A controversy boils about baby's binky

SOUTH WEYMOUTH -- When the American Academy of Pediatrics announced this month that putting a baby to sleep with a pacifier could reduce the risk of Sudden Infant Death Syndrome, Gina Pizziferri of Braintree bought several kinds. Mia rejected each one, sometimes spitting them out with vigor.

On a friend's recommendation that it was a sure thing, Pizziferri tried one more, the Soothie, but Mia, now 8 weeks old, is just as likely to spit it out as she is to suck it. ''She's clearly not a binky baby," says her mom as she cradles Mia on a pillow in her lap at a breast-feeding support group at South Shore Hospital.

As the academy recommends, Pizziferri isn't forcing the issue by reinserting the pacifier, and she's taking the rejection in stride. ''I'm not panicked," she says, adding a little sheepishly, ''I check on her constantly -- to be sure her chest is rising and falling."

When her daughter was born, the spectre of SIDS terrified Christie Breen of Hingham, another member of the breast-feeding group. ''I would have been forcing a paci down her throat," she says, if the recommendation had come out when her daughter was an infant. Now 15 months, Patricia, who is well beyond the age of SIDS danger, never used a pacifier.

Most parents either love pacifiers or hate them, so it's not surprising that the academy's recommendation has generated discussion, some of it heated, at new-mother support groups and among pediatricians. Ditto for the increasing popularity of the family bed, where baby sleeps in bed with you. The academy came out against that, advocating room-sharing instead. That was reaffirming for Pizziferri, who has had Mia sleep in a bassinet next to her bed since she was born, but it infuriated Breen. Her daughter sleeps in bed with her and her husband and she would do it that way again.

''We're very careful. We keep bedding tight, and nothing loose near her face, and we have a guard rail," she says. ''Even when you're asleep, you know what's going on with your baby. I'm more comfortable having her close to me."

Is that naive? Irresponsible?

John Kattwinkle, chairman of the task force that wrote the recommendations, pauses, then says, ''This isn't a mandate, it's a recommendation," he says. ''One-to-one, I would tell parents we want them to be aware of the risks and make informed decisions." He is a neonatologist at the University of Virginia medical center.

New studies show that more than half of SIDS cases occur when a baby is sleeping with parents. They also show that babies who use pacifiers are less likely to die from SIDS than babies who do not. ''It can reduce the risk by 50, 60, and in one study 90 percent," says pediatrician Rachel Moon, a researcher at the Children's National Medical Center in Washington, D.C., and a member of the task force. (For more on the academy's recommendations, see aap.org/ncepr/sids.htm.)

Researchers speculate that babies with SIDS have an immature arousal center in the brain, so when they fall into a deep sleep, they aren't able to awaken. Sucking on a pacifier may keep them from falling into that deep a sleep.

Co-sleeping per se may not cause SIDS, but there are many risks associated with it, such as a mattress that's too soft, presenting a potential suffocation risk (almost all adult mattresses are softer than crib mattresses), getting tangled in adult bedding, or overheating from adult body heat.

''I've seen cases where one pathologist will rule suffocation and another, on the same case, will rule SIDS. There's a lot of gray area here," Moon says.

''This is not a matter of right or wrong, it's a matter of a belief system," says Claire Lerner, director of parent education for Zero to Three: National Center for Infants, Toddlers and Families.

''Let's say a parent firmly believes in skin-to-skin contact or thinks it's not healthy to sleep separately. For them not to [sleep with the baby in their bed] may induce terrible feelings of guilt," she says. ''On the other hand, if they continue, they may be eaten up with worry that something terrible will happen."

She tells parents to go for a balance. ''Tune into yourself, your own beliefs, your child's needs, and the research."

SIDS is the leading cause of death in the first year of life, with 90 percent of cases occurring between 2 and 6 months, but cases nationwide have dropped by half since the academy issued its ''Back to Sleep" campaign 15 years ago, urging parents to put babies down on their backs, not their tummies. In 2002, there were .57 cases per 1,000 live births.

Both the LaLeche League International (laleche.org) and the Academy of Breast-feeding Medicine (bfm.org) have spoken against the academy's recommendations, saying they could interfere with breast-feeding. Moon, a former nursing mom herself, says there is no evidence of that, especially since the recommendation clearly states not to use a pacifier until after breast-feeding is established. As for the family bed, she recommends using a co-sleeper -- a sleep surface that attaches to and extends the adult bed. It makes a baby easily accessible for nursing and snuggling but still keeps him separate enough to be safe.

Not previously big on pacifiers, Moon now tells parents in her practice to try them and hopes other pediatricians will, too.

Pediatrician Bob Sege is another convert. Chairman of general pediatrics at the Floating Hospital for Children at Tufts-New England Medical Center, he's embracing the recommendation even though it took him by surprise.

Chicago pediatrician Marc Weissbluth says he would never tell parents not to co-sleep. ''I would say, 'Be aware of the risks. If you make the decision to do it, do it as safely as possible."

As for the pacifier, what parents who hate them hate about them is the way some toddlers become so attached. The trick, says Weissbluth, is to restrict use to the crib -- if not from the start, then by 9 months, so a child only associates it with sleep. He is author of ''Healthy Sleep Habits, Happy Child, 3d edition" (Ballantine).

But what happens if a younger baby comes to depend on the pacifier to fall asleep and can't find it if he wakes up during the night?

Moon says that some parents choose to put multiple pacifiers in the crib so the baby will find one. Others wake up and replace it; still others let the baby cry.

Kim Johnson of Weymouth, another mother in the breast-feeding group, knows of a woman who lost a baby to SIDS. She's perfectly willing to give her 3-month-old, Sophie, a pacifier if it will help. ''Luckily," she says, ''Sophie has discovered her fingers."

With so many styles of pacifiers, is it just a matter of finding the right one? Should Gina Pizziferri keep looking?

Probably not, says Kattwinkle. ''The differences between them? It's just a marketing gimmick," he says.

Contact Barbara Meltz at meltz@globe.com.