Maternal and Child Health Journal

, Volume 16, Issue 3, pp 609–614 | Cite as

Pacifier Use and Sids: Evidence for a Consistently Reduced Risk

  • Rachel Y. MoonEmail author
  • Kawai O. Tanabe
  • Diane Choi Yang
  • Heather A. Young
  • Fern R. Hauck


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.


SIDS Pacifier Sleep position Bed sharing Risk factor 



We thank Kristen Wells, PhD for statistical assistance. This study was supported by HRSA grant 1R40MC08963-01 and by funding from First Candle.


  1. 1.
    Willinger, M., et al. (1991). Defining the sudden infant death syndrome (SIDS): deliberations of an expert panel convened by the National Institute of Child Health and Human Development. Pediatric Pathology, 11, 677–684.PubMedCrossRefGoogle Scholar
  2. 2.
    Hoyert, D. L., et al. (2001). Deaths: final data for 1999. National Vital Statistics Report, 49(8), 1–113.Google Scholar
  3. 3.
    Haglund, B. (1993). Cigarette smoking and sudden infant death syndrome: some salient points in the debate. Acta Paediatrica. Supplement, 82(Suppl 389), 37–39.PubMedCrossRefGoogle Scholar
  4. 4.
    MacDorman, M. F., et al. (1997). Sudden infant death syndrome and smoking in the United States and Sweden. American Journal of Epidemiology, 146(3), 249–257.PubMedGoogle Scholar
  5. 5.
    Mitchell EA, Milerad J. Smoking and sudden infant death syndrome. WFO/TFI Reports 1999:
  6. 6.
    Schoendorf, K. C., & Kiely, J. L. (1992). Relationship of sudden infant death syndrome to maternal smoking during and after pregnancy. Pediatrics, 90(6), 905–908.PubMedGoogle Scholar
  7. 7.
    Ponsonby, A.-L., et al. (1993). Factors potentiating the risk of sudden infant death syndrome associated with the prone position. New England Journal of Medicine, 329, 377–382.PubMedCrossRefGoogle Scholar
  8. 8.
    Mitchell, E. A., et al. (1998). Sheepskin bedding and the sudden infant death syndrome. New Zealand Cot Death Study Group. Journal of Pediatrics, 133, 701–704.PubMedCrossRefGoogle Scholar
  9. 9.
    Brooke, H., et al. (1997). Case-control study of sudden infant death syndrome in Scotland, 1992–5. BMJ, 314(7093), 1516–1520.PubMedCrossRefGoogle Scholar
  10. 10.
    Kemp, J. S., et al. (1993). Unintentional suffocation by rebreathing: a death scene and physiologic investigation of a possible cause of sudden infant death. Journal of Pediatrics, 122, 874–880.PubMedCrossRefGoogle Scholar
  11. 11.
    Scheers, N. J., et al. (1998). Sudden infant death with external airways covered: case-comparison study of 206 deaths in the United States. Archives of Pediatrics and Adolescent Medicine, 152, 540–547.PubMedGoogle Scholar
  12. 12.
    Mitchell, E. A., et al. (1996). Soft cot mattresses and the sudden infant death syndrome. New Zealand Medical Journal, 109(1023), 206–207.PubMedGoogle Scholar
  13. 13.
    Hauck, F. R., et al. (2003). Sleep environment and the risk of sudden infant death syndrome in an urban population: the Chicago Infant Mortality Study. Pediatrics, 111(5 Part 2), 1207–1214.PubMedGoogle Scholar
  14. 14.
    Fleming, P. J., et al. (1996). Environment of infants during sleep and risk of the sudden infant death syndrome: results of 1993–5 case-control study for confidential inquiry into stillbirths and deaths in infancy. Confidential Enquiry into Stillbirths and Deaths Regional Coordinators and Researchers. BMJ, 313(7051), 191–195.PubMedCrossRefGoogle Scholar
  15. 15.
    L’Hoir, M. P., et al. (1998). Risk and preventive factors for cot death in The Netherlands, a low-incidence country. European Journal of Pediatrics, 157, 681–688.PubMedCrossRefGoogle Scholar
  16. 16.
    Beal, S. M., & Byard, R. W. (1995). Accidental death or sudden infant death syndrome? Journal of Paediatrics and Child Health, 31(4), 269–271.PubMedCrossRefGoogle Scholar
  17. 17.
    Baddock, S. A., et al. (2006). Differences in infant and parent behaviors during routine bed sharing compared with cot sleeping in the home setting. Pediatrics, 117(5), 1599–1607.PubMedCrossRefGoogle Scholar
  18. 18.
    Kattwinkel, J., et al. (2000). Changing concepts of sudden infant death syndrome: implications for infant sleeping environment and sleep position. American Academy of Pediatrics. Task Force on Infant Sleep Position and Sudden Infant Death Syndrome. Pediatrics, 105(3 Pt 1), 650–656.Google Scholar
  19. 19.
    Blair, P. S., et al. (1999). Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome. CESDI SUDI research group. BMJ, 319(7223), 1457–1462.PubMedCrossRefGoogle Scholar
  20. 20.
    Carpenter, R. G., et al. (2004). Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet, 363, 185–191.PubMedCrossRefGoogle Scholar
  21. 21.
    McGarvey, C., et al. (2006). An 8 year study of risk factors for SIDS: Bed-sharing vs. non bed-sharing. Archives of Disease in Childhood, 91(4), 318–323.PubMedCrossRefGoogle Scholar
  22. 22.
    McGarvey, C., et al. (2003). Factors relating to the infant’s last sleep environment in sudden infant death syndrome in the Republic of Ireland. Archives of Disease in Childhood, 88(12), 1058–1064.PubMedCrossRefGoogle Scholar
  23. 23.
    Tappin, D., et al. (2005). Bedsharing and sudden infant death syndrome in Scotland: a case control study. Journal of Pediatrics, 147(9413), 32–37.PubMedGoogle Scholar
  24. 24.
    Ruys, J. H., et al. (2007). Bed-sharing in the first four months of life: a risk factor for sudden infant death. Acta Paediatrica, 96(10), 1399–1403.PubMedCrossRefGoogle Scholar
  25. 25.
    Fleming, P. J., et al. (1999). Pacifier use and sudden infant death syndrome: results from the CESDI/SUDI case control study. CESDI SUDI Research Team. Archives of Disease in Childhood, 81, 112–116.PubMedCrossRefGoogle Scholar
  26. 26.
    Hauck, F. R., et al. (2005). Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics, 116(5), e716–e723.PubMedCrossRefGoogle Scholar
  27. 27.
    Li, D. K., et al. (2006). Use of a dummy (pacifier) during sleep and risk of sudden infant death syndrome (SIDS): population based case-control study. BMJ, 332(7532), 18–22.PubMedCrossRefGoogle Scholar
  28. 28.
    Vennemann, M. M., et al. (2005). Modifiable risk factors for SIDS in Germany: results of GeSID. Acta Paediatrica, 94(6), 655–660.PubMedCrossRefGoogle Scholar
  29. 29.
    Kattwinkel, J., et al. (2005). Task Force on Sudden Infant Death Syndrome, American Academy of Pediatrics. The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics, 116(5), 1245–1255.CrossRefGoogle Scholar
  30. 30.
    Hoffman, H. J., et al. (1988). Risk factors for SIDS. Results of the National Institute of Child Health and Human Development SIDS Cooperative Epidemiological Study. Annals of the New York Academy of Sciences, 533, 13–30.PubMedCrossRefGoogle Scholar
  31. 31.
    Porter, K. S., & Thomas, S. D. (2002). Birth outcomes and infant mortality in Chicago, 1990–1999. Chicago, IL: Chicago Department of Public Health Epidemiology Program.Google Scholar
  32. 32.
    Centers for Disease Control and Prevention NCHS. Infant mortality rates, fetal mortality rates, and perinatal mortality rates, according to race: United States, selected years 1950–1999. (Accessed September 7, 2010, at
  33. 33.
    Hauck, F. R., et al. (2002). The contribution of prone sleeping position to the racial disparity in sudden infant death syndrome: The Chicago Infant Mortality Study. Pediatrics, 110(4), 772–780.PubMedCrossRefGoogle Scholar
  34. 34.
    Annie E. Casey Foundation. (2008). 2008 KIDS COUNT data book: State profiles of child well-being. Baltimore, MD: Annie E. Casey Foundation.Google Scholar
  35. 35.
    Mathews, T. J., & MacDorman, M. F. (2008). Infant mortality statistics from the 2005 period linked birth/infant death data set. National Vital Statistics Report, 57(2), 1–32.Google Scholar
  36. 36.
    National Infant Sleep Position survey database. (Accessed September 7, 2010, at
  37. 37.
    Hauck, F. R., et al. (2008). Infant sleeping arrangements and practices during the first year of life. Pediatrics, 122(Suppl 2), S113–S120.PubMedCrossRefGoogle Scholar
  38. 38.
    Willinger, M., et al. (2003). Trends in infant bed sharing in the United States, 1993–2000: The National Infant Sleep Position study. Archives of Pediatrics and Adolescent Medicine, 157(1), 43–49.PubMedGoogle Scholar
  39. 39.
    Ponsonby, A.-L., et al. (2002). Population trends in sudden infant death syndrome. Seminars in Perinatology, 26(4), 296–305.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Rachel Y. Moon
    • 1
    • 2
    Email author
  • Kawai O. Tanabe
    • 3
  • Diane Choi Yang
    • 4
  • Heather A. Young
    • 4
  • Fern R. Hauck
    • 3
    • 5
  1. 1.Goldberg Center for Community Pediatric HealthChildren’s National Medical CenterWashingtonUSA
  2. 2.Department of PediatricsGeorge Washington University School of Medicine and Health SciencesWashingtonUSA
  3. 3.Department of Family MedicineUniversity of Virginia School of MedicineCharlottesvilleUSA
  4. 4.Department of Epidemiology and BiostatisticsGeorge Washington University School of Public Health and Health SciencesWashingtonUSA
  5. 5.Department of Public Health SciencesUniversity of Virginia School of MedicineCharlottesvilleUSA

Personalised recommendations