Sadly, I recently learned that one of my high school classmates had a SIDS (sudden infant death syndrome) death in her family. I was even more upset to learn that the baby was found on his stomach. As we discussed this tragic event, my mother commented that many of her friends confessed to putting their grandchildren on their stomachs to sleep while they cared for them. She said her generation did this with their children to facilitate sleep, and didn’t seem to agree that it was an important safety measure. Doctors and health advocates have undergone an intensive campaign in the last 18 years to educate people about preventing SIDS. The most important and effective measure parents and caregivers can take is to put babies to sleep on their backs. How sad that doctors that care for newborns (such as myself) have not fully convinced parents and caregivers that SIDS can be prevented with the simple act of putting a baby on his/her back to sleep.
So why is this so important? Let’s review what we know about SIDS:
SIDS is the leading cause of death among infants from 1 month to 1 year of age. Most deaths occur between 2 and 4 months of age, and the incidence increases during cold weather. No one really knows the exact cause of SIDS. Like so many disease processes, it seems to be a combination of an underlying genetic tendency and environmental factors. Recent research has identified a particular type of brain receptor that is associated with SIDS. Babies that have this type of receptor (which is genetically determined) are more likely to die of SIDS.
Environmental risk factors that increase the risk of SIDS include:
1. Stomach sleeping. The data is very clear on this one. Babies that sleep on their stomachs are between 3 and 9 times more likely to die of SIDS. Researchers speculate that babies who are stomach sleeping are more likely to have their airways obstructed and stop breathing, or to re-breathe their own exhaled air, which doesn’t have enough oxygen. Some babies may not have yet developed the normal brain mechanism needed for arousal in this situation.
2. Overheating, over-bundling, and excessive bedding
3. Prematurity and/or low birth weight
4. Smoking, drinking, or using drugs during pregnancy
5. Exposure to cigarette smoke after birth
6. Co-sleeping (a baby sleeping with an adult), particularly if the adult has been drinking or using drugs
Since the American Academy of Pediatrics began recommending back sleeping in 1992, the incidence of SIDS has decreased by about 50%. The data suggest that if everyone complied with back sleeping, the decrease would be substantially more.
So, how do parents prevent their baby from becoming a SIDS victim? Here are the recommendations:
1) Babies should be put on their backs to sleep. Side sleeping is still more dangerous than back sleeping. Continue this until one year of age. As your baby gets older, the risk of SIDS does decrease, and your baby will begin to roll both ways, but the baby should always be put down on his/her back.
2) Place your baby on a firm mattress to sleep. Do not allow your baby to sleep unsupervised on a waterbed, couch, pillow, chair, or other soft surface.
3) Do not put thick blankets, stuffed toys, bumpers, or pillows near your baby. Swaddling the baby with a thin blanket is OK as long as the baby’s head and face are fully uncovered. Putting the baby down in a sleeper only is the best.
4) Bring your newborn into your bed only if you will be awake and attentive with the baby. A bassinet next to your bed is the safest place for your baby.
5) Do not smoke, drink, or use drugs during your pregnancy or when you are caring for the child after birth. Get regular prenatal care.
6) Do not allow your baby to get overheated. Your baby does not need to be dressed any more heavily than you are. Your baby will be comfortable with the same amount of clothing that makes you comfortable.
7) Pacifier use has been linked with a lower risk of SIDS. Try to put your baby to sleep with a pacifier, but don’t worry if the baby doesn’t seem to want it. Don’t force it; just re-try later.
8) ALL caregivers need to be educated about all of the above. Don’t assume your day care provider or family members are aware of these recommendations.
Shari Phillips, M.D.