Here is the letter to the editor that I just sent regarding the article on  
pacifiers in yesterday's Boston Globe.
 
Marsha Walker, RN, IBCLC
Weston, MA
-----------------------
   
To the Editor:
 
It is true that there is a lower incidence of SIDS among breastfed  babies. 
However, giving a baby a pacifier at night does not necessarily protect  the 
infant from SIDS, as implied by the American Academy of Pediatrics new  
recommendations on the prevention of SIDS (A controversy boils about baby's  binky," 
Oct 27). The nature of the studies upon which this recommendation is  based 
does not warrant the blanket statement that all babies be given a  pacifier. 
Pacifiers were associated with SIDS in babies who were dependent upon  pacifiers 
to regulate their breathing and arousal patterns - the pacifier was  lost from 
the mouth or not given to the baby on the night SIDS occurred.  These were not 
prospective studies conducted with a group who received a  pacifier and a 
group that did not. Breastfed babies already rouse more  frequently during the 
night so giving them pacifiers would not confer an  advantage for a behavior 
that already exists. Formula-fed babies sleep more  deeply and do not rouse in 
the same manner as breastfed infants. This is  why when such a baby is routinely 
given a pacifier and becomes dependent on it  to regulate breathing and 
arousal from sleep, the loss of the pacifier at night  is what places the baby at 
risk. The question in my mind is if all babies  are given pacifiers, will it 
create dependency in some babies where none existed  before and place a 
sub-population of infants at risk when not given a pacifier?  The studies did not take 
into account if parents were using any of the sleep  training programs that 
condition a baby to sleep deeply through the night during  the time period of 
highest SIDS risk.
 
Pacifiers are also frequently recalled (311,000 in 2005), mainly because  
they separate and pose a choking hazard. Parents should be informed of this and  
be directed to the website of the Consumer Product Safety Commission to check  
for recalled pacifiers. Pacifier use increases the incidence of ear  
infections, gastrointestinal disease, candida (thrush), and early breastfeeding  
problems. Some pacifiers are made of latex which pose an allergy hazard. The  
differences in the shapes of pacifiers are most significant to babies, as any  
parent will tell you after buying $50 worth of pacifiers until they find one the  
baby will accept. The pacifier recommendation is very significant to  
manufacturers too. With 4 million babies born each year, "requiring" several  
pacifiers at over $2 apiece, there is a bundle of money to be made. 
 
Please check the statement from the Massachusetts Breastfeeding Coalition  at 
_www.massbfc.org_ (http://www.massbfc.org/) . Also, the Academy of  
Breastfeeding Medicine's statement is at _www.bfmed.org_ (http://www.bfmed.org/) . 
Their web address was incorrect  in the article.
 


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