Objective: To review the effect of pacifier use in healthy term infants on breastfeeding duration and the risk of
Sudden Infant Death Syndrome (SIDS).
Design: Two systematic reviews were conducted of published studies (meta-analysis, Systematic Literature Reviews
(SLRs), Randomised Controlled Trials (RCTs), cohort, case-control or cross-sectional studies). Electronic databases were
searched for articles that assessed the effect of infant pacifier use on the risk of SIDS and/or on breastfeeding outcomes.
Retrieved articles were assessed for validity and quality using the Dietitians Association of Australia (DAA) Quality Criteria
Checklist and the NHMRC Evidence Hierarchy before being included in the review.
Results: The initial search of the databases resulted in 68 references on the use of pacifiers and SIDS; three articles
(1 meta-analysis, 1 SLR, 1 narrative review) received a positive rating according to the DAA checklist. The three publications
consistently found pacifier use at last sleep was associated with a significant reduction in the risk of SIDS and to a
lesser extent, routine pacifier use also provided a significant reduction in the risk.
Searching the electronic databases for use of pacifiers and breastfeeding duration resulted in 188 publications and four of
these publications were retrieved for analysis (1 Cochrane review, 1 SLR, 1 meta-analysis, 1 cohort study). The epidemiological
evidence found pacifier use reduced the duration of any, full and exclusive breastfeeding, but this effect was not
significant in four out of the five RCTs analysed in the Cochrane review and the SLR.
Conclusion: The present review provides evidence of the association between pacifier use during the postnatal period and
a decreased risk of SIDS whilst also drawing attention to the negative association between early pacifier use and reduced
duration of breastfeeding (any, full and exclusive). This is the first review to emphasise the U-shaped effect of pacifiers on
infant health. When assessing the totality of the evidence the results indicate that pacifiers should be advised against in the
first month of life, but after the first month pacifier use may reduce the probability of SIDS.