SIDS Program Manual SIDS & Infant Death Program Manual and Trainer's Guide Trainer's Guide

What is SIDS?

Protective Measures

Baby with pacifer


Research indicates that there may be an association between pacifier use and a decrease in SIDS, but the mechanism by which the pacifier is helping in reducing the risk is unclear. Key points of the research are:75

More control infants used a pacifier for their last—or reference—sleep, giving an apparent protective effect against SIDS. The significance of this association increased when controlled for other factors.

Studies completed in New Zealand, Netherlands, Norway and the United States did report an association between pacifier use and SIDS that was protective.76,77,78,79

There are many theories on how pacifiers might be protective in the sleep environment. One recent study suggests that pacifiers lower the auditory arousal threshold.80 There appears to be an association between the use of a pacifier and a reduced risk of SIDS. However, the pathophysiology of SIDS upon which pacifiers may exert a positive effect remains unclear because pacifiers do not stay in an infant’s mouth for a very long period of time—approximately 20 minutes—during sleep. Theories that require pacifiers to be in the mouth are difficult to support for this reason.

Concern with possible negative outcomes related to pacifier use such as associated reduced breastfeeding, dental issues, ear infections and product safety have delayed making a recommendation to use a pacifier to reduce the risk of SIDS.

The 2005 AAP policy statement on SIDS, The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk, recommends the use of pacifiers at nap time and bedtime throughout the first year of life. The evidence that pacifier use inhibits breastfeeding or causes later dental complications is not compelling enough to discredit the recommendation.

However, it is recommended that pacifier introduction for breastfed infants be delayed until 1 month of age to ensure that breastfeeding is firmly established. In addition, if the infant refuses the pacifier, it should not be forced. There is a slight increased risk of ear infections associated with pacifier use, but the incidence of ear infection is generally lower in the first year of life, especially the first 6 months, when the risk of SIDS is the highest.