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Media Advisory:
SIDS and Pacifier Use

The Sudden Infant Death Syndrome Alliance 1314 Bedford Avenue
Suite 210
Baltimore, MD 21208
410-653-8226 voice
800-221-7437 voice
410-653-8709 fax

DATE: 5/10/99
RE: SIDS and Pacifier Use

There are now four published, well-designed studies which support a substantially lower incidence of Sudden Infant Death Syndrome in infants who use pacifiers compared to those who do not. According to the current data, the use of pacifiers appears to halve the risk. Two other studies, published in abstract form, report similar results. A review of the recent scientific literature demonstrating an apparent protective association between pacifier use and SIDS was presented by John Brooks, MD*, at the SIDS Alliance National Conference in Atlanta on April 9, 1999.

The reason or reasons for this apparent protective effect are not yet evident. A variety of mechanisms by which pacifiers may protect against SIDS have been proposed. It has been suggested that the presence of a pacifier in the mouth may discourage babies from turning over onto their faces during sleep. Moving or turning may dislodge the pacifier, which may have the effect of encouraging babies to stay on their backs.

Another theory suggests that pacifier use might help to keep the tongue positioned forward, keeping the airways open. Some scientists speculate that an infant sucking on a pacifier may be more attuned to keeping his or her nose free of bedding in order to breathe. It has also been hypothesized that pacifier use may quiet a restless infant, who might otherwise move more aggressively around the crib and end up underneath the bedding. On the other hand, pacifiers may stimulate the upper airway muscles and saliva production, possibly triggering brain activity and ability to arouse from sleep. Increased arousability is seen in infants who usually sleep with a pacifier, even if the pacifier is not being used.

The current data are consistent with the interpretation that pacifier use may only be protective against SIDS among habitual or daily pacifier users. At the same time, evidence suggests that occasional pacifier use offers no protective effect. Although pacifier use has been associated with increased ear infections, increased dental malocclusion, and shortened duration of breast feeding, the current findings indicate that it may not be appropriate for health care professionals to routinely discourage the use of pacifiers in young infants.


1. Current research connecting pacifier use with a lower risk of SIDS has been strong and consistent, however, the current findings tell us little about the mechanisms that may be involved and do not prove that pacifier use prevents SIDS.

2. It is important to consider that the apparent beneficial effect may have nothing to do with pacifiers, but pacifier use might be associated with some other characteristic(s) or factor(s) that protect against SIDS.

3. The SIDS Alliance recommends that babies be positioned on their backs for sleep. Prone (stomach) sleeping is a recognized risk factor for SIDS. Besides being routinely placed prone, there is a high SIDS risk when infants who are unaccustomed to prone sleeping are placed prone or spontaneously roll to prone.

4. The apparent protective association between pacifier use and SIDS presents an interesting new avenue for SIDS research. Further research is needed in order to explain this significant finding, as well as to uncover additional risk factors and possible underlying causes of SIDS.

*Chairman of the Department of Pediatrics at Dartmouth-Hitchcock Medical Center, Dr. Brooks is a member of the American Academy of Pediatrics SIDS Task Force and serves as Chairman of the SIDS Alliance Medical and Scientific Advisory Council.


Always place your baby on the back to sleep. Stomach sleeping more than doubles the likelihood of SIDS. While side sleeping is better, statistics clearly demonstrate that back is best. The rate of SIDS has dropped more than 45%, the equivalent of saving over 2,000 babies' lives a year, since 1992 when physicians first recommended that babies be positioned on the Back To Sleep.

Use a firm mattress in a safety-approved crib. Futons, waterbeds, beanbags, soft mattresses, sofa cushions, and pillows are unsafe sleep surfaces for your baby. There are proven dangers associated with makeshift or improvised sleep arrangements and with bedding that is intended for adult, rather than infant use. Second-hand, hand-me-down, and family heirloom cribs, cradles mattresses, or other bedding items may also pose infant safety risks.

Eliminate soft bedding from your baby's sleep area. Fluffy blankets, comforters, pillows and other soft bedding items and toys have no place in a baby's crib. Bedding that bunches up around your baby's face and head can block airways, causing potentially dangerous re-breathing of stale air.

Keep your baby's face and head clear of blankets and other coverings during sleep. Avoid using a blanket or other covering over your baby's face or head during sleep, as a sun or weather screen, or to block out distractions or sound while your baby is napping. If a blanket is used, parents are urged to position their baby on the Back To Sleep in the lower third of the crib, "feet to foot," and to secure the blanket under the sides of the mattress below the infant's armpits. A warm sleeper may be sufficient on colder nights; light pajamas in warmer weather.

Be careful not to overheat your baby. Set the thermostat to the temperature that you find comfortable. Too much clothing, too heavy bedding and too warm a room may overheat your baby, particularly if your baby already has a fever. Signs that your baby may be overheated include sweating, damp hair, heat rash, rapid breathing or restlessness. Always remember to remove hats and other head coverings when indoors, in cars, or stores to keep your baby from becoming overheated.

Provide a smoke-free environment for your baby. With the success of the Back To Sleep campaign, cigarette smoke exposure has emerged as the most significant risk factor for SIDS. Babies exposed to cigarette smoke during the first year of life are at twice the risk of SIDS. SIDS risk rises with each additional smoker in the household, the number of cigarettes smoked a day, and the length of the baby's exposure. No one should be allowed to smoke around your baby.

Educate baby sitters, child care providers and grandparents about SIDS risks. Continuity of care is an essential component of SIDS risk reduction, from parent to all other caregivers, as well as from nighttime to naptime. Don't assume that everyone knows about Back To Sleep and other SIDS risk reduction recommendations.

NOTE: While doctors are hopeful that following the Back To Sleep recommendations will continue to save lives, it is important to keep in mind that faithful adherence will still not prevent all SIDS deaths. The tragic truth is that any baby may be vulnerable to SIDS despite their parents' best efforts. Therefore, it is imperative that we all continue to support scientific efforts to uncover other risk factors and possible causes in order to solve the SIDS puzzle for good.

The Sudden Infant Death Syndrome Alliance is a national non-profit voluntary health organization uniting parents, caregivers, health professionals and researchers with government, business and community service groups concerned about the health of America's babies. The SIDS Alliance funds medical research; offers emotional support nationally and through local Affiliate programs to families who have lost babies to SIDS; and supplies up-to-date information on SIDS to the general public, particularly new and expectant parents, through a nationwide, 24-hour, toll free hotline number.

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