July 24, 2000 -- A new Belgian study could put an old myth to rest. Do infants who sleep with a pacifier have less risk of sudden infant death syndrome? Sleeping with a pacifier may indeed help babies wake more easily, according to a recent report in The Journal of Pediatrics.
But breast-feeding might have a similar effect and pacifier use has been linked with dental problems, so pediatricians recommend other ways to prevent sudden infant death syndrome (SIDS).
Also known as crib death, SIDS is the most common cause of death in infants between the ages of two weeks and one year, accounting for almost a third of all deaths in this age group. Occurring most often in babies between 2 and 4 months of age, SIDS strikes premature infants, particularly those with mothers who smoke. The cause of SIDS is not yet known, but it occurs more often in cold weather and is also associated with overheated environments.
"The study explains a reported protective effect, but the risks of pacifiers probably outweigh the benefits," says study co-author Andre Kahn, MD, PhD, professor and chief of pediatrics at the Free University of Brussels in Belgium. "One very important issue is the link with abnormal jaw development and dental cavities," he adds.
Because pacifiers are thought to have a protective effect against SIDS, Kahn and his colleagues explored their effect in over 50 infants from 6 to 19 weeks of age. In a sleep laboratory, those who normally slept with a pacifier were compared to those who did not. To measure how quickly the babies could be awakened, the researchers gradually increased background noise until the infants woke.
Overall, pacifier users woke more easily than nonusers, but only 20% still had their pacifier after one hour. In terms of sleep quality and heart function, both groups were similar. Among bottle-fed infants, pacifier users woke more easily than nonusers. But among all those who did not use pacifiers, breast-fed infants woke more easily than those who were bottle-fed.
Before the age of three, dentists say the effects of pacifiers are fairly minor. But dipping them in honey or jam is an entirely different matter. "Sometimes [the] cavities are so severe, that we have to take out all 20 baby teeth in the operating room," says Yasser Armanazi, DDS, an assistant professor and director of pediatric dentistry at Ohio's Case Western Reserve University.
After the age of three, pacifiers can cause both "buck teeth" and abnormal spacing. "Long-term use can also cause a narrowing of the upper jaw," Armanazi tells WebMD. "It's common in kids and can only be corrected with an external device known as head gear," he explains.
Until more is known about the effects of pacifiers, doctors recommend other ways to prevent SIDS. "Always place your baby on its back when unattended, because SIDS is linked with lying on the stomach," says Karen Duncan, MD, an associate professor of pediatrics at Emory University in Atlanta. "You also want to avoid wrapping blankets around your baby too tightly," she adds.
Pillows, comforters, and waterbeds are also associated with SIDS. "That's why it's so risky for babies to sleep in your bed," says Ellis Beesley, MD, an assistant clinical professor of pediatrics at the University of Southern California. "But if you want to have them nearby just after delivery, put a bassinet in your room or make one out of a dresser drawer," he advises.