What You Can Do to Prevent SIDS

Despite the widespread believe that SIDS is a baffling and unpredictable tragedy, there are ways you can significantly protect your baby. One thing that has been proven is that babies who sleep on their backs are less likely to die of SIDS than babies who sleep on their stomachs.  And so the “Back to Sleep” program was born in 1992, when the American Academy of Pediatrics (AAP) began warning parents of babies under 1 year old never to let their infants sleep on their stomachs. Since then, the rate of SIDS has dropped by over 50%.  In addition to this, Dr. Sears explains that there is a combination of many factors that lead to death: immature development of cardio-respiratory control mechanisms, defective arousability from sleep in response to breathing difficulties, medical conditions that compromise breathing, and unsafe sleeping practices.

The main risk factors for SIDS are:

• Prematurity or low birth-weight
• Smoking or taking illegal drugs during pregnancy
• Smoking around baby after birth
• Putting baby to sleep on their stomach
• Infants who are not breastfeeding
• Having little or no prenatal care
• Unsafe sleeping environment
• Overheating from excessive sleepwear and bedding
• There is no correlation between immunizations and SIDS.

Therefore, parents should follow the AAP recommendations for reducing the risk of SIDS:

• Place your baby on a firm mattress to sleep.
• Do not put your baby to sleep on a pillow, waterbed, sheepskin, couch, chair, or other soft surface.
• To prevent rebreathing (where the baby inhales the same air he just exhaled), do not put blankets, comforters, stuffed toys, or pillows near the baby.
• Make sure your baby does not get too warm while sleeping. A good temperature is one where an adult would be comfortable in a short-sleeve shirt. Do not over-bundle or over-swaddle your baby.
• Do not smoke, drink, or use drugs while pregnant and do not expose your baby to secondhand smoke. Exposure to secondhand smoke doubles a baby’s risk of SIDS, while a mother who smoked during pregnancy triples the risk.
• Receive early and regular prenatal care.
• Make sure your baby has well-baby checkups regularly.
• Breastfeed, if possible. There is some evidence that breastfeeding may help decrease the incidence of SIDS.
• If your baby has GERD (reflux), be sure to follow your doctor’s guidelines on feeding and sleep positions.
• Put your baby to sleep with a pacifier during the first year of life. If your baby rejects the pacifier, don’t force it. Pacifiers have been linked with lower risk of SIDS.

Attachment Parenting

Dr. Sears also advocates a style of caretaking called Attachment Parenting. In addition to many benefits for you and your baby, Attachment Parenting greatly reduces the odds of your baby succumbing to SIDS. For more information, read these worthwhile articles:

• 4 Ways Attachment Parenting can Reduce the Risk of SIDS
• 3 Reasons Babywearing reduces SIDS)
• 8 Reasons Breastfeeding Reduces SIDS
• Co-sleeping SIDS
• Beware of Sleep Trainers

When Stomach Sleeping is OK

Having said all that, for some babies, it is actually recommended that they sleep on their stomachs.

Premature babies or babies with breathing difficulties are put to sleep on their tummies, since the still partially collapsed lungs of some prematures tend to expand better when front-sleeping.

If an infant has gastroesophageal reflux, it is also recommended that he sleep tummy down, at least for two hours after a feeding.  Some babies sleeping on their tummies also seemed to settle better and spit- up less after feeding.

Listen to Your Baby: If your baby is just not content to sleep on his back, is it OK to put him to sleep on his stomach?  Well, because of the new research it is best to try to get baby accustomed to sleeping on her back or side. Newborn babies tend to get in the habit of sleeping the way they are first put down.  Nevertheless, Dr. Sears says that unless advised to the contrary by your doctor, it is best to let your baby sleep in a position she prefers. This means that if your baby doesn’t settle down, or stay asleep on her back or side, front sleeping is fine.  Newborn babies DO tend to prefer their tummies. “If a baby repeatedly doesn’t settle in a certain sleeping position, this may be a clue that this position may not be the safest for this individual baby. This is just one example of how babies often try to tell us what is in their best interest. Parents should not be afraid to listen.”

Just be sure to follow all the safety precautions listed above, such as placing baby on a firm mattress, not overheating the room, etc.

Another Possible Cause of SIDS

Sleep position may be important, but there is some evidence that SIDS may be related to the fire retardants in the baby’s mattress.  The reason this may be a culprit in SIDS is that an ordinarily harmless fungus (Scopulariopsis brevicaulis) consumes the chemicals used in the plasticized mattress cover. Baby’s drool, vomit, urine, and perspiration, combined with body heat, enable the fungus to grow rapidly.  When this occurs, neurotoxic gases are emitted. If baby breathes a significant amount of these odorless gases for a prolonged time, the central nervous system can shut down, causing death.

Using a mattress pad that is NOT made from polyvinyl chloride (PVC) would eliminate this tragedy.  For more information, read Is sleep position really important in SIDS? Also, read about mattress wrapping, which means wrapping baby’s mattress in a polyethylene cover, to prevent your infant from breathing the gases. You can also look into an organic crib mattress, made from all-natural fibers which have not be treated with flame-retarding chemicals.

Feature image from Delio: Organic Bedding for Baby

The new study, reported on by Science Daily, appears in the first issue for June of the American Journal of Respiratory and Critical Care Medicine, a publication of the American Thoracic Society.

“Our results provide some of the most direct evidence to date suggesting that prenatal cigarette smoke exposure can contribute to the destabilizing effects of hypoxia [inadequate oxygenation of the blood] and thermal stress on neonatal breathing,” said Dr. Hasan.

That the effects of second-hand cigarette smoke are damaging is well known. But according to this study, the effects were much more pronounced when a fetus was exposed to cigarette smoked prenatally.

“Our results show that prenatal cigarette smoke exposure compounds the risk by increasing the likelihood of gasp-like respiration and prolonging the time that it takes for neonates to return to normal breathing following hypoxia,” said Dr. Hasan. “These observations provide important evidence of how prenatal cigarette smoke exposure, hypoxic episodes and hyperthermia might place infants at higher risk for SIDS and further support efforts to foster prenatal smoking cessation programs.”

To read the details of this study, please refer to Science Daily: Smoking During Pregnancy Increases Risk of SIDS.

I slept with my daughter until she was two and expecting my second child. Now I sleep with my 5-month old son and have no plans yet to move him out of my bed. When people comment on it, I reply that I like having him close by. Yes, it’s slightly uncomfortable to sleep with him next to me (my arm gets numb and tingly if it’s wrapped around him too long, my back hurts when I’m curled around him in a funny position, or when I fall asleep feeding him…) but for me that’s better than having to get out of bed and go to his room a few times a night to feed him. I like that he’s so close by I can sense him wriggling around and can feed him before he wakes up completely. I like to know he’s right there next to me and that he’s OK.

For those who are unaware of the facts, sleeping with your baby in bed may indeed sound like a dangerous practice. What if she falls off or gets stuck between the mattress? What if one parent rolls onto the baby, or she gets smothered by a pillow or blanket? But when you examine the reality of the situation, it’s apparent that sleeping with your baby in a safe manner may actually be healthier for her than putting her to sleep alone in a crib.

Dr. Sears points out that the incidence of SIDS is dramatically higher in a crib versus a parent’s bed. Although there are cases of accidental smothering and entrapment, such situations are very rare. The September/October 2002 issue of Mothering Magazine presents research done throughout the whole world on the issue of safe sleep. They conclude that not only is sleeping with your baby safe, but it is actually much safer than having your baby sleep in a crib. Infants who sleep in a crib are twice as likely to suffer a sleep related fatality (including SIDS) than infants who sleep in bed with their parents.

Instead of warning parents not to sleep with their babies, Dr. Sears advocates teaching parents how to sleep safely in bed with their babies. Much of this is common sense, but here are the guidelines he suggests:

• It is unlikely for baby to fall out of bed while sleeping next to mother. Dr. Sears compares it to a heat-seeking missiles; babies automatically gravitate toward a warm body. But to be on the safe side, place baby between mother and a guardrail or push the mattress flush against the wall and position baby between mother and the wall. Be sure there are no crevices that baby could sink into.

• Place baby adjacent to mother, rather than between mother and father. Many mothers feel they are so physically and mentally aware of their baby’s presence even while sleeping, that it’s extremely unlikely they would roll over onto their baby. Some fathers, on the other hand, may not enjoy the same sensitivity of baby’s presence while asleep; so it is possible they might roll over on or throw out an arm onto baby. After a few months of sleep-sharing, most dads seem to develop a keen awareness of their baby’s presence.
• Place baby to sleep on his back.
• Use a large bed, preferably a queen-size or king-size. A king-size bed may wind up being your most useful piece of “baby furniture.” If you only have a cozy double bed, use the money that you would ordinarily spend on a fancy crib and other less necessary baby furniture and treat yourselves to a safe and comfortable king-size bed.
• Some parents and babies sleep better if baby is still in touching and hearing distance, but not in the same bed. For them a bedside bassinet or co-sleeper is a good option. This arrangement gives parents and baby their own separate sleeping spaces yet, keeps baby within arm’s reach for easy nighttime care. Dr. Sears suggests the Arm’s Reach® Co-Sleeper® Bassinet (www.armsreach.com).

• Do not sleep with your baby if:
  1. You are under the influence of any drug, alcohol, or tranquilizers. If you are drunk or drugged, these chemicals lessen your arousability from sleep.
  2. You are extremely obese. Obesity itself may cause sleep apnea in the mother, in addition to the smothering risk.
  3. You are exhausted from sleep deprivation. This lessens your awareness of your baby and your arousability from sleep.
  4. You are sleeping on a cushiony surface, such as a waterbed or couch.
• Don’t allow older siblings to sleep with a baby under nine months. Sleeping children do not have the same awareness of tiny babies as do parents, and too small or too crowded a bed space is an unsafe sleeping arrangement for a tiny baby.
• Don’t overheat or overbundle baby. Be particularly aware of overbundling if baby is sleeping with a parent. Other warm bodies are an added heat source.
• Don’t wear lingerie with string ties longer than eight inches. Ditto for dangling jewelry. Baby may get caught in these entrapments.
• Avoid pungent hair sprays, deodorants, and perfumes. Not only will these camouflage the natural maternal smells that baby is used to and attracted to, but foreign odors may irritate and clog baby’s tiny nasal passages.