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Use of a dummy (pacifier) during sleep and risk of sudden infant death syndrome (SIDS): population based case-control study

BMJ 2006; 332 doi: (Published 05 January 2006) Cite this as: BMJ 2006;332:18
  1. De-Kun Li, senior research scientist (dkl{at},
  2. Marian Willinger, health scientist administrator3,
  3. Diana B Petitti, senior scientific advisor2,
  4. Roxana Odouli, research associate1,
  5. Liyan Liu, programmer analyst1,
  6. Howard J Hoffman, director4
  1. 1 Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612
  2. 2 Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA 91188
  3. 3 Pregnancy and Perinatology Branch, Centre for Research on Mothers and Children, National Institute of Child Health and Human Development, NIH, Bethesda, MD 20892
  4. 4 Epidemiology and Biostatistics Program, Division of Scientific Programs, National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, MD 20892
  1. Correspondence to: Dr Li
  • Accepted 8 November 2005


Objectives To examine the association between use of a dummy (pacifier) during sleep and the risk of sudden infant death syndrome (SIDS) in relation to other risk factors.

Design Population based case-control study.

Setting Eleven counties in California.

Participants Mothers or carers of 185 infants whose deaths were attributed to SIDS and 312 randomly selected controls matched for race or ethnicity and age.

Main outcome measure Use of a dummy during sleep determined through interviews.

Results The adjusted odds ratio for SIDS associated with using a dummy during the last sleep was 0.08 (95% confidence interval 0.03 to 0.21). Use was associated with a reduction in risk in every category of sociodemographic characteristics and risk factors examined. The reduced risk associated with use seemed to be greater with adverse sleep conditions (such as sleeping prone or on side and sleeping with a mother who smoked), although the observed interactions were not significant. In addition, use of a dummy may reduce the impact of other risk factors for SIDS, especially those related to adverse sleep environment. For example, infants who did not use a dummy and slept prone or on their sides (v on their back) had an increased risk of SIDS (2.61, 1.56 to 4.38). In infants who used dummies, there was no increased risk associated with sleeping position (0.66, 0.12 to 3.59). While cosleeping with a mother who smoked was also associated with increased risk of SIDS among infants who did not use a dummy (4.5, 1.3 to 15.1), there was no such association among those who did (1.1, 0.1 to 13.4).

Conclusions Use of a dummy seems to reduce the risk of SIDS and possibly reduces the influence of known risk factors in the sleep environment.


  • Funding National Institute of Child Health and Human Development (NICHD) and National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health, contract N01-HD-5-3227.

  • Competing interest None declared.

  • Ethical approval Institutional Review Boards of Kaiser Permanente in Northern and Southern California and California State Committee for the Protection of Human Subjects.

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