RISK REDUCTION

A number of factors seem to put a baby at higher risk of dying from SIDS. Babies who sleep on their stomachs or sides are more likely to die of SIDS than those who sleep on their backs. Mothers who smoke during pregnancy are three times more likely to have a baby die of SIDS, and exposure to passive smoke from smoking by mothers, fathers, and others in the household doubles a baby's risk of SIDS. Other risk factors include mothers who are less than 20 years old at the time of their first pregnancy, babies born to mothers who had no or late prenatal care, and premature or low birth weight babies. [American Academy of Pediatrics Task Force on Infant Sleep Position and Sudden Infant Death Syndrome. The Changing concepts of sudden infant death syndrome, diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducting risk. Pediatrics 2005; 116:1245-55.

No one can guarantee prevention of SIDS. However, as families have adopted risk reducing behaviors, the incidence of SIDS has been cut in half in the U.S.A. The most up-to-date research suggests ways in which you can decrease your risk for SIDS.

The Risk Reduction Messages

The Task Force on Sudden Infant Death Syndrome of the American Academy of Pediatrics (AAP) issued an updated policy statement concerning risk factors for Sudden Infant Death Syndrome (SIDS), the leading cause of post-neonatal infant mortality (Pediatrics 2005;116:1245-55).

Since the onset of the risk reduction initiative known as the Back to Sleep Campaign in 1994, the incidence of SIDS has declined by over 54%. In New Jersey, the rate fell from 97 cases or 0.8 per thousand live births in 1993 to 38 cases or 0.3 per thousand live births in 2003.

The recommendations put forth by the newest AAP guidelines are:

1. Back to sleep. Infants should be placed for sleep in a supine (wholly on back position) for every sleep. (The side position is no longer recommended as an alternative.) Back sleep is associated with the lowest risk for SIDS. There is no evidence that the back position increases the risk for aspiration.

2. Use a firm sleep surface. A firm crib mattress, covered by a well-fitting sheet, is the recommended sleeping surface.

3. Keep soft objects and loose bedding out of the crib. Pillows, quilts, comforters, sheepskins, stuffed toys and other soft objects should be kept out of an infant's sleeping environment.

4. Do not smoke during pregnancy. Avoid an infant's exposure to second-hand smoke. In addition to SIDS risk, this is advisable for numerous reasons.

5. A separate, but proximate sleeping environment is recommended, such as a separate crib in the parent's bedroom. Bed sharing during sleep is not recommended. However, room sharing is recommended. Although infants may be brought into bed for feeding or comforting, they should be returned to their own sleep surface when the parent is ready to sleep.

6. Consider offering a pacifier at nap time and bedtime. The pacifier should be used when placing infant down for sleep and not be reinserted once the infant falls asleep. However, if a parent is breastfeeding, it is recommended that pacifier use not begin until one month of age so that breastfeeding can be fully established. If the baby refuses the pacifier, he or she should not be forced to take it. Pacifiers should not be coated in any sweet solution and they should be cleaned and replaced often.

7. Avoid overheating. The infant should be lightly clothed for sleep and the bedroom temperature should be kept comfortable for a lightly clothed adult.

8. Avoid commercial devices marketed to reduce the risk of SIDS. Although various devices have been developed to maintain sleep position or reduce the risk of re-breathing, none have been tested sufficiently to show efficacy or safety.

9. Do not use home monitors as a strategy to reduce the risk of SIDS. There is no evidence that use of such home monitors decreases the risk of SIDS.

10. Avoid development of flat back of head (positional plagiocephaly). a) Encourage "tummy time" when awake and under supervision; b) avoid having the infant spend excessive time in car-seat carriers and "bouncers"; c) place the infant to sleep with the head toward one side for a week and then changing toward the other.

11. Assure that others caring for the infant (child care provider, relative, friend, babysitter) are aware of these recommendations. Unaccustomed prone sleep is associated with the highest risk of SIDS.

12. These policies apply to premature as well as term infants.

As always, parents should discuss any recommendations concerning their infant with their health care provider. The SIDS Center of New Jersey is available to respond to any general questions you may have about the new AAP policy statement. You may call the program's medical directors Thomas Hegyi, MD, at 732-235-7354, or Harold Perl, MD, at 201-996-5362. For brochures and other educational materials, please call 732-249-2160 or the hotline at 1-800-545-7437.