SIDS Risk Drops With Sleep-Time Pacifier Use

Hauck FR, Omojokun OO, Siadaty MS. Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics. 2005. E-pub ahead of print.

In recommendations endorsed by the American Academy of Pediatrics, researchers contend that in order to prevent incidence of sudden infant death syndrome (SIDS), parents and/or caregivers should offer a pacifier to infants younger than 1 year before all sleep episodes, whether these are daytime naps or nighttime sleep. With the exception of a 2.9% increase in the SIDS rate from 2001 to 2002, the overall incidence of SIDS has decreased by half since 1994 (the year in which the Back to Sleep campaign began), the researchers note.

Hauck et al performed a meta-analysis of studies that included data on pacifier use and its association with SIDS and other adverse outcomes. Seven studies met inclusion criteria (eg, an appropriate definition for SIDS, performance of autopsies in 98% of cases, matched controls, sufficient data to calculate odds ratios [ORs]). These criteria were based on those developed by the American Academy of Pediatrics Task Force on Infant Positioning and SIDS.

The pooled, weighted OR for SIDS with usual pacifier use was a nonsignificant 0.90 after univariate analysis of seven studies and 0.71 after multivariate analysis of four studies, the researchers found. However, for pacifier use during last sleep, ORs for SIDS in univariate and multivariate analysis were 0.47 and 0.39, respectively, when data from all seven studies were compiled. These data demonstrate that pacifier use for all sleep periods is "necessary" to prevent SIDS, the researchers note. Among the variables adjusted for were maternal and infant ages, parity, birth weight, socioeconomic status, smoking status, and sleep position.

The researchers offer several recommendations to address the issue of possible adverse consequences of habitual pacifier use and other concerns that have traditionally caused clinicians to discourage such use (see box above). They also note that according to the American Academy of Pediatric Dentistry, long-term problems related to dental malocclusion are unlikely to occur if pacifier use is stopped by the time the child is age 3.