Objectives-To investigate the relation between pacifier use and sudden infant death syndrome (SIDS).Design-Three year population based, case control study with parental interviews for each death and four age matched controls. Setting-Five regions in England (population > 17 million). Subjects-325 infants who had died from SIDS and 1300 control infants. Results-Significantly fewer SIDS infants (40%) than controls (51%) used a pacifier for the last/reference sleep (univariate odds ratio (OR), 0.62; 95% confidence interval (CI), 0.46 to 0.83) and the diVerence increased when controlled for other factors (multivariate OR, 0.41; 95% CI, 0.22 to 0.77). However, the proportion of infants who had ever used a pacifier for day (66% SIDS v 66% controls) or night sleeps (61% SIDS v 61% controls) was identical. The association of a risk for SIDS infants who routinely used a pacifier but did not do so for the last sleep became non-significant when controlled for socioeconomic status (bivariate OR, 1.39 (0.93 to 2.07)). Conclusions-Further epidemiological evidence and physiological studies are needed before pacifier use can be recommended as a measure to reduce the risk of SIDS. (Arch Dis Child 1999;81:112-116)

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