In looking at the studies cited for the recommendation of pacifier use, I am struck by the description that the SIDS incident occurred on a night where the infant lost the pacifier out of his mouth. This suggests to me that these infants were already pacifier-dependent for the regulation of their breathing during sleep. We know that exclusively breastfed infants, especially if they sleep in the same room as the parents have a lower incidence of SIDS. My question regarding the advice to give all babies pacifiers is why would we want to make them pacifier-dependent in the first place and actually raise the risk of SIDS? We already have RestFull infant formula that is supposed to make babies sleep longer and deeper, sleep-through-the-night baby training programs to make babies sleep deeper and longer, and research being done on putting tryptophan into formula to make babies sleep deeper and longer! 

Pacifier use during the day for a few minutes to calm a fussy baby or in a NICU for sucking experience is different in my mind than addicting a baby to a pacifier to the point where he is dependent on it to breathe at night. Is there a subset of infants who need a pacifier to regulate breathing during sleep or do we create this subset by accustoming them to pacifier use as a newborn?

Marsha Walker, RN, IBCLC
Weston, MA




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