In response to today's media reports on a study (1) suggesting that dummy use may protect babies against cot death, the UNICEF UK Baby Friendly Initiative has issued the following statement:

While welcoming any research which may help to reduce the risk of sudden infant death syndrome (SIDS), there are considerations which must be taken into account before using this latest data to make recommendations to parents.

Firstly, we must look at other research (2) into dummies and SIDS. This tends to show that babies who used a dummy during their last sleep were less likely to die, but that routine dummy use is not protective. This may indicate that infants are at greater risk of SIDS if they routinely use a dummy but have not been given their dummy on a particular night.

Secondly, the potential risks of dummy use need to considered. These include:

• interference with good establishment of breastfeeding in the early weeks
• increased risk of otitis media infection
• increased dental malocclusion
• risk of accidents such as obstruction of the airway

Thirdly, we need to ensure that the advice being proposed is realistic. If dummy use is really protective against SIDS but only if used every night, parents must be informed of this. The possibility that missing a night will increase risk among routine dummy users creates confusion and concern. We must be secure that parents will never forget to give the dummy once they have started to use it.

It is therefore clear that we must support parents to make informed decisions about using a dummy, based on their own personal circumstances. This should include a discussion of the benefits and risks of dummy use, and acknowledgement that we do not know everything about the issue.

Finally, since we do not know the mechanism by which dummy use may protect babies, other sources of sucking comfort during the night also need to be investigated. It is possible that thumb sucking is protective, and a baby who routinely sucks his thumb is not dependant on his parents to remember to give it to him. Some studies have also suggested that breastfeeding may be protective against SIDS. While this also needs further investigation, the access a bed sharing baby has to his mother's breast during the night may offer another mechanism for protection.

Footnote, added 5 January 2006:
Projecting risk reduction or quantifying attributable risk in Li's study (1) is inappropriate. As the authors point out in the discussion a causal effect between dummy use and SIDS has not been established. In SIDS research we still need to determine what the protective mechanism might be, if indeed it exists, or whether dummy use is a marker for something else.
Any discussion of potentially modifiable factors and impact on infant care practices is better served by a review on the subject taking into account a more detailed study of infant sleep behaviour and any detrimental effect of the exposure outside this research field (3).