Arch Dis Child 1999;81:112-116 ( August )

Pacifier use and sudden infant death syndrome: results from the CESDI/SUDI case control study

Peter J Fleming^a, Peter S Blair^a, Katie Pollard^a, Martin Ward Platt^b, Charlotte Leach^a, Iain Smith^c, P J Berry^a, Jean Golding^a, the CESDI SUDI Research Team

^a FSID Unit, Department of Child Health, Developmental Physiology, Royal Hospital for Children, St Michael's Hill, Bristol BS2 8BJ, UK, ^b Newcastle Neonatal Service, Ward 35, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK, ^c Nuffield Institute for Health, 71-75 Clarendon Road, Leeds LS2 9PL, UK

Correspondence to: Professor Fleming. email: peter.fleming{at}bris.ac.uk

Accepted 29 March 1999

OBJECTIVESTo investigate the relation between pacifier use and sudden infant death syndrome (SIDS).
DESIGNThree year population based, case control study with parental interviews for each death and four age matched controls.
SETTINGFive regions in England (population > 17 million).
SUBJECTS325 infants who had died from SIDS and 1300 control infants.
RESULTSSignificantly fewer SIDS infants (40%) than controls (51%) used a pacifier for the last/reference sleep (univariate odds ratio (OR), 0.62; 95% confidence interval (CI), 0.46 to 0.83) and the difference increased when controlled for other factors (multivariate OR, 0.41; 95% CI, 0.22 to 0.77). However, the proportion of infants who had ever used a pacifier for day (66% SIDS v 66% controls) or night sleeps (61% SIDS v 61% controls) was identical. The association of a risk for SIDS infants who routinely used a pacifier but did not do so for the last sleep became non-significant when controlled for socioeconomic status (bivariate OR, 1.39 (0.93 to 2.07)).
CONCLUSIONSFurther epidemiological evidence and physiological studies are needed before pacifier use can be recommended as a measure to reduce the risk of SIDS.

Key messages There was no difference between victims of SIDS and control infants in routine use of a pacifier ("dummy" or "soother") for day or night sleeps The use of a pacifier was associated with a lower prevalence and shorter duration of breast feeding, lower socioeconomic status, and mothers who smoked more heavily There was no association between pacifier use and sleeping position More control infants used a pacifier for the last/reference sleep, giving an apparent "protective" effect against SIDS; the significance of this association increased when controlled for other factors Further epidemiological evidence and physiological studies are needed before we can recommend pacifier use as protective against SIDS

Keywords: sudden infant death syndrome; pacifiers; breast feeding

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© 1999 by Archives of Disease in Childhood
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