Dummies, breastfeeding and prevention of sudden infant death syndrome (SIDS).
Subject: Sudden infant death syndrome (Prevention)
Breast feeding (Health aspects)
Authors: Mayes, Georgina
Timms, Lynn
Pub Date: 02/01/2011
Publication: Name: Community Practitioner Publisher: Ten Alps Publishing Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2011 Ten Alps Publishing ISSN: 1462-2815
Issue: Date: Feb, 2011 Source Volume: 84 Source Issue: 2
Geographic: Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom
Accession Number: 248402386
Full Text: At the Unite/CPHVA conference concurrent session 'Reducing the risk of cot death: what information to give to parents', the speakers reminded us of Foundation for the Study of Infant Deaths (FSID) recommendations to reduce the risk of SIDS:

* Sleep position with head uncovered

* Bed sharing

* Promotion of breastfeeding

* Dummy use

* Temperature control

* Prevention of smoking

* Prompt and appropriate medical attention.

The ethos of dummy use conflicts with our role as health visitors. Using dummies can negatively affect breastfeeding initiation (Newman, 1990; Joanna Briggs Institute, 2006), breastfeeding duration (Barros and Victoria, 1995), Baby Friendly accreditation (UNICEF, 2006, 2008) and risk of infection and dental malocclusion (Callahan et al, 2005).

We asked the conference session speakers to clarify the reliability and validity of the research upon which the FSID and Department of Health (DH) recommendations on dummy use were based. The response indicated that the 10 research papers were authenticated as they had been peer reviewed and published. Assuming that studies are sound because they have been published is not acceptable (Polit et al, 2001).

It cannot be presumed that all reputable research should be taken into practice. Bias may be present if there are conflicting interests and associations. The Wakefield et al (1998) MMR paper is a prime example of where the validity was not considered before publication (Aveyard, 2007).

Discussions with conference delegates at our poster presentation indicated a professional confusion regarding the information that they should be providing parents on this. We invited delegates to complete an anonymous questionnaire, and the 36 completed forms provide an interesting insight:

* Two-thirds stated that they were not very confident in recommending dummies in the prevention of SIDS

* 19% recommended the use of dummies, but nearly half did so due to external stipulations (such as protocols)

* 50% said that they did not recommend the use of dummies, despite the DH recommendations

* Half stated that their reasons for not recommending dummies were due to concerns about the effect on breastfeeding.

In our view, the evidence is not strong enough for professionals to promote dummy use to prevent SIDS and more information is required. We strongly urge FSID and the DH to provide evidence that the research on which the pacifier use recommendation is based is sound, valid and reliable. Clarity on this issue is a priority due to the confusion and controversy that professionals are experiencing.

Georgina Mayes, health visitor and Lynn Timms, health visitor for breastfeeding, Solent Healthcare


Aveyard H. (2007) Doing a literature review in health and social care: a practical guide. Milton Keynes: Open University.

Callahan A, Kendall G, Lock C et al. (2005) Association between pacifier use and breastfeeding, sudden infant death syndrome, infection and dental malocclusion. Int J Evid Based Healthc 3(6): 147-67.

Barros FC, Victoria CG. (1995) Use of pacifiers is associated with decreased breastfeeding duration. Pediatrics 95: 497-9.

Joanna Briggs Institute. (2005) Early childhood pacifier use in relation to breastfeeding, SIDS, infection and dental malocclusion. Best Practice 9(3): 1-6.

Newman J. (1990) Breastfeeding problems associated with the early introduction of bottles and pacifiers. J Hum Lact 6(2): 59-63.

Polit D, Beck CT, Hungler BP. (2001) Essential of nursing research: methods, appraisal, and utilisation (fifth edition). Philadelphia: Lippencott.

UNICEF. (2006) UK statement on dummy use, sudden infant death syndrome and breastfeeding. See: www.babyfriendly.org.uk/items/ item_detail.asp?item=140 (accessed 1 Dec 2010).

UNICEF. (2008) Ten steps to successful breastfeeding. See: www.babyfriendly.org.uk/ page.asp?page=218 (accessed 1 Dec 2010).

Speakers response:

The letter from Mayes and Timms confuses two unrelated questions. First, is there convincing evidence that dummy use protects against the risk of SIDS? Second, is a negative effect of dummy use on the establishment and duration of breastfeeding supported by the scientific evidence?

On the first, two meta-analyses of the relevant literature have been performed (Hauck et al, 2005; Mitchell et al, 2006). The conclusions of both are accepted by the authors of the report from the Joanna Briggs Institute (2006), who write: 'The results indicate that the risk of SIDS for infants who did not use a pacifier in the last or reference sleep was at least twice and possibly five times, that of infants who did use a pacifier'

On the second, four randomised controlled trials were systematically reviewed (O'Connor, 2009) and a fifth published later (Jenik et al,

2009). O'Connor et al (2009)

write that 'the highest level of evidence does not support an adverse relationship between pacifier use and breastfeeding duration or exclusivity', and the conclusions of the fifth study were identical. As to dental malocclusion, this is not a significant problem unless dummy use continues for at least 30 months, and even then digit sucking is probably worse (Levine, 1999).

The statement that 'assuming that studies are sound on the basis that they have been published is not acceptable' is meaningless, and the reference to the paper by Wakefield et al (1998) irrelevant. The whole point of scientific journals is that the data are published in a form that impartial observers can evaluate independently--unpublished work is not thus available. As to the results of the questionnaire included in the letter, it is pertinent to point out that scientific disputes are not settled democratically, but by a proper statistical appraisal of all the available evidence.

Joyce Epstein, director, FSID and Krissie Poyser, health visitor/professional development CPT, Central London Community Healthcare


Hauck FR, Omojokun OO, Siadaty MS. (2005) Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics 116(5): e716-23.

Jenik AG, Vain NE, Gorestein AN et al. (2009) Does the recommendation to use a pacifier influence the prevalence of breastfeeding? J Pediatr 155(3): 350-4.

Joanna Briggs Institute. (2006) Early childhood pacifier use in relation to breastfeeding, SIDS, infection and dental malocclusion. Nursing Standard 20(38): 52-5.

Levine RS. (1999) Briefing paper: oral aspects of dummy and digit sucking. British Dental Journal 186(3): 108.

Mitchell EA, Blair PS, L'Hoir MP. (2006) Should pacifiers be recommended to prevent sudden infant death syndrome? Pediatrics 117(5): 1755-8.

O'Connor NR, Tanabe KO, Siadaty MS et al. (2009) Pacifiers and breastfeeding: a systematic review. Arch Pediatr Adolesc Med 163: 378-82.

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