Rest infants on their backs, confirms pediatrics association

Resting infants on their backs in cribs remains the safest position to reduce the risk of Sudden Infant Death Syndrome.

The American Academy of Pediatrics confirmed that standard this week. The association also formally recommended against crib bumper pads in updated standards released this week, another precaution for preventing SIDS.

Breast-feeding and immunizations also offer protection, the guidelines state.

The syndrome involves a quick death of an undetermined cause for a child younger than 12 months old.

Dr. Fern Hauck, professor of family medicine at the University of Virginia, is part of the association’s Task Force on SIDS. She said she is concerned that SIDS rates have remained constant within the past few years and that some parents disregard safety guidelines.

“For example, not all parents put their babies on the back for sleep, despite clear evidence that this is the single most important thing to do,” she said. “Also, rates of suffocation or strangulation in bed have increased in recent years, mostly related to more mothers sleeping with their babies.”

Jessica Black, a student at the University of New Mexico School of Medicine, presented research from her studies with infants last weekend at an association convention in Boston. Her research examines the sleep guidelines, particularly the advice that infants sleep safest when lying on their backs.

“One of the newest things for the recommendations is that [association members] try to make it not so much about SIDS but about safe sleep in general,” Black said. “There’s really no need to have a bumper because the infants aren’t going to be injuring themselves. Actually, infants can become entrapped between the crib and bumper.”

Hauck said more research is needed to isolate the cause of SIDS. “We have theories and are getting closer to an answer,” she said. “The research needs to look at physiological, brain anatomy/neurochemicals, immune system and genetic explanations.”

Black and her colleagues conclude that lying with the back upward does indeed seem to reduce the chance of SIDS. They also recommend that parents remove all the trimmings that can adorn a crib.

“If you go to baby store, you see these elaborate cribs with blankets and cute stuffed animals, but it’s not safe,” Black said. An essentially bare crib is the safest.

“It’s not as cute and fluffy – just a firm mattress with a fitted sheet and the infant swaddled in a sleep sack with no other blankets or anything. It’s difficult for parents.” Sleep sacks can be layered over sleepers.

Recently, the Food and Drug Administration released a report advising consumers to be wary of products that claim to prevent SIDS. Black said such products would have to be regulated by the FDA as medical devices.

Black and her colleagues in New Mexico reviewed 91 infant deaths that occurred from January 2006 to last December, working with the state’s medical examiner to determine the cause of death through forensic photos and autopsy and toxicology reporters.

A total of 59 were classified as SIDS deaths. Of these cases, 52 percent of the babies were found lying on their stomachs and 71 percent were found on unsafe sleep surfaces. Half of the cases involved infants who died sharing their bed with another person. Some 57 percent of the cases involved infants who died sleeping outside of their cribs, though almost three quarters of the subjects’ homes had cribs.

Dr. Clarissa Krinsky, who was involved in the study, has a 4-month-old child and said she wishes parents were better educated about child safety.

“Swaddling is great for babies if they’re tightly wrapped in a light blanket that they can’t kick off,” she said. “The most important thing is to keep any heavy bedding out of the crib, and sleep sacks are great as a self-contained, little sleeping bag [babies] can sleep in.”

Dr. Sarah Lathrop analyzed data in the study, and she notes that the distinction between SIDS and SUID often eludes the public.

“SIDS in the past was sort of a catch-all term for any infant found deceased the next morning,” she said. “As we’ve learned more about it, the preferred term is Sudden Unexpected Infant Death. Sometimes a death will start off as SUID, but then when you do an autopsy, you find it was due to infection or pneumonia or a congenital heart problem, so some of them do go on to have [another] cause of death.”

The infant subjects in the study represented the ethnic makeup of New Mexico, Lathrop said, but she said the study looks only at a subset of children from the Southwest. She thinks further research is needed to find out why families with cribs might not choose to use them. Black believes another limitation of the data is that researchers lacked jurisdiction over tribal land and military installations, so there might be cultural variables that weren’t observed.

“There are lots of things that go into raising a baby,” Black said. “Not all of it is recommendations from your pediatrician or OB/GYN. Maybe it’s your family tradition that the baby sleeps with you in bed, and sometimes it’s hard for people to change from that.”

Although general wisdom has not always upheld the supine position, Krinsky believes the American Academy of Pediatrics guideline is here to stay.

“I think this is definitely going to stay stable because we saw such a dramatic reduction in SIDS cases when people started putting babies on their backs,” she said.

Lathrop said that public health messages need to be better disseminated, and it could all start with hospitals.

“I have a 7-year-old son, and I know when I had him, you get a stack of paperwork, and you’re tired, and you might go home and not read it at all.”

Sleeping with infants poses another hazard. As an epidemiologist, Lathrop said it breaks her heart to sees sudden death cases. “It’s an empty crib – next to a king-sized waterbed. And it’s like, ‘If you could have just put them in their crib.’ This is what we have to combat.”

This story is courtesy of the Medill News Service.

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