SUDDEN INFANT DEATH (SIDS)
Q: Is there any new information on SIDS? My wife wants our new baby to sleep in our bed and I am concerned about that.
A: I specifically remember the conference in Dallas in 1994, when pediatricians launched their Back to Sleep campaign. It was suggested at that time to put babies on their backs when they were put to sleep—–as opposed to the side or on their stomachs. At the time that decision was controversial. Critics pointed out that the data indicating it may reduce SIDS came from New Zeeland and that it was premature to recommend that babies sleep on their backs.
Since then we know that the Back to Sleep campaign worked well in that SIDS was reduced. It remains the third leading cause of death in infancy and the most common cause of death between 1 month and 12 months. Since 2001 the rates have remained constant.
SIDS is defined as an unexplained death before age one in a previously healthy baby.
It is more common in boys at a 3:2 ratio. Other risk factors are: maternal smoking during pregnancy, environmental tobacco smoke, a baby who is overheated, sleeping in a crib with soft bedding and loose blankets and pillows, a low birth weight, prematurity, and a young maternal age.
Despite the above campaign to teach caregivers to put the baby to sleep on his or her back (the supine position) 25% of infants continue to sleep in the non-supine position. One study found that 36% of pictures in parenting magazines, of infants sleeping, show the infants in the non-supine position.
Babies with reflux often are not put on their backs. Parents worry that if the baby’s stomach contents come back up (GERD) that the baby may choke or aspirate. However there are a number of studies which show that babies with GERD do not aspirate when placed on their backs to sleep.
Babies who sleep on their sides are at a higher risk of SIDS than babies who sleep on their stomachs.
The motives for bed sharing vary from parent to parent. One of the most common reasons is to make breastfeeding easier and also to allow bonding between the baby and mother. Both the Canadian Pediatric Society and the American Academy of Pediatrics recommend against bed sharing. The AAP recommends that infants share a room with their parents without bed sharing. This reduces the risk of SIDS by 50%.
Babies who died of SIDS related to bed sharing were mostly under 3 months old; in some cases the parents also smoked; the family slept on a waterbed, sofa or armchairs; a parent was intoxicated or under the influence of medications that caused drowsiness; pillows and blankets were present and there were multiple bed sharers (not just the parents)
A recent study done in New Zeeland and published in the online version of Pediatrics studied 40 babies. There were two groups: those who slept in the same room as the parents and those who slept with the parents in the same bed. (It’s a miracle that any of these babies slept at all because they had monitors on their chests, close to their nostrils and devices in their rectums to measure core temperatures)
The babies who shared a bed with parents were noted to be in a more stuffy environment; they tended to re-breathe their exhaled air, their oxygen saturation dropped to 80% and they paused longer before taking a new breath (only for 10 seconds; never more than 15 seconds) However, these babies were able to self arouse when these changes took place, thus returning to normal values on their own. The authors speculate that some babies genetically and due to their race and gender are more prone to SIDS, because they are less able to self-arouse. They simply forget to breathe and die.
What disturbs researchers is the fact that although SIDS has remained stable after it was reduced due to the Back to Sleep campaign, the deaths from accidental suffocation and strangulation in bed quadrupled. Some blame co sleeping and improper bedding.
Babies should not sleep on soft surfaces. It is dangerous to place sheepskins, pillows, quilts, blankets, bumper pads and comforters in a baby’s crib. Doing this increases the risk for SIDS up to 21-fold.
The jury is still out on the role of fans in the room or swaddling babies. If a baby is swaddled in put in a non-supine position the risk of SIDS increases.
The data on pacifiers is robust—they reduce SIDS when used at naptime and bedtime. However, experts recommend that pacifiers be introduced after breast feeding has been well established. (Usually by 4 weeks of age)
There is no data that links SIDS to immunizations. In 2007 a study published in the journal Vaccine showed that immunization decreased the risk of SIDS by 46%.
Comments on this entry are closed.