Use pacifier to reduce risk of SIDS, doctors say

And babies should sleep near, not with, parents, according to pediatrics academy


If you brought home a new baby at least 15 years ago, some of the things you did turned out to be inadvisable, if not completely wrong.

You made sure the baby slept on her stomach because your doctors said back-sleeping raised the risk of sudden infant death syndrome (SIDS). You resisted offering a pacifier because it set the baby up for middle-ear infections and interfered with proper tooth formation.

And, if you subscribed to the natural-everything movement, you may have allowed the baby to fall asleep in your bed while breastfeeding and then kept her there overnight.

In 1992, the first of these accepted truths fell by the wayside when the American Academy of Pediatrics announced that belly-sleeping actually increased the risk of SIDS, and not the other way around. Thus began a national back-to-sleep campaign widely credited with lowering SIDS deaths in the U.S. from 5,000 to about 3,000 a year.

Now, in new SIDS prevention guidelines that are raising hackles among some breastfeeding advocates, the academy said this week that babies should sleep in a crib near the parents' bed - but never in the grown-ups' bed. What's more, the doctors are encouraging parents to offer pacifiers once the baby has finished nursing at bedtime, a practice the group says could save hundreds more lives annually.

Dr. Robert Meny, a Baltimore physician specializing in childhood sleep problems, said he noticed the tide turning in favor of pacifiers a few years ago. He didn't quite believe the conclusions of the first study showing pacifiers might be beneficial.

"The first time I saw it, I kind of thought, `That's weird, it's happenstance, one of those statistical things,' " said Meny, who performs sleep studies at St. Joseph's Medical Center and Franklin Square Hospital Center. "Then I saw it again ... yet another study."

Small studies suggesting a reduced SIDS risk among pacifier-sucking babies started cropping up more than a decade ago. More recently, researchers from the University of Virginia in Charlottesville and Children's National Medical Center in Washington pulled together seven studies to see if they could draw a conclusion.

Their analysis, appearing in the November issue of the journal Pediatrics, formed the basis of the academy's recommendations. It concluded that one SIDS death could be prevented for every 2,733 babies who drift off to sleep with pacifier in mouth.

"It's a strong reduction," said Dr. Fern Hauck, an associate professor of family medicine at the University of Virginia Health System. "We don't know why that is, and we don't really know why back sleeping is protective either. It's just that it works."

The academy said pacifiers should be introduced once breastfeeding is fully established, which could take about three weeks. Also, they shouldn't be used after a baby's first birthday, to allow for healthy tooth development.

Doctors offer two reasons why pacifiers might prevent sudden infant deaths. One is that babies seem to arouse more easily when they suck on a pacifier, a tendency that could save them if for some reason they have trouble breathing.

Another is that sucking on a pacifier pulls the tongue forward, clearing the back of the throat for unobstructed breathing. The baby's tongue is larger in proportion to the size of its mouth than an adult's, so tongue position can be an important factor.

"The pacifier may help in moving that tongue into a better position for breathing through the nose and mouth," said Dr. Carol Blaisdell, head of pulmonary medicine at the University of Maryland's Hospital for Children.

In contrast to many physicians, Blaisdell said she never discouraged parents from offering pacifiers to their babies, nor did she encourage them either. The hospital has, however, used pacifiers to calm fussy newborns.

"This will guide us in terms of making the recommendation that pacifiers are beneficial, though I wouldn't say it's essential," she said.

Dr. Robert Ancona, chief of pediatrics at St. Joseph's, said he has discouraged pacifiers because they seem to set babies up for middle ear infections and can interfere with emerging teeth. The best course now may be to encourage pacifiers generally - especially for babies at high risk for SIDS - but to discourage them for infants who have recurrent ear infections, he said.

"The new data shows it increases their arousability and may lower their risk of SIDS," Ancona said. "All that data may be true, but it has to be tempered. It has to be balanced."

Hauck, who also helped frame the academy's recommendations, said the evidence shows that pacifiers slightly raise the risk of ear infections, but not enough to overcome the potential benefits.

"We're talking about a pretty minor illness in the scheme of things, compared to death ... " she said. "Most people would say if your child has one additional ear infection in the first year of life, that's a minor price to pay."

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