Night-time non-nutritive sucking in infants aged 1 to 5 months: relationship with infant state, breastfeeding, and bed-sharing versus room-sharing

Aim: Epidemiological studies suggest that pacifier use may be protective ag ainst SIDS but little is known of the relationship between pacifier use and other forms of non-nutritive sucking (NNS) in infancy, or of patterns of N NS during the night, when most SIDS deaths occur. We report the first longi tudinal study of NNS by direct overnight observations in healthy infants in a sleep laboratory. Methods: Healthy, breast fed term infants (n = 10) wer e enrolled at birth, and sequential overnight polygraphic and infrared vide o recordings of infants with their mothers performed at monthly intervals f rom 1 to 5 months. Each month, mother baby pairs were randomized to 1 night bed-sharing (BN) then 1 room-sharing (RN), or vice versa. 'Episodes' of pa cifier. own digit and mother's digit sucking (> 1 min) were identified and compared with state-matched control periods without sucking or feeding befo re and after each such episode. Results: 329 episodes of NNS were identifie d in 749 h of video recording. The prevalence of pacifier sucking decreased with age, whilst digit sucking increased. Routine pacifier users rarely su cked their digits. There were temporal differences throughout the night in the distribution of different types of sucking and in infant state during a nd around sucking episodes. Sleeping in the 'non-routine' location was asso ciated with a larger percentage of nights with sucking episodes and increas ed sleep latency. Bed sharing (routinely or on a given night) was associate d with less sucking behavior and more breastfeeding. Non-nutritive sucking was not, however, associated with decreased total time breastfeeding per ni ght or number of feeds per night. Conclusion: Patterns of NNS during the ni ght change with age and are affected by maternal proximity. Digit sucking h as state modulating effects, and may be suppressed by pacifier use. Thus an y benefits of pacifier use must be set against the potential loss of a self -directed ability to modulate state during the night, and possible shorteni ng of breastfeeding duration. (C) 1999 Elsevier Science Ireland Ltd. All ri ghts reserved.