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Pacifiers and SIDS?
I want to know what you think. And we have some fresh evidence to consider. In October 2005, the American Academy of Pediatrics (AAP) updated its position on preventing SIDS, boldly including the use of pacifiers in an attempt to save many more lives. But first, I’ll tell you about a Kaiser Permanente study that appeared online in the British Medical Journal on December 9, 2005, then let’s consider the AAP recommendations, and then I’d like to hear what you think. The new evidence comes from interviews of parents in California whose children had died from SIDS and from carefully matched random parents with the same characteristics. All were asked exclusively about their baby’s last sleep. The statistical analysis was meticulous. The authors found that babies who had sucked their thumb had a 57 percent decreased chance of SIDS (not reported in any news stories I’ve seen, by the way). But those who used a pacifier had a 92 percent decreased chance of SIDS. Only 4 percent of the babies who died of SIDShad been using a pacifier, while 24 percent of babies in matched homes who had slept safely had been using a pacifier. The pacifier was associated with decreased SIDS rates in every group: those who used soft bedding and those who did not; those who slept with smoking parents and those who did not; those who were breastfeeding and those who were not; those who had been sick recently and those who had not; those who sucked their thumbs and those who did not; and in every cultural, age, education, and income group. The association was dramatic in all groups, and all the more so in the higher risk groups.
Clearly, there is a link between pacifier use and decreased SIDS – but an important question remains – which causes which? Perhaps the effect is only that babies who are fussier are more vigorous and more likely to have used a pacifier. This might address why pacifier use was so much lower than the neighborhood average in SIDS homes – these babies were calmer. Or perhaps the pacifiers are actually preventing SIDS. Pacifiers often have a bulky handles, which might create a tenting effect, preventing the baby’s nose from being blocked by soft bedding or by covers. Or maybe the sucking action encourages growth of important neural pathways or changes the threshold of what wakes a baby up. We just don’t know.
Currently, there is no strong evidence that pacifiers prevent SIDS, or if they do – how they work. But that there is a connection between the two has now been soundly proven, and it may be that pacifiers are one of the most important preventive health measures ever devised. Or not.
Similarly, there is now considerable evidence that pacifier use is associated with decreased breastfeeding. But again, which causes which? Perhaps pacifiers discourage breastfeeding. Perhaps babies who are weaning are fussier and more likely to be given a pacifier. Neither has been proven.
In the new official guidelines, the AAP has taken bets on both issues. They recommend pacifier use to prevent SIDS (even though it is just a proven association, not a cause), because it is a life-and death issue. Meanwhile, they dismiss breastfeeding concerns because the pacifier link is just a proven association, not a proven cause.
The 2005 official recommendation (italics and bold are mine):
“Consider offering a pacifier at nap time and bedtime: Although the mechanism is not known, the reduced risk of SIDS associated with pacifier use during sleep is compelling, and the evidence that pacifier use inhibits breastfeeding or causes later dental complications is not. Until evidence dictates otherwise, the task force recommends use of a pacifier throughout the first year of life according to the following procedures:
- The pacifier should be used when placing the infant down for sleep and not reinserted once the infant falls asleep. If the infant refuses the pacifier, he or she should not be forced to take it.
- Pacifiers should not be coated in any sweet solution.
- Pacifiers should be cleaned often and replaced regularly.
- For breastfed infants, delay pacifier introduction until 1 month of age to ensure that breastfeeding is firmly established.”
With respect to the above AAP recommendations, it’s important to point out that SIDS is very rare before 1 month old. The peak age is between 2 and 4 months, and drops off rapidly after 6 months.
Now, I’ll put the question to you. So what do you think? And more importantly, what would you do?
| Alan Greene MD FAAP |
December 11, 2005 | Permalink
Comments
I do use a pacifier for my 2 month old son, not because I had heard it decreases incidence of SIDS but because it helps an infant to self-soothe. Yes it pops out and we have to find it in the cradle and put it back in but he is getting the hang of it more and more and it does "soothe" him a lot. I'm glad to hear that there are other associated benefits with giving a pacifier (ie. decreased incidence of SIDS) regardless of the reason why it helps is still unknown.
Posted by: Marina FItzpatrick | Feb 17, 2008 7:09:01 AM
I'm not sure on this one. My two year old sucks her thumb and started at 3 months. She refused a pacifier. I now have a 10 week old who seems to "need to suck" so I presented the pacifier, and as of today, I'm taking it away. Neither one of us were getting any sleep. As soon as he would fall asleep and the pacifier would pop out, he would search for it. This has been happening every hour. We're not sleeping and I just cant do it anymore. The AAP recommends it, I know, however it is a recommendation and SIDS is still an unknown. They dont even know if their recommendation is accurate. I'm very torn on this, but I know that my baby isnt getting the appropriate amount of sound sleep he needs to grow, so I'm stopping the pacifier after one month of use.
Posted by: Jessica Cribbs | Sep 22, 2007 1:21:41 PM
What about all of the sleep recommendations that refer to pacifiers as sleep crutches? It seems to me that all three of my children would awaken in the night, in search of the pacifier. Until they were old enough to find it (takes a great deal of fine motor skill as well as an understanding of object permanence), we were in a bit of a predicament. As a pediatrician and mother, I found this particular point difficult. A pacifier in the mouth on the way to sleep is almost a guarantee that they will wake up wanting the very thing that helped them fall asleep. Thoughts?
Posted by: CiCi | Jul 9, 2007 8:06:36 PM
We lost Alexys to SIDS after 26 hours. Now, I wonder if using a pacifier might have saved her life. I am now pg again and I will definitely use a pacifier this time. Just wanted to share my experience.
Posted by: Crystal | Aug 20, 2006 5:16:41 AM
My grandmother saw something that said in the first month of life, it is dangerous to use a pacifier. And once she told me, I understood why. Babies depend on their noses to breath. If the nose is plugged up with mucous and a baby is sucking on a pacifier it has no way to breath. The baby can then stop breathing. I didn't give my daughter a pacifier until she was almost 2 months old. I would think, with that factor, pacifiers would increase the risk of sids.
Posted by: Devon Derrick | Apr 23, 2006 6:55:21 PM
when i was expecting my son i said i would never give him a pacifier because i would be nursing him. well i had some complications with nursing in the hospital and so i asked for one.it helped me out alot.when i lay him down he gets it but there are times he doesnt want it at all and he falls to sleep without it. he is 3 months old now. i dont plan on giving him the pacifier past 6 months of age. if it is true that it helps with SIDS then great news for us. now if i have another child in the future im not sure if he or she will get a pacifier or not. but if it is proven that they help reduce SIDS then im sure they will use one also.
Posted by: Pamela | Apr 21, 2006 8:17:33 AM
Both my older daughters used a pacifier and so does my baby son. A pacifier does what it's name claims. Pacify. it helps the baby self sooth. it helps control his weight in terms that once he ate, rather than feeding him more and more because he needs to suckle, the pacifier addresses his suckling needs. And, if there is even the remotest chance that it reduces the risk of sids... all the better. we'll worry about dental problems once he grows up. that is what orthodontists are for. let him grow up and get to that stage!
Posted by: etty Benartzy | Dec 23, 2005 8:09:09 AM
thank you nicole pauling!!!! Thats what i had to do for my son! It was essential to my breastfeeding to have him suckle as much as possible, I nursed him for two years and for those who believe my son will be marred for life then you sure don't know brice! He is extremely outgoing and confident and well behave for a two and a half year old! Personally I hate pacifiers, its a means to not have to deal with a child when maybe thats all they need. Sounds like this issue can go either way but personally none of my future children will have pacifiers and if all goes right will wean them selves from breastfeeding ; ). Unfortunatley i've seen to many mothers use pacifiers as a means of not having to deal with their child, when they are that little i would rather they form a loving attachment to me and not an object, it has worked well for us and i wish everyone the best of luck and god bless!
Posted by: jennifer | Dec 21, 2005 11:34:50 PM
My son got a pacifier when he was 2 days old. He was born hungry with a huge sucking reflex. He is now 7 months old and loves his pacifier. We try to limit his pacifier use to his nap/bedtime. I noticed that now he wakes up at night, finds his pacifier that fell out when he was asleep, puts it back in his mouth and goes back to sleep. I follow my gut feeling, and I give the pacifier to my son because this is what HE wants. I would not have encouraged pecifier use trying to prevent SIDS. There is no proof of causation, and I would go nuts putting attention to all things that show statistical association. In my opinion, all of those preventative SIDS guidelines are blown way out of proportion. My gut feeling is my best guide when it comes to my baby.
Posted by: Julia Sinyakov | Dec 18, 2005 11:40:27 AM
This is comforting advice. 2/2 of my kids loved the pacifier - very soothing for them. There were times I thought child #2 wouldn't 'take' it - but he did. I think anything that brings comfort AND can possibly prevent SIDS is a win/win. Nothing wrong with a pacifier. Per the pediatric dentist, it's okay up until 3 years old (for proper growth of their palette). I must say for child #1, it was the hardest time in my parenting life to get that binky away right at 3 (binky fairy came), but looking back at all the comfort it brought, ...it was worth it! (PS little brother's binky fairy came at the same time,...it was the only way).
Posted by: V turner | Dec 16, 2005 11:17:50 PM
I love this website. That said, I think that parents spend so much time trying to figure out the "right" way to parent, that the "perfect spoils the good". If you want to use a pacifier, you should try it. If you want to breastfeed you should. If you want to bottlefeed, you should. I've used all of the above methods of feeding and soothing and it has worked for my family. Whether it would work for another family is not for me to say. Educate yourself for sure AND listen to your gut. They are all kinds of great ways to raise well-adjusted humans.
Posted by: Victoria | Dec 15, 2005 6:48:56 PM
We were determined (BEFORE our daughter was born) that no child of ours would use a pacifier. Once it became apparent that our baby was colicky, and unable to soothe herself to sleep we ran out to buy one! She wouldn't accept it though, so we put it out of our minds. I tried again when she was about four months old and still sleeping for very short stretches of time at night, and she took to it right away - a lifesaver really. Reading your article, the question you raised about whether fussier babies are more vigorous & therefore also less susceptible to SIDS struck a chord - that's how I always felt about our daughter.
Had I known about this recommendation then, I would have felt less guilt & anxiety about the introduction of a pacifier - generally seen as an unhygenic crutch by my peers.
Posted by: Rachel | Dec 13, 2005 8:27:58 PM
We were determined (BEFORE our daughter was born) that no child of ours would use a pacifier. Once it became apparent that our baby was colicky, and unable to soothe herself to sleep we ran out to buy one! She wouldn't accept it though, so we put it out of our minds. I tried again when she was about four months old and still sleeping for very short stretches of time at night, and she took to it right away - a lifesaver really. Reading your article, the question you raised about whether fussier babies are more vigorous & therefore also less susceptible to SIDS struck a chord - that's how I always felt about our daughter.
Had I known about this recommendation then, I would have felt less guilt & anxiety about the introduction of a pacifier - generally seen as an unhygenic crutch by my peers.
Posted by: Rachel Paul | Dec 13, 2005 8:26:39 PM
I worry with the new study that parents will force a pacifier onto their children in hopes of saving them from SIDS and for their own personal re-assurance. However, I must share with you that both of my daughters never wanted a pacifier. They ALWAYS spit it out immediatly. I tried on several occassions as they got older (never past 4 months) just to hope it would soothe them to sleep. It never stayed. So I worry that some first time mothers might go overboard with worry that if the child will not take one they need to watch their children all through the night.
I know the Europeans had done a number of studies on this (a few years back) and found smoking (even if it is still on your clothing) is a major cause for concern. I think a firm matress, the less blankets the better, and a smoke free environment (including never being held by a person who has recently smoked let alone smoking at the time of being held) are the safest alternatives.
I must also include I am not against pacifiers, but when they reach the age of one are they really necessary? Nothing worse than seeing a 3 year old with a passy. LOL! But I have seen the benefits of them for calming a baby, or giving the new mom a break from nursing when a newborn baby is "addicted" to the sucking motion. If I have another child I will try again to offer a pacifier, but you can't make a baby take it if they don't want it. I think education is the best and never ignore a mother's intuition. Well educated Moms seem to know best;-)
Posted by: Kristi Dockum | Dec 13, 2005 6:18:40 PM
My son is now 13 months old. I didn't want to give him a pacifer. However, when he was in the NICU after he was born (due to extremely low blood sugar) several of the nursing staff gave him one. I figured if that soothed him while they were tending to other babies, that was fine.
After leaving the hospital, we rarely gave him one. When we gave him a pacifer, he would spit it out. He did suck his thumb when he was going to sleep. He doesn't do that as much because of his teeth. His teeth starting coming in fairly early.
With this latest information, I may have tried to encourage him to use the pacifer more and worried more that he didn't use it. My biggest concerns still would be the bedding, the firmness of the mattress, making sure he was sleeping on his back, and whether he was too warm.
Posted by: Teresa Walls | Dec 13, 2005 11:58:13 AM
It's kind of nice to see that the AAP agrees with what I've been doing, lol!
With my child, I regularly gave her a pacifier to help her soothe herself, normally around naptime or bedtime. She began rejecting it around 6 months of age, and I thanked my lucky stars that I wouldn't have to stop her from using one when she got older.
I plan to do the same thing with the baby I'm now expecting. We don't plan to share a bed at all, or to nurse the baby to sleep past six months, which are mostly personal choices, choices that worked very well with our first. Heaven knows if they will with #2, but I'm trying what worked with #1 first!
Posted by: Beverly Morris | Dec 12, 2005 10:41:25 AM
I love pacifiers... a great way to teach a baby to self soothe. If it is true that they can help prevent SIDS, then great! I still don't agree with everything that the SIDS coalition asks to do, but each baby is very different. Great article though Dr. Greene!
Posted by: Amy Prather SnowWhite760 | Dec 12, 2005 9:51:36 AM
If it were even a small chance that it might somehow prevent SIDS I would give the child a pacifier every night. In fact since I'm due in April I will probably do just that.
Oddly I never gave my daughter (she's 3) one because I didn't want it to become a crutch. But if it might save a life that's a whole different matter.
Posted by: Nicole Pauling | Dec 12, 2005 8:36:19 AM
The question that I have is this: if the pacifier is used as recomended by the AAP, what's the difference between nursing to sleep and having the pacifier fall out once asleep? I would like to see comparison with co-sleeping and nursing on demand.
Posted by: Asya Haikin | Dec 12, 2005 5:59:43 AM
