Other considerations with respect to pacifier use
While the authors have substantiated a compelling reason for
positional issues in infants who use pacifiers during sleep, this
important factor may well be influencing a basic risk for SIDS. All
infants "spit up" (reflux). In adults, this occurs more often during sleep
partly because of a reduction in swallowing , saliva swallowing being a
major protection against reflux. Aspiration of refluxed material is, as we
know, extremely dangerous and is not always identified at autopsy.
Aspiration pneumonitis in the adult is often unidentified because of the
lack of a witnessed event.
The use of a pacifier stimulates saliva and, we may assume, also
encourages swallowing. The supine position with the airway superior to the
upper esophageal sphincter, thereby reducing the risk of aspiration of
refluxed material, as well as increased (stimulated) saliva swallowing may
both account for the protective effect.
Competing interests: No competing interests