Friday, February 10, 2012

Use of Pacifiers and the Risk of Sudden Infant Death Syndrome

Welcome to part 3 in our series on pacifiers. In part 1, we shared a study about pacifier use and reasons parents give their babies pacifiers. Then in part 2, we shared what the research has to say about breastfeeding and pacifier use. Now in this post, we will explore the evidence behind the American Academy of Pediatrics (AAP) recommendation to put your baby to sleep with a pacifier in order to decrease risk of Sudden Infant Death Syndrome (SIDS).

The Recommendation

Consider offering a pacifier at nap time and bedtime—Although the mechanism is yet unclear, studies have reported a protective effect of pacifiers on the incidence of SIDS. The protective effect persists throughout the sleep period, even if the pacifier falls out of the infant's mouth.

The Evidence

Two large analyses of the literature evaluating whether or not pacifier use has a protective effect against SIDS were conducted in 2005 and 2006. Each analysis looked at multiple studies and evaluated each study’s quality. Once quality was determined, the consistency of findings across all studies was evaluated. Consistently, pacifier use at bedtime or nap time was associated with a decreased risk for SIDS by as much as 61%. (Mitchell 2006, Hauck 2005) Results of these studies led the AAP to make the current recommendation for parents to offer a pacifier at bedtime and nap time.

Another study, published after the above analyses were conducted, found a 90% reduction in risk of SIDS among infants using pacifiers at last sleep compared to control. (Willinger 2003) These results further support the AAP recommendations.

What about the Breastfed Baby?

We have long heard that pacifier use in the first month postpartum can undermine breastfeeding efforts. Therefore, the AAP recommends that breastfeeding mothers wait until breastfeeding is fully established, or about 3-4 weeks, before introducing a pacifier at sleep times. For more detailed information about pacifier use and breastfeeding, click here.

Frequently Asked Questions about the AAP Pacifier Recommendation*

What if the pacifier falls out of my baby’s mouth while she is sleeping?

There is no need to put the pacifier back in your baby’s mouth. You only have to put it in your baby’s mouth when he or she is falling asleep.

What if my baby won’t take a pacifier?

Do not force your baby to take a pacifier. You can retry again when the baby is a little older.

How does pacifier use during sleep decrease SIDS risk?

Several mechanisms have been proposed to explain exactly how pacifiers are protective against SIDS, but none have been confirmed. Some researchers and practitioners think that it is related to increased arousal during sleep or assistance in maintaining an open airway, while others think that pacifier use at sleep onset effects the position that the baby is sleeping in, thus reducing the risk.

*All of the answers to the above frequently asked questions are from the AAP Policy Statement: SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment

Do you have any other questions? Let us know and we’ll do our best to find the answer for you. Also, for a full list of recommendations to protect against SIDS, click here.

References and Resources

Hauck FR, Omojokun OO, Siadaty MS. Do pacifiers reduce the risk of sudden infant death syndrome? a meta-analysis. Pediatrics. 2005;116:e716-e723.

Mitchell EA, Blair PS, L'Hoir MP. Should pacifiers be recommended to prevent sudden infant death syndrome? Pediatrics. 2006;117:1755-1758.

Task Force on Sudden Infant Death Syndrome. The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics. 2005;116:1245-1255.

Li D, Willinger M, Petitti D, et al. Use of pacifier and the risk of sudden infant death syndrome (SIDS). Am J Epidemiol. 2003;157:S85

Task Force on Sudden Infant Death Syndrome, Moon RY. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics. 2011;128:1030-9.

1 comment:

  1. Have they compared babies who nurse to sleep against the pacifier use group? if it is the sucking while falling asleep, surely nursing to sleep would have the same protective effects as having a pacifier? (Plus having all the breastfeeding benefits). I know we already know that breastfed babies have a lower incidence if SIDS... would be interesting to see if this is partially because of the nursing to sleep.