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Back Sleeping and Pacifiers at Bedtime Reduce SIDS Risk

Sleep AidOct 12, 05

To reduce the risk of sudden infant death syndrome (SIDS), babies should be put on their backs—not their sides or stomachs—for sleep, and should not share the parents’ bed except for nursing and comforting.

On the other hand, sharing a room with parents appears to be protective against SIDS, as is putting infants to bed with a pacifier.

Those are some of the findings included in a policy statement on SIDS prevention issued today by the American Academy of Pediatrics.

“More babies still die of sudden infant death syndrome than any other cause during infancy beyond the newborn period,” said John Kattwinkel, M.D., chief of neonatology at the University of Virginia Health System, in a briefing.

“This is despite a 53% decrease in the U.S. SIDS rate since the American Academy of Pediatrics recommended in 1992 that babies be placed to sleep on their backs,” Dr. Kattwinkel continued. “This reduced rate reflects nearly 3,000 fewer infant deaths per year, or over 15,000 fewer deaths since the original back-to-sleep recommendation.”

The new recommendations reaffirm the original finding that back-sleeping is the best means for preventing SIDS. That message has evidently gotten through to parents, since about 90% of mothers are said to follow the back-sleeping recommendation, Dr. Kattwinkel said.

But many secondary caregivers—grandparents, daycare providers, and the lot—don’t seem to have assimilated the advice.

“This is particularly concerning, because studies have shown that babies who are used to sleeping on their backs are placed at a much higher risk for SIDS when they are subsequently placed on their stomachs,” Dr. Kattwinkel said.

Parents of newborns often return to work when the child is two to three months old, a time when risk for SIDS begins to rise, and leave their infants in the care of another, he pointed out.

One change from the earlier recommendations is that allowing children to sleep on their side is no longer recommended, he added.

The guidelines, issued by the AAP’s Task Force on SIDS, also recommended that babies sleep in their own crib rather than share the parental bed, based on evidence from 10 case-control studies showing the practice of co-sleeping to be hazardous.

“On the other hand, room-sharing, having the infant’s crib in the same room as the mother, appears to reduce the risk of SIDS,” Dr. Kattwinkel said.

In addition, six studies have found that putting a baby down to sleep with a pacifier in his mouth is associated with reduced risk of SIDS, the guidelines say. Although the reason for the protective effect of pacifier use is unclear, it could be due to helping infants, who are obligate nose breathers, maintain patent airways during sleep, Dr. Kattwinkel said.

Alternatively, pacifiers could alter the child’s sleep state, which could affect arousal patterns speculated to be responsible for SIDS.

In a study to be published in the November issue of Pediatrics and made available online today, Fern R. Hauck, M.D., and colleagues from the University of Virginia in Charlottesville, reported that one SIDS death could be prevented for every 2,733 infants who use a pacifier.

While some developmental experts have expressed concern that pacifiers cause a risk of later malocclusion of teeth, the American Dental Association has stated that the risk from pacifier use during the first year of life insignificant.

Other key recommendations to parents include:

  • Use firm crib mattress covered by a sheet, and keep loose bedding and soft toys out of the crib.  
  • Mothers should not smoke during pregnancy, and parents should not smoke near the baby after birth to prevent exposure of the child to secondhand smoke.  
  • Avoid overheating by keeping the child lightly clothed during sleep and keeping the bedroom temperature comfortable for a lightly clothed adult.  
  • Avoid the use of home monitors or commercial devices marketed for their ability to reduce SIDS, because their efficacy and safety have not been verified. Some devices can actually trap babies in a dangerous position, Dr. Kattwinkel said.  
  • To avoid development of plagiocephaly, or flattening of the back of the head, caregivers should give the children, while they’re awake, plenty of “tummy time,” which is also good for development of muscles of the trunk and upper extremities. Infants can also be put to sleep on their backs but with their heads to one side for one week, then the other side the next week to help avoid head flattening.  
  • Assure that secondary caregivers—relatives, friends, daycare providers, babysitters—are aware of the recommendations and follow them.

This study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary as they have not yet been reviewed and published in a peer-reviewed publication.

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