Pacifier Use and Sids

Evidence for a Consistently Reduced Risk

Rachel Y. Moon; Kawai O. Tanabe; Diane Choi Yang; Heather A. Young; Fern R. Hauck


Matern Child Health J. 2012;16(3):609-614. 

In This Article

Abstract and Introduction


Pacifier use at sleep time decreases sudden infant death syndrome (SIDS) risk. It is yet unclear whether pacifier use can modify the impact of other sleep-related factors upon SIDS risk. The objective of this study was to examine the association between pacifier use during sleep and SIDS in relation to other risk factors and to determine if pacifier use modifies the impact of these risk factors. Data source was a population based case–control study of 260 SIDS deaths and 260 matched living controls. Pacifier use during last sleep decreased SIDS risk (aOR 0.30, 95% CI 0.17–0.52). Furthermore, pacifier use decreased SIDS risk more when mothers were ≥20 years of age, married, nonsmokers, had adequate prenatal care, and if the infant was ever breastfed. Pacifier use also decreased the risk of SIDS more when the infant was sleeping in the prone/side position, bedsharing, and when soft bedding was present. The association between adverse environmental factors and SIDS risk was modified favorably by pacifier use, but the interactions between pacifier use and these factors were not significant. Pacifier use may provide an additional strategy to reduce the risk of SIDS for infants at high risk or in adverse sleep environments.


Sudden infant death syndrome (SIDS) is defined as "the sudden death of an infant less than 1 year of age, which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history".[1] As a result of risk reduction campaigns encouraging families to place infants on their backs to sleep, the rates of both prone positioning and SIDS have declined more than 50%;[2] however, SIDS remains the leading cause of death for infants aged 1 month to 1 year.[2] Epidemiologic studies have identified other behavioral factors that affect SIDS risk, including smoke exposure,[3–6] soft bedding,[7–16] and bedsharing.[17–24]

Pacifiers, through a yet undefined mechanism, when used at sleep time, may reduce the risk of SIDS by as much as 90%.[25–28] Indeed, the American Academy of Pediatrics (AAP) Task Force on SIDS recommends that parents consider pacifier use for their infants at naptime and bedtime.[29] While several studies have examined the association between pacifier use and SIDS, it is still unclear if pacifiers remain protective in the context of known SIDS risk factors, and what, if any, interactions exist between pacifier use and these factors in association with SIDS risk. A recent population-based case–control study in California found pacifiers to reduce the risk of SIDS for every category of maternal and infant factor examined, for example, for breastfeeding babies as well as for formula fed babies.[27] It also found that with pacifier use, the increased risk of SIDS with prone sleeping, bedsharing, or soft bedding was reduced, although these results did not reach statistical significance. To our knowledge, no other studies have been published that examine these more complex interactions.


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