Scientific Article

Pacifier Use and SIDS

Interview with Dr. Alejandro Jenik, MD

Interview with Dr. Alejandro Jenik about his recently published article “Pacifier Use and SIDS” in the book “Investigation of Sudden Infant Death Syndrome”, edited by Marta C. Cohen, Irene B. Scheimberg, J. Bruce Beckwith and Fern R. Hauck.

Can you briefly explain Sudden Infant Death Syndrome?

Jenik: Sudden Infant death Syndrome (SIDS) is a term used to describe the sudden, unexpected death in infancy (SUID) when subsequent investigations (autopsy, review of the circumstances of death, clinical history) fail to demonstrate a definite cause of death. SIDS is a diagnosis of exclusion. Other causes of SUID must be considered and excluded before a diagnosis of SIDS can be established. Among these, fatal child abuse and metabolic and genetic disease are particularly important because they have implications for other children in the family.

What factors increase the risk of SIDS?

Jenik: There are numerous risks that have been consistently identified as independent factors. These include late or no prenatal care, preterm birth and/or low birth weight, maternal smoking during pregnancy, a prone sleeping position, sleeping in the parental bed and, under certain circumstances, parental smoking, alcohol or drugs consumption or sleeping next to an adult on a sofa. Babies who usually sleep on their backs but who are afterwards placed on their stomachs for a nap, for example, are at very high risk of SUID. There is an increased risk of SUID associated with adverse social circumstances that are independent of maternal smoking, prone position and birth weight.

Do mothers need to be concerned that the use of pacifiers affects the duration of breastfeeding? Is there any scientific evidence?

Jenik: Scientific evidence confirms that there is no need for mothers to worry about the use of pacifiers in relation to the duration of breastfeeding. Well-designed studies have shown that there is no difference in breastfeeding outcomes and different patterns of pacifier use among preterm infants and healthy newborn infants after 15 days of life (at Baby Friendly Hospital Initiative (BFHI) member hospitals). These findings strongly suggest that pacifier use is an indicator but not a cause of breast-feeding difficulties or reduced breastfeeding duration. Our research group demonstrated that if the pacifier is offered when breastfeeding is well established, it has no effect on feeding duration. However, we don’t know what happens if the pacifier is offered during the first days of life as there have been no well-designed studies to provide the relevant information.

How many babies does SIDS affect each year, worldwide? Is there a difference between developing and industrialized countries?

Jenik: Recent SIDS rates vary across high-income countries (2012-2014), ranging from 0.05 deaths per 1,000 live births in Sweden to 0.39 per 1,000 live births in the US. This latter figure is attributable to high rates of childhood vulnerability.
High rates of SIDS and SUID still prevail among certain racial and ethnic groups linked to poverty and discrimination (African-Americans, native Americans, indigenous Alaskans and Canadians, New Zealand Māori, Australian aborigines and low‐income British). There is under-reporting and a dearth of literature on SIDS among developing countries, and I am sure that grief and guilt play a role in this.

Source: Sudden Infant and Early Childhood Death: The Past, the Present and the Future. Duncan JR, Byard RW, editors.Adelaide (AU): University of Adelaide Press

In the past, the World Health Organization (WHO) actively advised against the use of artificial teats or pacifiers for breastfeeding infants. This position was revised in April 2018 to “counsel mothers on the use and risks of feeding bottles, teats and pacifiers” rather than discouraging their use. Do you think this has influenced healthcare professionals in favor of pacifiers?

Jenik: This modification represents a paradigm shift that allows families to make informed decisions on the use or avoidance of pacifiers. It paves the way for physicians, nurses and healthcare staff in general to continue supporting breastfeeding without needing to avoid an adequate recommendation of pacifier use when putting the baby to sleep; an intervention that has been clearly demonstrated to reduce the risk of SIDS.

Why did the Cambridge University Press recently decide to publish “Investigation of Sudden Infant Death Syndrome”? What is the target group for this scientific book?

Jenik: This book includes aspects in the investigation of SUID and SIDS that are not taken into account by other publications, including current standards of police investigation and post-mortem, incorporating all aspects of the investigation, the home visit, medical history and autopsy findings. Written by multidisciplinary experts, this vital guide uses clear reference tables and diagrams to present cutting-edge knowledge for the use of pediatric and general pathologists, pediatricians, medico-legal practitioners and anyone involved in the investigation of sudden infant deaths.

Please briefly explain how a pacifier can help to reduce the risk of SIDS.

Jenik: There are numerous mechanisms that can contribute to pacifiers reducing the risk of SIDS. They improve autonomic control and prevent the infant from rolling over into the prone position, with the pacifier’s external grip having a favorable influence on the infant’s sleeping environment. They also help to maintain upper airway patency, increase blood pressure during sleep, increase “arousability” (controversial) and induce a forward movement of the mandible.


Dr. Alejandro Jenik, MD

Paediatrician

Dr. Alejandro Jenik MD is Head of the Neonatal Department at the Hospital Italiano in Buenos Aires (Argentina)

1Jenik A.G., Vain N.E., Gorestein A.N., Jacobi, N.E.: Does the Recommendation to Use a Pacifier Influcnece the Prevalence of Breastfeeding? The Journal of Pediatrics 2009