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Is there a simple, cheap and trusted intervention that can reduce the risk of Sudden Infant Death Syndrome (SIDS)?

Yes there is: the pacifier.

In fact, a recent study found that pacifiers at bedtime reduced the risk of death from SIDS by 61%. These findings led the American Academy of Pediatrics (AAP) to recommend the use of pacifiers in their updated guidelines on preventing SIDS.

"The evidence has been very consistent," assured Dr. Fern Hauck, author of the study and associate professor of family medicine and public health sciences at the University of Virginia Health System in Charlottesville, Virginia.

Hauck and her colleagues reviewed reports on the subject and concluded that approximately one death caused by SIDS could be prevented for every 2,733 babies who used a pacifier at bedtime.

Experts are not sure why this simple step works, mainly because they still don't know why seemingly healthy babies can die suddenly in their cribs from SIDS.

Theories abound, affirmed Hauck. Viruses may have something to do with it, she said, or some babies may be born with a predisposition for SIDS. Deaths may occur when babies wake up at night and can't get enough oxygen because they're lying face down, or if there is a blanket or another obstacle in the way that doesn't let them breathe correctly. Rather than turn their heads, gasp, or cry, these babies for some reason can't inhale the air they need, she said.

That could be why the national campaign "Back to Sleep," which encourages caregivers to place babies on their backs when they go to sleep, has been so successful in reducing the number of babies who die from SIDS each year. However, experts affirm that in the United States about 2,500 babies succumb to SIDS annually.

So, how might pacifiers help prevent the problem?

According to Hauk, they may have a direct effect on opening the airways. Babies who suck on a pacifier may not sleep as soundly and may awake more easily than infants who don't use them because they look for the pacifier when it falls out of their mouths. Other experts have theorized that the pacifier's bulky handle leaves a protective airspace around the baby's nose and mouth as the baby lies on the mattress or pillow.

However, pacifiers do have one drawback for breastfeeding mothers.

Extended pacifier use can reduce a breastfeeding mother's production of milk, noted Katy Lebbing, manager of the Center for Breastfeeding Information of the La Leche League International in Schaumburg, Illinois. As babies suck, the stimulation produces breast milk for the next feeding, she explained.

"If we put the baby to sleep with a pacifier instead of nursing the baby, the mother's milk supply will diminish and eventually end," she warned.

So, when is the right time to start using pacifiers? Both sides agree that in the beginning at least, babies have a difficult time going from a nipple to a pacifier. Hauk points out that the AAP guidelines suggest not using a pacifier for the first month of a breastfeeding baby's life.

Other key recommendations for preventing SIDS include:

• Putting infants to bed, lying on their backs
• Using only firm sleep surfaces and keeping soft objects such as pillows and heavy blankets out of the crib.
• Providing a baby with a smoke-free environment before and after pregnancy.
• Keeping the baby in the parent's bedroom, but not in the same bed.
• Not allowing the baby to get too hot. Infants shouldn't feel hot to the touch.

More information

The National Institutes of Health can tell you more about SIDS

SOURCES: Katy Lebbing, manager, Center for Breastfeeding Information, La Leche League International, Schaumburg, Ill; Fern Hauck, M.D., associate professor, family medicine and public health sciences, University of Virginia Health System, Charlottesville, Va. Last updated Jun-25-2006 © Author rights 2006, Scout News, LLC