Pacifiers for risk reduction in sudden infant death syndrome

The understanding of the causes of sudden infant death syndrome is incomplete, but several risk and protective factors have been identified.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut202115 Registration no: SBU 2021/248

Question

What systematic reviews and scientific studies are there on the effects of pacifier use on sudden infant death syndrome?

Identified literature

One relevant systematic review with medium risk of bias [1] and 18 primary studies were identified [2–19]. The primary studies were not assessed for risk of bias.

Table 1. Systematic reviews with low/medium risk of bias.
CI = confidence interval; OR = odds ratio; SIDS = Sudden Infant Death Syndrome
Included studies Population/Intervention Outcome
Nasjonalt kunnskapssenter for helsetjenesten (2005)
Samsoving, smokk, amming og krybbedød – finnes det en sammenheng? [1]
5 case control studies investigating pacifier use and other risk factors in the sleep environment.

Setting: Norway, Netherlands, England, Ireland and New Zealand.		 Population: 1260 infants diagnosed with SIDS

Control: 4243 matched controls

Exposure: Pacifier use		 Effect OR (95% CI):
Routine pacifier use vs non-use in last/reference sleep
n=1 study
0.17 (0.07 to 0.42)

Pacifier use ever vs never, 0–4 months
n=1 study
Daytime: 0.51 (0.27 to 0.96), Night-time: 0.36 (0.18 to 0.69)

Pacifier use vs pacifier non-use in last/reference sleep
n=3 studies
0.19 (0.08 to 0.46)
0.41 (0.22 to 0.77)
0.43 (0.24 to 0.78)
Authors' conclusion:
“All included studies found that the use of pacifier is associated with a reduction in the risk of cot-death. However, because of limitations in the study design it is impossible to determine if there is causation.”

 

Table 2. Primary studies. Not assessed for risk of bias.
Included studies Population/Intervention Exposure
Arnestad et al, 1997
Is the use of dummy or carry-cot of importance for sudden infant death? [2]
Study design:
Case control
Setting:
10 Norwegian counties		 Population:
167 SIDS infants
352 matched controls		 Main exposure:
Dummy use and carry-cots

Pacifier use measure:
  • Routine night use
  • Routine day use
  • Ever night use
  • Ever day use
Arnestad et al, 2001
Changes in the epidemiological pattern of sudden infant death syndrome in southeast Norway, 1984-1998: implications for future prevention and research. [3]
Study design:
Case control
Setting:
Southeastern Norway		 Population:
174 SIDS infants
375 matched controls		 Main exposure:
Risk factors

Pacifier use measure:
  • Ever night use
  • Ever day use
Blair et al, 2014
Bed-sharing in the absence of hazardous circumstances: Is there a risk of sudden infant death syndrome? An analysis from two case-control studies conducted in the UK. [4]
Study design:
Case control
Setting:
5 English health regions		 Population:
400 SIDS infants
1386 control infants		 Main exposure:
Co-sleeping

Pacifier use measure:
Dummy used in last sleep/reference sleep
Carpenter et al, 2004
Sudden unexplained infant death in 20 regions in Europe: case control study. [5]
Study design:
Case control
Setting:
20 regions in eastern and western Europe		 Population:
745 SIDS infants
2411 control infants		 Main exposure:
Potential risk factors

Pacifier use measure:
  • Dummy used ever
  • Dummy used in last sleep/reference sleep
Fleming et al, 1996
Environment of infants during sleep and risk of the sudden infant death syndrome: results of 1993-5 case-control study for confidential inquiry into stillbirths and deaths in infancy. Confidential Enquiry into Stillbirths and Deaths Regional Coordinators and Researchers. [6]
Study design:
Case control
Setting:
3 regions in England		 Population:
195 SIDS infants
780 matched control infants		 Main exposure:
Sleeping arrangements (sleeping position, bedding)

Pacifier use measure:
Using dummy in last sleep/reference sleep
Fleming et al, 1999
Pacifier use and sudden infant death syndrome: Results from the CESDI/SUDI case control study. [7]
Study design:
Case control
Setting:
5 regions in England		 Population:
325 SIDS infants
1300 matched control infants		 Main exposure:
Pacifier use

Pacifier use measure:
  • Routine pacifier use (stratified by time of use and infant/family characteristics)
  • Pacifier use for last sleep/reference sleep
Fu et al, 2010
Bed sharing among black infants and sudden infant death syndrome: Interactions with other known risk factors. [8]
Study design:
Case control
Setting:
Chicago, USA		 Population:
195 black SIDS infants
195 matched control infants		 Main exposure:
Bed sharing

Pacifier use measure:
Pacifier use
Hauck et al, 2003
Sleep environment and the risk of sudden infant death syndrome in an urban population: the Chicago Infant Mortality Study. [9]
Study design:
Case control
Setting:
Chicago, USA		 Population:
260 SIDS infants
260 matched control infants		 Main exposure:
Sleep environment risk factors

Pacifier use measure:
Pacifier use
L'Hoir et al, 1998
Risk and preventive factors for cot death in the Netherlands, a low- incidence country. [11]
Study design:
Case control
Setting:
Netherlands		 Population:
73 SIDS infants
146 control infants		 Main exposure:
Risk and preventive factors

Pacifier use measure:
  • Usually
  • Last sleep/reference sleep
L'Hoir et al, 1999
Dummy use, thumb sucking, mouth breathing and cot death. [10]
Study design:
Case control
Setting:
Netherlands		 Population:
73 SIDS infants
146 control infants		 Main exposure:
Dummy use, thumb sucking, mouth breathing

Pacifier use measure:
  • Usually
  • In last/reference sleep
  • Usually and in last/reference sleep
  • Usually but not in last/reference sleep
  • Not usually and not in last/reference sleep
Li et al, 2006
Use of a dummy (pacifier) during sleep and risk of sudden infant death syndrome (SIDS): population based case-control study. [12]
Study design:
Case control
Setting:
Eleven counties in California, USA		 Population:
185 SIDS infants
312 matched control infants		 Main exposure:
Dummy use

Pacifier use measure:
Dummy used during last/reference sleep
Matthews et al, 2004
A multivariate "time based" analysis of SIDS risk factors. [13]
Study design:
Case control
Setting:
Ireland		 Population:
203 SIDS infants
622 control infants		 Main exposure:
Risk factors

Pacifier use measure:
  • Routine use
  • Use in last/reference sleep
  • Lack of use in last/reference sleep when routinely used
  • Use in last/reference sleep when not routinely used
McGarvey et al, 2003
Factors relating to the infant's last sleep environment in sudden infant death syndrome in the Republic of Ireland. [14]
Study design:
Case control
Setting:
Ireland		 Population:
203 SIDS infants
622 control infants		 Main exposure:
Risk factors, bed sharing

Pacifier use measure:
  • Routine use
  • Use in last/reference sleep
  • Lack of use in last/reference sleep when routinely used
  • Use in last/reference sleep when not routinely used
Mitchell et al, 1993
Dummies and the sudden infant death syndrome. [15]
Study design:
Case control
Setting:
New Zealand		 Population:
485 SIDS infants
1800 control infants		 Main Exposure:
Dummy use

Pacifier use measure:
  • Dummy use in the two weeks before death/nominated time
  • Dummy use at death/nominated time
Moon et al, 2012
Pacifier Use and Sids: Evidence for a Consistently Reduced Risk. [16]
Study design:
Case control
Setting:
Chicago, USA		 Population:
260 SIDS infants
260 control infants		 Main exposure:
Pacifier use

Pacifier use measure:
Pacifier use in last/reference sleep
Thompson JM et al, 2006
Sudden infant death syndrome: risk factors for infants found face down differ from other SIDS cases. [17]
Study design:
Case control
Setting:
New Zealand		 Population:
154 SIDS infants found face down
239 SIDS infants not found face down		 Main exposure:
Risk factors

Pacifier use measure:
Dummy use
Vennemann et al, 2009
Sleep environment risk factors for sudden infant death syndrome: the German Sudden Infant Death Syndrome Study. [18]
Study design:
Case control
Setting:
Germany		 Population:
333 SIDS infants
998 matched control infants		 Main exposure:
Sleep environment risk factors

Pacifier use measure:
Use during last/reference sleep
Vennemann et al, 2005
Modifiable risk factors for SIDS in Germany: Results of GeSID. [19]
Study design:
Case control
Setting:
Germany		 Population:
333 SIDS infants
998 matched control infants		 Main exposure:
Risk factors

Pacifier use measure:
Use during last/reference sleep

References

  1. Nasjonalt kunnskapssenter for helsetjenesten. Samsovning, smokk, amming og krybbedød - finnes det en sammenheng? Oslo: Nasjonalt kunnskapssenter for helsetjenesten; 2005. Rapport fra Kunnskapssenteret 5-2005. [accessed Jun 21 2021]. Available from: https://www.fhi.no/globalassets/dokumenterfiler/rapporter/2009-og-eldre/rapport_0505_krybbedod_rev_nettversjon.pdf.
  2. Arnestad M, Andersen M, Rognum TO. Is the use of dummy or carry-cot of importance for sudden infant death? Eur J Pediatr. 1997;156(12):968-70. Available from: https://doi.org/10.1007/s004310050753.
  3. Arnestad M, Andersen M, Vege Å, Rognum T. Changes in the epidemiological pattern of sudden infant death syndrome in southeast Norway, 1984–1998: implications for future prevention and research. ARCH DIS CHILD. 2001;85(2):108-15.
  4. Blair PS, Sidebotham P, Pease A, Fleming PJ. Bed-sharing in the absence of hazardous circumstances: Is there a risk of sudden infant death syndrome? An analysis from two case-control studies conducted in the UK. PLoS ONE. 2014;9(9). Available from: https://doi.org/10.1371/journal.pone.0107799.
  5. Carpenter R, Irgens L, Blair P, England P, Fleming P, Huber J, et al. Sudden unexplained infant death in 20 regions in Europe: case control study. The Lancet. 2004;363(9404):185-91.
  6. Fleming PJ, Blair PS, Bacon C, Bensley D, Smith I, Taylor E, et al. Environment of infants during sleep and risk of the sudden infant death syndrome: results of 1993-5 case-control study for confidential inquiry into stillbirths and deaths in infancy. Confidential Enquiry into Stillbirths and Deaths Regional Coordinators and Researchers. BMJ (Clinical research ed). 1996;313(7051):191-5.
  7. Fleming PJ, Blair PS, Pollard K, Platt MW, Leach C, Smith I, et al. Pacifier use and sudden infant death syndrome: Results from the CESDI/SUDI case control study. ARCH DIS CHILD. 1999;81(2):112-6. Available from: https://doi.org/10.1136/adc.81.2.112.
  8. Fu LY, Moon RY, Hauck FR. Bed sharing among black infants and sudden infant death syndrome: Interactions with other known risk factors. Acad Pediatr. 2010;10(6):376-82. Available from: https://doi.org/10.1016/j.acap.2010.09.001.
  9. Hauck FR, Herman SM, Donovan M, Iyasu S, Merrick Moore C, Donoghue E, et al. Sleep environment and the risk of sudden infant death syndrome in an urban population: the Chicago Infant Mortality Study. PEDIATRICS. 2003;111(5 Pt 2):1207-14.
  10. L'Hoir MP, Engelberts AC, van Well GT, Damste PH, Idema NK, Westers P, et al. Dummy use, thumb sucking, mouth breathing and cot death. Eur J Pediatr. 1999;158(11):896-901.
  11. L'Hoir MP, Engelberts AC, van Well GT, McClelland S, Westers P, Dandachli T, et al. Risk and preventive factors for cot death in The Netherlands, a low-incidence country. Eur J Pediatr. 1998;157(8):681-8.
  12. Li D, Willinger M, Petitti DB, Odouli R, Liu L, Hoffman HJ. Use of a dummy (pacifier) during sleep and risk of sudden infant death syndrome (SIDS): population based case-control study. BMJ: British Medical Journal (International Edition). 2006;332(7532):18-21. Available from: https://doi.org/10.1136/bmj.38671.640475.55.
  13. Matthews T, McDonnell M, McGarvey C, Loftus G, O'Regan M. A multivariate "time based" analysis of SIDS risk factors. ARCH DIS CHILD. 2004;89(3):267-71. Available from: https://doi.org/10.1136/adc.2002.025486.
  14. McGarvey C, McDonnell M, Chong A, O'Regan M, Matthews T. Factors relating to the infant's last sleep environment in sudden infant death syndrome in the Republic of Ireland. ARCH DIS CHILD. 2003;88(12):1058-64. Available from: https://doi.org/10.1136/adc.88.12.1058.
  15. Mitchell EA, Taylor BJ, Ford RP, Stewart AW, Becroft DM, Thompson JM, et al. Dummies and the sudden infant death syndrome. ARCH DIS CHILD. 1993;68(4):501-4.
  16. Moon R, Tanabe K, Yang D, Young H, Hauck F. Pacifier Use and Sids: Evidence for a Consistently Reduced Risk. Maternal & Child Health Journal. 2012;16(3):609-14. Available from: https://doi.org/10.1007/s10995-011-0793-x.
  17. Thompson JM, Thach BT, Becroft DM, Mitchell EA. Sudden infant death syndrome: risk factors for infants found face down differ from other SIDS cases. J Pediatr. 2006;149(5):630-3. Available from: https://doi.org/10.1016/j.jpeds.2006.07.041.
  18. Vennemann MM, Bajanowski T, Brinkmann B, Jorch G, Sauerland C, Mitchell EA. Sleep environment risk factors for sudden infant death syndrome: The German sudden infant death syndrome study. PEDIATRICS. 2009;123(4):1162-70. Available from: https://doi.org/10.1542/peds.2008-0505.
  19. Vennemann MMT, Findeisen M, Butterfass-Bahloul T, Jorch G, Brinkmann B, Kopcke W, et al. Modifiable risk factors for SIDS in Germany: results of GeSID. Acta paediatrica (Oslo, Norway : 1992). 2005;94(6):655-60.

Literature search

MedLine via Ovid 17 May 2021

Association between dummy use and SIDS

.ab. = Abstract; .ti. = Title; .kf. = Keyword; / = Term from the Medline controlled vocabulary, but does not include terms found below this term in the MeSH hierarchy.; Exp = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy.; ADJn = Positional operator that retrieves records containing your terms (in any order) within a specified number (n) of words of each other.
  Search terms Items found
Intervention:
1. Pacifiers/ 501
2. (pacifier* or soother* or comforter* or dummy or dummies or (non adj1 nutriti* adj1 sucking)).ab,kf,ti. 7 410
3. 1 or 2 7 495
Outcome:
4. Sudden Infant Death/ 7 606
5. ((sudden or unexpected) adj2 (infan* or baby or newborn) adj2 death*).ab,kf,ti. 6 681
6. ((cot or crib) adj2 death*).ab,kf,ti. 814
7. (SIDS or SUDI).ab,kf,ti. 4 035
8. 4 or 5 or 6 or 7 10 089
Combined sets:
9. 3 and 8 182
Final   182

Scopus via Elsevier 17 May 2021

Association between dummy use and SIDS

TITLE-ABS-KEY = Title or abstract or keywords; W/n = "Within". Positional operator that retrieves records containing your terms (in any order) within a specified number (n) of words of each other.; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
  Search terms Items found
Intervention:
1. TITLE-ABS-KEY ( pacifier OR soother OR comforter OR dummy OR ( non W/1 nutri* W/1 sucking ) ) 24 416
Outcome:
2. TITLE-ABS-KEY ( ( sudden OR unexpected ) W/2 ( infan* OR baby OR newborn ) W/2 death ) 12 928
3. TITLE-ABS-KEY ( ( cot OR crib ) W/2 death ) 966
4. TITLE-ABS-KEY ( sids OR sudi ) 5 980
5. 2 OR 3 OR 4 14 645
Combined sets:
6. 1 AND 5 234
Final   234

Embase via embase.com 17 May 2021

Association between dummy use and SIDS

/de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; NEAR/n = Positional operator that retrieves records containing your terms (in any order) within a specified number (n) of words of each other.; :ti,ab,kw = Title, abstract or keyword; * = Truncation; ’ ’ = Citation Marks; searches for an exact phrase
  Search terms Items found
Intervention:
1. ‘pacifier’/exp 908
2. (pacifier* OR comforter* OR soother* OR dummy OR dummies OR (non NEAR/2 nutri* NEAR/2 sucking)):ti,ab.kw 9 912
3. 1 OR 2 10 103
Outcome:
4. ‘sudden infant death syndrome’/exp 10 836
5. ((sudden OR unexpected) NEAR/2 (infan* OR baby OR newborn) NEAR/2 death*):ti,ab,kw 8 555
6. ((cot OR crib) NEAR/2 death*):ti,ab,kw 872
7. sids:ti,ab,kw OR sudi:ti,ab,kw 4 979
8. 4 OR 5 OR 6 OR 7 13 220
Combined sets:
9. 3 AND 8 242
Final   242

CINAHL via ebsco.com 17 May 2021

Association between dummy use and SIDS

AB = Abstract; SU = All keyword fields; TI = Title; Nn = Positional operator that retrieves records containing your terms (in any order) within a specified number (n) of words of each other.; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
  Search terms Items found
Intervention:
1. TI ( pacifier* OR comforter* OR soother* OR dummy OR dummies OR (non N1 nutri* N1 suck*) ) OR AB ( pacifier* OR comforter* OR soother* OR dummy OR dummies OR (non N1 nutri* N1 suck*) ) OR SU ( pacifier* OR comforter* OR soother* OR dummy OR dummies OR (non N1 nutri* N1 suck*) ) 2 644
Outcome:
2. TI ( ( ( sudden OR unexpected ) N2 ( infan* OR baby OR newborn ) N2 death* ) ) OR AB ( ( ( sudden OR unexpected ) N2 ( infan* OR baby OR newborn ) N2 death* ) ) OR SU ( ( ( sudden OR unexpected ) N2 ( infan* OR baby OR newborn ) N2 death* ) ) 3 536
3. TI ( ( ( cot OR crib ) N2 death* ) ) OR AB ( ( ( cot OR crib ) N2 death* ) ) OR SU ( ( ( cot OR crib ) N2 death* ) ) 222
4. TI ( SIDS OR SUDI ) OR AB ( SIDS OR SUDI ) OR SU ( SIDS OR SUDI ) 1 871
5. 2 OR 3 OR 4 4 311
Combined sets:
6. 1 AND 5 181
Final   181
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