Prevalence and predictors of non-nutritive sucking habits in infants and children: A systematic review and meta-analysis  — The Association Specialists
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  3. Prevalence and predictors of non-nutritive sucking habits in infants and children: A systematic review and meta-analysis 

Prevalence and predictors of non-nutritive sucking habits in infants and children: A systematic review and meta-analysis  (24114)

Niluja Karmacharya 1 2 , Kh Shafiur Rahaman 1 2 , Shirin Mumu 1 , Tiffany Patterson-norrie 3 4 5 , Amit Arora 1 2 4 6 7 8
  1. School of Medicine, Faculty of Health, Western Sydney University, Campbelltown Campus, Locked Bag,, Penrith, NSW, Australia
  2. Health Equity Across the Lifecourse (HEAL) Research Lab, Campbelltown, NSW, Australia
  3. School of Health Sciences, Western Sydney University, Locked Bag, Penrith, NSW, Australia
  4. Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
  5. Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
  6. Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The Children’s Hospital at Westmead Clinical School, The University of Sydney, Westmead, NSW 2145, Australia
  7. Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW, Australia
  8. Aureolin Research, Consultancy & Expertise Development (ARCED) Foundation, Dhaka, Bangladesh

Background 
Non‑nutritive sucking habits (NNSH),such as pacifier use and thumb or finger sucking, are common in infancy and early childhood. While these behaviors provide comfort and emotional regulation, they are linked with adverse oral health outcomes. This review aimed at synthesizing the current global evidence to explore the prevalence and predictors of NNSH in children and to develop targeted preventive strategies. 
Methods 
This review was conducted following the Joanna Briggs Institute (JBI) framework and reported according to PRISMA guidelines. Studies that included healthy infants and children aged 0-12 years and published in English from January 2000 onwards have been included. Four electronic databases (MEDLINE, Embase, Scopus, and CINAHL) were systematically searched, complemented by citation tracking. Where appropriate, results were pooled using random‑effects meta‑analysis; otherwise, findings were synthesised narratively due to heterogeneity.
Results 
From 4,454 retrieved records, 2,246 studies were screened, 71 articles underwent full-text review, and 38 studies were included. Most studies reported on specific NNSH types, particularly pacifier use and thumb or finger sucking. A meta-analysis of cross-sectional studies showed the weighted pooled prevalence of pacifier use, finger sucking, overall NNSH, and both pacifier and finger was 26% (CI: 16%-38%), 13% (CI: 8%-18%), 42% (CI: 29%-56%), and 1% (CI: 0%-3%), respectively. Cohort studies reported higher weighted pooled prevalence for pacifier use (43%, CI 32%-56%) and overall NNSH (51%, CI 36%-65%). Consistent predictors included shorter duration or absence of exclusive breastfeeding, early bottle or pacifier introduction, younger maternal age, lower maternal education, lower socioeconomic status, birth order, and prematurity. 
Conclusion 
NNSH are highly prevalent among infants and children worldwide, with substantial variation by habit type and study design. Pacifier use and finger sucking remain common beyond infancy. Targeted, culturally appropriate prevention strategies and early parental guidance are essential to minimize persistence and reduce potential adverse oral and general health outcomes.