| A Note to Teams from Miriam Labbok, MD |
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 Dear Colleagues:
Thank you for a lively learning session last week. Two interesting questions have already emerged:
Question 1: "I heard that pacifiers reduce SIDS. Is this true?"
Response: Studies have found pacifier use to be associated with a lowered incidence of SIDS. This may be causative, or it may reflect other issues, such as what the infant is used to (SIDS increases significantly with commencement of child care outside the home), that infants that sleep on their backs are more likely to be given pacifiers, or some other association. However causality is nearly impossible to establish. SIDS is thought to be associated with arousability, and research has shown that pacifiers do not impact the frequency or duration of arousals. Additionally, it is important to remember that pacifiers also are reservoirs for micro-organisms and are associated with increased dental malocclusion, otitis media, GI infections and oral thrush.
As a result of all the pluses and minuses, the AAP recommendation states that pacifier use related to SIDS prevention is for its use at time of sleep and only if the infant accepts it, and not to reinsert at other times. For breastfed infants, they recommend delaying pacifier introduction until 1 month of age to ensure that breastfeeding is firmly established.
The implication of these studies for me (Miriam) is that pacifiers have some risks and that SIDS may be associated with changes in what the baby finds normal, and if a baby has been put to sleep with a pacie, so be it. As to SIDS, some fascinating new information on SIDS seems to be identifying different mechanisms for SIDS deaths due to frontal sleep, vs those that occur otherwise. All in all, this is clearly an area where we have a lot to learn, and meanwhile, we probably should follow AAP recommendations.
None of this implies a general need for pacifiers in the first 1 or 2 days of life. In this initiative we have not taken a position AGAINST pacifiers, only against pacifiers in the first month for breastfed infants.
Question 2: "Does anyone have mom's breastfeeding while procedures are being done? This was mentioned concerning circs, and I thought I misheard, or that someone might just be seeing if we were awake."
Response: Well, that was me(Miriam) who brought this up. Why? Because in other countries where I have worked, I have seen breastfeeding encouraged during minor procedures, and I was simply curious if anyone had seen it as analgesia for the circs. Is it feasible? Perhaps. Logistically, the way we carry out circs, with the infant tied in place in a form, it is hard to imagine it...but think about it: if we find that breastfeeding reduces baby's pain, we may wish to try it out one day! For now, it was just a question, and we should follow standard procedures when the family requests a circumcision.
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| Contact |
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 Karen Metzguer
PQCNC Improvement Advisor
metzguer@med.unc.edu
Work: 919-966-8391
Mobile: 919-619-6332
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