By Judith Palfrey, MD, chief of Children's Hospital Boston's Division of General Pediatrics
New parents have a lot of worries. Is their baby eating enough? Is she developing appropriately? Is she sleeping well? But the one that keeps them up at night is the fear of Sudden Infant Death Syndrome, or SIDS.
Characterized by the sudden death of an infant under the age of 1 year with no logical explanation, SIDS claims the lives of 2,300 babies annually and is the leading cause of infant death in the United States. Overall, babies 2 to 3 months of age are at the highest risk, regardless of gender, but SIDS is more likely to occur in males from 1 to 4 months old than in females of the same age.
Despite its obvious prevalence, doctors and researchers remain baffled by its cause. Thirty years of research, however, has shown some babies are more at risk than others, so the American Academy of Pediatrics (AAP) issued guidelines to reduce the incidence of SIDS. Those guidelines were updated in October to reflect issues that have become relevant since the last update in 2000.
In an effort to keep parents informed and help them sleep at night, we at Children's Hospital Boston have taken a closer look at these guidelines to shed some light on measures parents can take to decrease their baby's risk of SIDS.
Here are the AAP's most recent recommendations that parents should apply to reduce the SIDS risk:
SIDS tends to occur more often when mothers have little to no prenatal care. Frequent and consistent medical visits from the start to completion of pregnancy decreases the risk of a low birth weight or premature baby, both of which carry a high risk for SIDS. Mothers should also avoid smoking, alcohol and drugs during pregnancy, and maintain a proper diet.
Placing the baby on its back reduces the incidence of SIDS more so than any other sleep position, including side-sleep, which was previously recommended to prevent possible choking. No conclusive evidence, however, exists that back-sleep increases the chance of choking. While the baby should never be placed on her stomach to sleep, parents should encourage supervised "tummy time."
A firm mattress and sleep surface is important in decreasing the risk of SIDS. Pillows, comforters, blankets, stuffed animals, should not be placed in a baby's crib. A firm mattress with a sheet is highly recommended.
Babies should be kept warm, but should not be overdressed for sleep. The temperature in a baby's room should feel comfortable to a lightly clothed adult. Overheating may induce deep sleep, which is harder for a baby to wake up from if air restrictions occur.
Avoid bed sharing
Although many mothers find bed sharing to be convenient and beneficial for breast feeding and enhancing the mother-infant bond, it can be hazardous. Soft surfaces and chances of overheating increase because adult beds do not conform to safety standards for babies. Instead of bed sharing, the AAP recommends room-sharing, where the baby's crib is located in the same room, but parents and baby do not share the same bed.
The latest AAP recommendations support the possible use of a pacifier at sleep and nap time to reduce the risk of SIDS.
The pacifier should not be forced, coated with any sweet substance or reinserted after the baby falls asleep. Mothers concerned that the pacifier will interfere with breast feeding should introduce the pacifier after one month or once breast feeding has been established. Giving the pacifier at bed or nap time will help the baby identify it with sleep and not hunger, which can aid in reducing nipple confusion.
SIDS deaths have dropped by 50 percent since the AAP introduced the "Back to Sleep" campaign in 1992, proof positive that following these simple guidelines is imperative in guarding against the incidence of SIDS.