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The SIDS Message Has Spread--but Not Far Enough


A most vital lesson in infant care, hopefully gleaned before baby and mother leave the hospital, is profound as much for its simplicity as for its effect: Putting infants to sleep on their backs may save their lives.

The number of deaths attributed to Sudden Infant Death Syndrome, or SIDS--the inexplicable, sudden death of an infant under one year that usually occurs while sleeping in a crib--plummeted after pediatricians advocated putting infants to sleep on their backs. There were 3,000 SIDS victims in 1996, down from 4,900 in 1992, according to the National Center for Health Statistics.

American pediatricians launched a public health campaign in 1994 using the slogan "Back to Sleep" after European countries did studies showing that when parents put their babies to sleep on their backs, SIDS deaths declined by half. But the message has not taken root with everyone. About 24% of American infants are still being put to sleep on their stomachs, according to a study published in the Journal of the American Medical Assn., but the good news is this is a radical drop from the 70% of babies who were sleeping on their stomachs in 1992.

The babies at greatest risk have mothers who are ages 20 to 29, are inner-city African Americans and come from families living in the mid-Atlantic and Southern states, according to the National Institute of Child Health and Human Development. More boys than girls die of SIDS, which may be related to infant boys' higher rate of neurological disorders, says Marian Willinger, director of SIDS research at the institute. And recent mortality statistics reveal that black infants succumb to SIDS at 2 1/2 times the rate of white infants. Native American infants are at greatest risk, dying from SIDS at three times the rate of white infants, according to National Center for Health Statistics data.

"There are pockets of people who don't get the message, and it is probably largely the economically disadvantaged," Willinger says. "There are other factors like if [a mother, caregiver or grandmother] had a previous child she placed prone. It is changing traditional habit. The other factor is babies tend to sleep better on their stomach and mothers need their babies to sleep."

But sleeping on the stomach increases the chances a baby will rebreathe exhaled air (high in carbon dioxide), which becomes trapped in pockets of soft bedding or pillows, Willinger says.

Additional clues are gleaned from mounting evidence (based upon the autopsies of SIDS victims) suggesting that some SIDS babies are born with abnormalities in the arcuate nucleus, a portion in the brain that is likely to be involved in controlling breathing and waking. The brain of a baby with a flawed arcuate nucleus may lack the ability to trigger the baby to wake from sleep and cry or to adjust the heartbeat and breathing to compensate in situations in which there is a lack of oxygen.

However, scientists believe abnormalities alone will not cause SIDS but are probably compounded by other factors such as infection, overheating or lack of oxygen. A respiratory infection in an infant can hamper breathing, which may already be affected by sleeping on the stomach. Infections may explain why more SIDS cases occur during the colder months of the year, when respiratory and intestinal infections are more common.

Despite great strides in getting the Back to Sleep message out, SIDS remains the leading cause of death in infants 1 month to 1 year old, accounting for roughly 10% of infant deaths in 1996 in the U.S. If parents or caregivers have trouble getting an infant to sleep on her back, they should contact the infant's pediatrician. Along with placing infants to sleep on their backs (the side position is unstable because if a baby rolls over, it is usually onto the stomach), parents can take the following steps to reduce the risk of SIDS:

* Place baby to sleep on a firm surface free of fluffy bedding, soft toys and pillows.

* Make sure expectant mothers receive early and regular prenatal care.

* Provide a smoke-free environment before and after baby is born.

* Avoid smoking, drinking alcohol and taking drugs during pregnancy.

* Ensure that babies don't get too warm when sleeping. An overheated baby is more likely to go into a deep sleep from which it is difficult to arouse. The baby's room temperature should feel comfortable to an adult.

* Ensure that babies receive immunizations on schedule.

* When possible, breast-feed. Some studies have found SIDS to be less common in breast-fed infants, possibly because breast milk provides protection from some infections that can trigger SIDS.

* Electronic home monitors (which detect and sound an alarm when a baby stops breathing) are recommended for infants who have experienced one or more severe episodes in which they stopped breathing, premature infants with apnea and siblings of two or more SIDS infants.

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