Major news stations including CBS, Fox, and CNN responded in full force to the article “Injuries Associated with Bottles, Pacifiers, and Sippy Cups in the United States” published last week in the medical journal “Pediatrics”. The authors’ stated goals were to increase parental awareness and potentially develop products that could minimize likelihood of trauma.
News coverage of article by Keim et. al
The study was a well constructed retrospective analysis using data from the National Electronic Injury Surveillance System. Ultimately, the authors identified that over the 20 year study period (1991-2010), an average of 2,270 children were taken to the ER for injuries related to the items each year. The results of the project were that over 70% of injuries were to the mouth and most children were around the age of 1, when kids are most unstable as they learn to walk and run. Bottles accounted for 66% of injuries, pacifiers 20%, and sippy cups 14%.
As dental students, we also know the dangers bottles, sippy cups, and pacifiers can pose to a child’s oral health. When used between meals, and especially when left with a child at bedtime, bottles and sippy cups can lead to childhood caries. If not discontinued at an early age, pacifiers can lead to occlusal anomalies like restricted palatal width and anterior open bite.
There remains, however, some ambiguity regarding appropriate use of pacifiers and bottles. The American Academy of Pediatrics recommends that pacifiers be used in infancy (which is associated with decreased risk for SIDS) and discontinued by 6 months to prevent otitis media. Our own American Academy of Pediatric Dentistry has a slightly different standard, recommending discontinuation of pacifiers before the age of 3 to prevent changes in dental occlusion. The AAPD also advocates transitioning from a bottle directly to a lidless cup by 12 months in order to prevent dental caries, while the AAP is more lenient with advice to wean by 15 months.
Unfortunately, many parents do not adhere to recommendations from either organization. An Arizona study showed that almost half of children aged 1-2 are still using bottles and an Infant Feeding Practices study demonstrated that ~40% of one year olds are still using pacifiers. If parents would follow the guidelines and implement changes, the vast majority of these traumas could be avoided.
So parents, start listening to your pediatricians and your dentists! Encourage your children to only drink when seated. Don’t allow kids to constantly sip on liquids (especially sugary ones!) throughout the day. And follow the recommendations set forth by the AAP and AADP. Your reward will be healthier, safer environment for your child.
What do you think about the usage of bottles, sippy cups, and pacifiers in children? Have you seen any interesting cases on your pediatric rotations? Share your thoughts!
~Ashley N. Phares, UConn ’13, contributing editor