Marsha
Thank you for sending in more thoughts about the AAP recommendations and
pacifier use.
You raise the possibility of SIDS being related to cessation of pacifier
use, and I think you're on to something. I have wondered for many years
whether there is a relationship between crying and SIDS. More crying might
be likely when a baby has become programmed to a pacifier/dummy, and is
then deprived of it.
To continue this thought, I believe that New Zealand (where the first
cot-death studies were done) had the world's highest rate of SIDS. Many
years ago I had the opportunity of spending several hours listening to a
man named Tony Nelson speak about the NZ cot death research. He was a
young white Zimbabwean who had gone to New Zealand, had been involved in
the research, and had returned to Harare for a short holiday. He related
how both his children had been born in New Zealand. And that the village
women had given his wife "advice" about how to get these babies to sleep
through the night - as we know, a baby milestone highly prized in the
Western, European societies ... They advised her to put her baby in his
pram at night, and leave him in the kitchen at one end of the house. She
was then to shut every intervening door between the kitchen and the bedroom
so that she couldn't hear him cry, and eventually he would "learn" to sleep
through. I gather the advice was not taken, and both little boys
survived, but this man told us this story as he was telling the SIDS
research story, as if the two things were connected.
There is also an English book about Cot Death and SIDS, (I used to have the
book, but gave it away and have forgotten the title, I think it was just
Cot Death). It relates the stories of five babies who had died of SIDS,
from the perspective of the five affected families. The common thread (not
highlighted in the book, probably because it was normal for the culture?)
seemed to be that the babies had all been fine and healthy, had been put to
bed in the usual way, on their stomachs, and had been crying for a little
while, and then stopped, but were then discovered lifeless, all bunched up
at the top of their prams or cribs a short time later. Really very
heart-breaking.
So I've always wondered since about the relationship between crying and
SIDS, and whether this might have been one of the reasons why the NZ rates
were so high. And now, whether the apparent "protective" effect of
pacifiers is that they may be used to comfort (pacify) a baby in preference
to just leaving him to cry?? Could it be that breastfeeding appears to be
protective, because breastfed babies are also less likely to be left to
cry? Could the over-heating which apparently is the result of prone
sleeping also occur as a side-effect of crying? I don't believe these
questions have been answered - and to use a randomized double-blind trial
(ie properly!) would no doubt be unethical, but in the absence of such
evidence, the questions remain. Thank you for your in-depth analysis
highlighting that the problem may lie not with the lack of pacifiers per
se, but with what may happen when babies are not pacified by any means.
Pamela Morrison IBCLC
Rustington, England
At 17:55 16/10/2005, you wrote:
>Date: Sun, 16 Oct 2005 08:35:20 EDT
>From: [log in to unmask]
>Subject: Yet more on AAP/pacifiers
>
>I have been looking at some of the references used by the AAP in making
>their blanket pacifier use recommendation. Part of the problem is that these
>articles do not differentiate between whether it is the absence of
>the pacifier
>(ie, babies who never use them) or whether it is being dependent on a
>pacifier
>but then being denied it that puts the baby at risk. Not having slept with
>the pacifier in the reference sleep is the criteria being used to tell 4
>million parents in the US to use pacifiers. Babies who usually used a
>pacifier and
>did not have it during the reference sleep were almost 6 times more at risk
>than regular users who did have it (McGarvey et al, Arch Dis Child 2003;
>88:1058-1064. Arousal thresholds from sleep are different
>between breastfed and
>bottle-fed babies. Breastfed babies are more easily aroused from active
>sleep
>at 2-3 months of age than formula fed babies. This age coincides with the
>peak incidence of SIDS. One theory about SIDS is that it arises from
>a deficit
>in arousal responses to a life threatening situation. Using a pacifier
>increases arousability, something which is already present in a
>breastfed infant.
>Infants dying of SIDS typically have less mature autonomic function and
>delayed
>neuronal maturation that affects the arousal pathway in the brain.
>Breastfeeding a baby during the critical risk period for SIDS
>(2-4 months) "covers"
>the period of time when reduced arousal capability impairs the infant's
>ability
>to respond to life threatening situations. The studies do not tell us if
>parents were using any of the sleep training programs (Ezzo, Ferber, Baby
>Whisperer, etc) that deliberately train babies to sleep soundly through
>the night,
>especially during the peak time of night when SIDS occurs.
>
>The question becomes, should we artificially create a need for the use of a
>pacifier, i.e. hook babies on it so they are dependent on it to breathe
>while
>sleeping? Would this actually increase the risk for SIDS in more babies if
>AAP's recommendations are followed? These studies are all retrospective.
>There
>is not one piece of prospective evidence, randomizing babies into pacifier
>and no-pacifier groups. Mostly what is shown is that pacifier-dependent
>babies
>are at higher risk for SIDS when they are not put to sleep with their
>breathing aid.
>
>Also, Linda Smith has provided the information showing some of the
>partnerships between the authors of the AAP guidelines and SIDS
>organizations that
>receive funding from pacifier and formula makers.
>
>
>Fleming PJ, Blair PS, Pollard K, et al. Pacifier use and sudden infant death
>syndrome: results from the CESDI/SUDI case control study. Arch Dis Child
>1999; 81:112-116
>
>Horne RSC, Parslow PM, Ferens D, et al. Comparison of evoked arousability in
>breast and formula fed infants. Arch Dis Child 2004; 89:22-25
>
>L'Hoir MP, Engelberts AC, van Well GTJ, et al. Dummy use, thumb sucking,
>mouth breathing and cot death. Eur J Pediatr 1999; 158:896-901
>
>Vennemann MMT, Findeisen M, Butterfab-Bahloul T, et al. Modifiable risk
>factors for SIDS in Germany: results of GeSID. Acta Paediatr 2005; 94:655-660
>
>Marsha Walker, RN, IBCLC
>Weston, MA
>
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