Gonneke is quite right.  Research showing the apparent protective 
effect of pacifier use against SIDS made sense to me immediately I 
heard about it.  Years ago I read a book about cot death which 
described five cases from different families.  In all instances, the 
babies had been put in their cots, left to cry themselves to sleep, 
and some time later had been found squished up in a corner of the cot 
no longer breathing.  Ever since, I've wondered about the link 
between extreme distress and SIDS.

As we know, babies just love to suck - it soothes and comforts them - 
quite apart from whether they receive nutrition as a reward.  Thus it 
makes sense that there would be fewer deaths when babies who would 
otherwise have no other form of warm, close cuddling and contact, 
were given pacifiers to suck on for comfort and for self-soothing, 
rather than leaving them to cry and scream alone with all the 
dangerous physical consequences that would ensue.

Clearly, babies who are breastfed whenever they show signs of wanting 
to suck are safest.  Those whose mothers are unwilling or are 
persuaded not to provide this continuous day and night care are at 
most risk.  Pacifiers probably "work" to reduce the risk by providing 
at least some substitute comfort-sucking and reduced distress/crying 
and screaming.

But it's no accident that in many English-speaking countries the word 
for Pacifier is Dummy - a substitute for the real thing.  Physicians 
can bypass the dilemma of needing to counsel mothers about the risks 
and benefits of pacifier use and how it might interfere with 
breastfeeding when they recommend allowing infants unlimited access 
to the breast in order to _facilitate_ breastfeeding.   Or is this too simple??

Pamela Morrison IBCLC
Rustington, England
------------------------------------------
Date:    Mon, 27 Apr 2009 22:07:59 -0700
From:    gonneke van veldhuizen <[log in to unmask]>
Subject: Re: Pacifier use may not affect breastfeeding?

Dear friends,
How well done can any study be that starts from the wrong hypothesis: [qout=
e]"Physicians who counsel families about pacifier use must now weigh the=0A=
potential protective effect against SIDS [sudden infant death syndrome]=0Aa=
gainst the potential deleterious effect on breastfeeding," write Nina=0AR. =
O'Connor, MD, from University of Virginia School of Medicine in=0ACharlotte=
sville (at the time of the study), and colleagues[unquote]. Of course pacif=
iers are only a safeguard for children that do not have unlimited access to=
  the breast. Breastfed children do not need any artificial replacement to s=
afeguard them from the results of taking away their natural protection from=
  them.

Warmly,

Gonneke, IBCLC in very early morning southern Netherlands

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