Intended for healthcare professionals

Rapid response to:


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

Rapid Response:

Dummy use and primary mode of death in SIDS

The paper's findings permit far-reaching and important considerations
in SIDS. Its conclusions indicate the dummy not only structures a physical
space external to the nose and mouth, but must also actively maintain
airway patency, by splinting the mouth open and, as I have previously
suggested in 2001, by depressing the obstructing tongue away from the
palates. Together with the finding of considerable reduction in syndrome
risk, such reasoning supports obstructive (or mixed) apnoea as being the
predominant primary death mode in SIDS, rather than the only alternative,
namely central apnoea, where subsequent hypoxia is not dependent on airway
patency. Furthermore, the finding that dummy use has a protective effect
against SIDS risk from a broad range of syndrome risk factors, including
those associated with socioeconomic deprivation, supports the concept that
their lethal mechanism ends in primary respiratory upper airway
obstruction, rather than primary cardiac arrest.

Competing interests:
None declared

Competing interests: No competing interests

14 December 2005
J. Michael Simpson
Consultant anaesthetist
Apartado 128 (PO box), 8401-902 Lagoa, Algarve, Portugal