Idiotic Advice for Preventing SIDS: Use Pacifiers

Has American medical science come so far that pediatricians have become stupid?

Yesterday, the American Academy of Pediatrics (AAP) announced its latest advice for preventing sudden infant death syndrome (SIDS): Plug your baby's mouth with a pacifier! Have these people no knowledge of nature's perfect, simple plan—breast-feeding? Have they, as Americans, so completely bought into the mind–body split of our culture that they can think only of artificial means for infant care? Or have they given up hope of convincing American women to breast-feed, assuming that bottle-feeding is the norm? I'm sure European pediatricians are thinking that the latest AAP advice is ridiculous.

Here's the statement from the AAP web site:

Despite major decreases in the incidence of Sudden Infant Death Syndrome (SIDS) over the past decade, SIDS is still responsible for more infant deaths beyond the newborn period in the United States than any other cause of death during infancy. In an updated policy statement on “The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk,” the American Academy of Pediatrics (AAP) addresses several issues that have become relevant since they last published a statement in 2000.

The AAP no longer recognizes side sleeping as a reasonable alternative to fully supine (lying on back) sleeping. Studies have found that the side sleep position is unstable and increases the chances of the infant rolling onto his or her stomach. Every caregiver should use the back sleep position during every sleep period.

Bed sharing is not recommended during sleep. Infants may be brought into bed for nursing or comforting, but should be returned to their own crib or bassinet when the parent is ready to return to sleep. However, there is growing evidence that room sharing (infant sleeping in a crib in parent’s bedroom) is associated with a reduced risk of SIDS. The AAP recommends a separate but proximate sleeping environment.

Research now indicates an association between pacifier use and a reduced risk of SIDS, which is why the revised statement recommends the use of pacifiers at nap time and bedtime throughout the first year of life. The evidence that pacifier use inhibits breastfeeding or causes later dental complications is not compelling enough to discredit the recommendation. However, it is recommended that pacifier introduction for breastfed infants be delayed until one month of age to ensure that breastfeeding is firmly established. In addition, if the infant refuses the pacifier, it should not be forced. There is a slight increased risk of ear infections associated with pacifier use, but the incidence of ear infection is generally lower in the first year of life, especially the first six months, when the risk of SIDS is the highest.

The following have been consistently identified as risk factors for SIDS: prone (lying on stomach) sleep position, sleeping on a soft surface, maternal smoking during pregnancy, overheating, late or no prenatal care, young maternal age, preterm birth and/or low birth weight and male gender. Consistently higher rates of SIDS are found in black and American Indian/Alaska Native children—two to three times the national average.

The policy recommendations include:

• Back to sleep: Infants should be placed for sleep in a supine (wholly on back position) for every sleep.
• Use a firm sleep surface: A firm crib mattress, covered by a sheet, is the recommended sleeping surface.
• Keep soft objects and loose bedding out of the crib: Pillows, quilts, comforters, sheepskins, stuffed toys and other soft objects should be kept out of an infant’s sleeping environment.
• Do not smoke during pregnancy: Also avoiding an infant’s exposure to secondhand smoke is advisable for numerous reasons in addition to SIDS risk.
• A separate but proximate sleeping environment is recommended such as a separate crib in the parent’s bedroom. Bed sharing during sleep is not recommended.
• Consider offering a pacifier at nap time and bedtime: The pacifier should be used when placing infant down for sleep and not be reinserted once the infant falls asleep.
• Avoid overheating: The infant should be lightly clothed for sleep, and the bedroom temperature should be kept comfortable for a lightly clothed adult.
• Avoid commercial devices marketed to reduce the risk of SIDS: Although various devices have been developed to maintain sleep position or reduce the risk of rebreathing, none have been tested sufficiently to show efficacy or safety.
• Do not use home monitors as a strategy to reduce the risk of SIDS: There is no evidence that use of such home monitors decreases the risk of SIDS.
• Avoid development of positional plagiocephaly (flat back of head): Encourage “tummy time.” Avoid having the infant spend excessive time in car-seat carriers and “bouncers.” Place the infant to sleep with the head to one side for a week and then changing to the other.
• Assure that others caring for the infant (child care provider, relative, friend, babysitter) are aware of these recommendations.

EDITOR’S NOTE: In a related review article, “Do Pacifiers Reduce the Risk of Sudden Infant Death Syndrome? A Meta-Analysis,” found that several studies show a significant reduced risk of SIDS with pacifier use, particularly when used during sleep.

Nature has a much simpler plan: For centuries, mothers have slept with their babies right next to their bodies, letting their babies breast-feed whenever they wanted during the night. It's easy to do, it's the way nature set things up, and it results in much better sleep for mother and baby. I know; I've done it with the last two of my three children. But don't take just my word for it. There's a whole body of research out there to back me up.

Why does the AAP think pacifiers will prevent SIDS? According to the article referenced at the end of the official AAP statement, pacifiers may keep babies from sleeping too deeply and thus not awaking when their immature nervous systems don't keep them breathing properly.

But if babies sleep next to their mothers, their sleep cycles become regulated by their mothers' cycles, simply because they're next to each other. Babies can find their mothers' breasts and latch on in their sleep. I know I've been asleep many times only to wake up and find my child nursing. If I had had to get up out of bed several times a night to breast-feed, I'd have been severely sleep deprived, and my child would have slept poorly knowing he was all alone. I've always thought it bizarre that many Americans put their babies to sleep in another room, all alone. Why leave a defenseless, physically immature creature alone to fend for itself physically and emotionally? That strikes me as very selfish. If you have a baby, you've got to know that your time is not going to be your own for years. You can't have it both ways.

Bottle-feed if you must—there are physical reasons in mothers (rarely) and in infants (physical and developmental disabililties) why breast-feeding won't always work—but if you can breast-feed, why not make life easier for you and your baby, and why not set your baby off on the path to a healthy life?

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