 Contingency Tables

  2013influential reference
• The Diagnosis and Management of Acute Otitis Media

  2013cited by this paper
• A practitioner's guide to developing critical appraisal skills: what is the difference between clinical and statistical significance?

  2013cited by this paper
• Suture restriction of the temporal bone as a risk factor for acute otitis media in children: cohort study

  2012cited by this paper
• Predictors of and reasons for pacifier use in first-time mothers: an observational study

  2012cited by this paper
• Burden of Disease Caused by Otitis Media: Systematic Review and Global Estimates

  2012cited by this paper
• Deleterious sucking habits and atypical swallowing in children with otitis media with effusion.

  2011cited by this paper
• Correlation between otitis media and dental malocclusin in children

  2011cited by this paper
• Comportamiento de la otitis media en el recién nacido en el servicio abierto de Neonatología en el año 2010

  2011influential reference
• GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology.

  2011cited by this paper
• Breastfeeding and Otitis Media: A Review of Recent Evidence

  2011cited by this paper
• Otitis media with effusion and dental occlusion: is there any relationship?

  2010cited by this paper
• A Study on Risk Factors of Recurrent Otitis Media

  2010cited by this paper
• The health care burden and societal impact of acute otitis media in seven European countries: results of an Internet survey.

  2010cited by this paper
• Cochrane Handbook for Systematic Reviews of Interventions

  2010influential reference
• DETERMINANTS OF ACUTE OTITIS MEDIA IN INFANTS

  2009cited by this paper
• [Bottle feeding during the first month of life: determinants and effect on breastfeeding technique].

  2008cited by this paper
• Is pacifier use a risk factor for acute otitis media? A dynamic cohort study.

  2008cited by this paper
• Systematic literature review of modifiable risk factors for recurrent acute otitis media in childhood.

  2006cited by this paper
• Changes in the prevalence of nonnutritive sucking patterns in the first 8 years of life.

  2006cited by this paper
• International Child Care Practices Study: Breastfeeding and Pacifier Use

  2005cited by this paper
• The effect of the season on otitis media with effusion resolution rates in the New York Metropolitan area.

  2004cited by this paper
• A guide to systematic reviews.

  2002cited by this paper
• Uso del chupete: hallazgos preliminares

  2002cited by this paper
• Duration of nutritive and nonnutritive sucking behaviors and their effects on the dental arches in the primary dentition.

  2002cited by this paper
• The Relationship Between Dental Overbite and Eustachian Tube Dysfunction

  2001cited by this paper
• Direct expenditures related to otitis media diagnoses: extrapolations from a pediatric medicaid cohort.

  2000cited by this paper
• On the physics of the infant feeding bottle and middle ear sequela: ear disease in infants can be associated with bottle feeding.

  2000influential reference
• A simple method for converting an odds ratio to effect size for use in meta-analysis.

  2000cited by this paper
• Pacifier use and otitis media in infants twelve months of age or younger.

  1999cited by this paper
• Risk factors of otitis media with effusion during infancy.

  1999cited by this paper
• Role of surgery for otitis media in the era of resistant bacteria.

  1998cited by this paper
• Relationship of breastfeeding and formula-feeding practices with infant health outcomes in an urban poor population.

  1997cited by this paper
• Prevalence of otitis media with effusion amongst pre-school children in Malaysia.

  1997cited by this paper
• Auditory consequences of early mild hearing loss associated with otitis media.

  1996cited by this paper
• A meta-analytic review of the risk factors for acute otitis media.

  1996cited by this paper
• A pacifier increases the risk of recurrent acute otitis media in children in day care centers.

  1995cited by this paper
• A Pacifier Increases the Risk of Recurrent Acute Otitis Media in Children in Day Care Centers

  1995cited by this paper
• Relation between infant feeding and infections during the first six months of life.

  1995cited by this paper
• Risk factors in otitis media with effusion. A 1 year case control study in 5-7 year old children.

  1994cited by this paper
• Pacifiers and dental structure as risk factors for otitis media.

  1994influential reference
• Dummies and the sudden infant death syndrome.

  1993cited by this paper
• Control of the temporal aspect when considering risk factors for acute otitis media.

  1993cited by this paper
• Protective effect of breast feeding against infection.

  1990cited by this paper
• Statistical Power Analysis for the Behavioral Sciences (2nd ed.)

  1989cited by this paper
• Infectious illnesses in the first two years of life.

  1985cited by this paper
• The Pima infant feeding study: breastfeeding and respiratory infections during the first year of life.

  1984cited by this paper
• Psychotherapy outcome research: Methods for reporting variability and evaluating clinical significance

  1984cited by this paper
• Factors associated with infections among breast-fed babies and babies fed proprietary milks.

  1983cited by this paper
• Breast-feeding and respiratory virus infection.

  1982cited by this paper
• PROLONGED BREAST FEEDING AS PROPHYLAXIS FOR RECURRENT OTITIS MEDIA

  1982cited by this paper
• Observations on the relation of environmental and behavioral factors to the occurrence of otitis media among Indian children.

  1981cited by this paper
• Otitis media and bottle-feeding. An epidemiological study of infant feeding habits and incidence of recurrent and chronic middle ear disease in Canadian Eskimos.

  1971cited by this paper
• Thumb- and finger-sucking

  1959cited by this paper

• No citing papers are available for this paper.