SIDS :: Steps to reduce risk for SIDS in infants

Though SIDS cannot be prevented, parents of infants are encouraged by pediatricians and popular parenting books to take several precautions in order to reduce the likelihood of SIDS or cot death.

Sleep position —

Place the infant on its back to sleep. Among the theories supporting this habit is the idea that the small infants with little or no control of their heads may, while face down, inhale their exhaled breath or smother themselves on their bedding. Another theory states that babies sleep more soundly when placed on their stomachs, and are unable to rouse themselves when they have an incidence of sleep apnea (e.g., breath-holding, which is thought to be common in infants).

Bedding —

Only use a firm mattress with well fitted (tight) sheets in a crib or bassinet. No pillows, stuffed animals, or fluffy bedding should be used or placed in a crib. In cold weather dress the infant warmly in well fitted clothing. Wearable blankets are preferable over loose blankets. These directions also stem from the belief that small babies with little or no control of their bodies may inadvertently smother themselves in their sleep.

In the UK, BBC TV presenter Anne Diamond became involved in raising awareness of cot death after her son, Sebastian, died from the syndrome in 1991.

Sleep sacks —

In colder environments where bedding is required to maintain a baby’s body temperature the use of a sleep sack is becoming more popular. A study published in the European Journal of Pediatrics in August 1998 has shown the protective effects of a sleep sack as reducing the incidence of turning from back to front during sleep, reinforcing putting a baby to sleep on their back for placement into the sleep sack and preventing bedding from coming up over the face which leads to increased temperature and carbon dioxide rebreathing. They conclude in their study “The use of a sleeping-sack should be particularly promoted for infants with a low birth weight.”

Breastfeeding —

A study published in the May 2003 issue of Pediatrics revealed that breastfeeding infants have 1/5 the rate of SIDS as formula-fed infants.

Two other studies supported breastfeeding for reducing SIDS rates.

Co-sleeping —

A controversial approach to lowering SIDS rates is co-sleeping. Although a 2005 policy statement by the American Academy of Pediatrics on sleep environment and the risk of SIDS condemned all co-sleeping and bedsharing as unsafe, empirical data[3] has suggested that almost all SIDS deaths in adult beds occur when other prevention methods, such as placing the infant on his back, are not used. Infant deaths in adult beds are also reduced when parents are non-smoking, not impaired by drugs or alcohol, not obese, and are not using fluffy comforters and pillows. A firm sleeping surface is also required, which rules out waterbeds or soft mattresses. With these factors accounted for, SIDS rates for co-sleeping infants are actually lower than for crib-sleeping infants. Parents also have newer room and bedsharing options including bed side and bedtop sleeping devices to make co-sleeping safer and more convenient.

A 2005 study states that “sleeping with an attentive, unimpaired mother is not only safe but biologically sound” (McKenna JJ, McDade T. Why babies should never sleep alone: a review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Paediatr Respir Rev 2005;6:134?52. PMID 15911459). The practice of solitary sleep for infants leads, among other things, to an absence of exogenous stimuli that influence breathing, cardiovascular function, and sleep architecture in the sleeping infant. Sleep and waking states and state transitions are apparently produced by suites of state regulatory mechanisms that function as a dynamical system. Modeling of dynamical systems has demonstrated that they are organized, or ?tweaked? by episodic, irregular inputs. Some investigators (Mosko et al., 1993; McKenna, 1996) have argued that cosleeping provides infants with stimuli that organize their immature systems and thereby buffer them from risk for regulatory failures in sleep over a developmentally vulnerable postnatal period.

Sleeping near the baby —

Parents are also encouraged to sleep near their babies. ‘Near’ is generally understood to mean in the same room, but not in the same bed. Adult bedding often does not follow the ‘no pillows, no fluffy blankets and firm mattresses only’ instuctions mentioned before. Keeping the baby in the same room as the parent is thought to allow the parent to be wakened by a baby in distress even if the child is unable to cry.

Pacifiers —

A 2005 study indicated that use of a pacifier is associated with a 90% reduction in the risk of SIDS (Li et al). PMID 16339767 It has been speculated that the raised surface of the pacifier holds the infant’s face away from the mattress, reducing the risk of suffocation. Although suffocation is an actual cause, while SIDS refers to an unexplained infant death, in the absence of sufficient postmortem investigation, a SIDS diagnosis may result.

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