Literature review for - Flourish Paediatrics

Parslow et al. 2004). In addition, breastfeeding reduces infection, which could also be the
protective mechanism (Howie 2002).
Even if the recommendation to breastfeed is not included in the specific SIDS prevention
advice, it should be included in the general advice, as it reduces morbidity and mortality in
infants even in developed countries.
Pacifiers (dummies)
For several years now, The Netherlands has recommended the use of pacifiers in bottle-fed
infants. In October 2005, the American Academy of Pediatrics recommended the use of a
pacifier throughout the first year of life. Two recent meta-analyses have shown that pacifier
use in the last sleep is associated with a reduced risk of SIDS. Hauck and colleagues
recommended pacifier use up to 1 year of age (Hauck, Omojokun et al. 2005; Hauck 2006).
Concerns about possible adverse effects, especially on breastfeeding, and an increase in otitis
media, led the other review69 to recommend that pacifier use should not be discouraged, but
not specifically recommended.
Moon. Sudden Infant Death Syndrome (Moon, Horne et al. 2007)
Published case-control studies have shown a significantly reduced risk of SIDS when a
pacifier is used at sleep time and two meta-analyses have reported a strong protective effect.
Several mechanisms have been postulated to explain this protective effect. Franco and
colleagues found a lower arousal threshold in infants who frequently used a pacifier than
those who did not during sleep, perhaps allowing increased responsiveness to a lifethreatening
challenge, such as obstructive apnoea, cardiac arrhythmia, or external conditions
leading to hypoxia and asphyxia (Franco, Scaillet et al. 2000). Other theories include an
improved ability to breathe through the mouth if the nasal airway becomes obstructed and
decreased likelihood of oropharyngeal obstruction by bringing the tongue forward. Use of a
pacifier might also reduce SIDS risk by affecting sleep position. Even when pacifiers
become dislodged from the mouth after an infant falls asleep, which generally occurs soon
after sleep onset the protective effect still persists. Displacement of the pacifier might
contribute to increased sleep disruption and greater arousability of the infant.
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