The Pacifier Debate

Abstract

To the Editor In their recent Pediatrics article, Hauck et al1 reported on the association between pacifier use at last sleep and sudden infant death syndrome (SIDS) and recommended universal pacifier use to reduce the risk of SIDS. It is far from clear, however, that pacifiers play a causal role in SIDS. Each of the 9 studies in the meta-analysis conducted by Hauck et al used a case-control design to assess whether a pacifier was used during the last sleep before SIDS death, or the sleep among control infants. In such a study design, there is potential for differential recall bias between parents of infants with SIDS and those of control infants on the basis of both the timing of the questioning and the parents' perceptions of whether pacifier use is “right.” If an infant usually used a pacifier, it seems unlikely that control parents could recall whether the infant did or did not …