Keep Your Baby Safe From SIDS

This month, the American Academy of Pediatrics (AAP) released updated guidelines on safe sleep for babies. These guidelines are worth discussing, so we can keep all infants healthy and safe in their cribs.

I thought it would first be worthwhile to review this topic of sudden infant death syndrome (SIDS), as well as some of the earlier AAP recommendations.

In the early 1990s, the AAP launched a "Back to Sleep" campaign, which emphasized its recommendation to have all babies sleep on their backs (instead of on their bellies or sides), so as to reduce the number of SIDS cases. This change in parental behavior made a huge impact and SIDS cases have significantly decreased.

What is SIDS?

  • SIDS occurs when an infant is found dead after a sleep period, and yet no explanation for the death can be determined.
  • 90 percent of cases occur in infants less than 6 months of age.

Why should babies sleep on their backs?

  • Stomach-sleeping is thought to increase the risk that the infant will overheat and/or will re-breath air that has less oxygen in it. Both of these situations are felt to increase the risk of SIDS.
  • Babies on their backs may wake up more frequently. While this is not wonderful for sleep-deprived parents, waking up is actually thought to be a helpful protective mechanism in preventing SIDS in infants.
  • Babies who sleep on their backs are at no greater risk of choking (on saliva or vomit) than are babies who sleep on their bellies.

Because of the success of the "Back to Sleep" campaign, the number of SIDS cases significantly decreased. Unfortunately, we are now seeing a rise in other causes of sleep-related death, such as suffocation (when something blocks the breathing or cuts off oxygen) and asphyxia (when the blood cells lack enough oxygen or contain an excess of carbon dioxide). This is why some of the newer recommendations also take a harder look at what objects the parents are putting into the crib with the baby.

How can you keep your baby safe while he or she sleeps?

  • Place your infant on his or her back every time for sleep. 
  • Use a firm sleep surface--i.e., a hard mattress. Places where the AAP does not recommend putting babies down to sleep: car seats, platform swings, on someone's shoulder or lap, etc.
  • Keep all soft bedding, stuffed animals, pillows, etc., out of the crib. (At most, think mattress, baby, and a light blanket in the crib.) Remember, if a baby's face gets trapped against a soft pillow or animal, they don't have the ability to turn away or lift their heads to fix the situation.
  • Immunize your infant with the recommended childhood vaccines. Yes, there is evidence that this can reduce the risk of SIDS by 50 percent.
  • Breastfeed. This also helps to reduce the risk of SIDS.
  • Don't place your baby on his or her side. In this position, babies have a risk of rolling onto their stomachs. Also, do not use a wedge or positioner to keep a baby on her side; these can also pose a suffocation risk.
  • Use a pacifier at naps and nighttime. I can hear the gasps. When used correctly, a pacifier can be a good thing, especially if pacifier use is reserved primarily for encouraging sleep when an infant is having trouble calming down.
  • Don't smoke--even if you are smoking outside of the house. Dangerous smoke particles will still be clinging to your clothes when you come back in. And don't let anyone smoke in your house.
  • Don't overdress your infant. Overheating is now known to increase the risk of SIDS. Better for an infant to be a little cool. I really don't even like blankets, since babies can get them up over their heads and then can't move them away. "Footie" pajamas are generally sufficient.
  • Don't waste money on monitors that say they help to reduce SIDS. They have not been proven to work.
  • Make sure that the nurses in the hospital's nursery for newborns place the babies on their backs for sleep. While most hospitals are encouraging babies to spend more and more time in the room with their mothers after birth, many babies must still go back to the nursery for periods of time--and, believe it or not, many nursery nurses still place babies on their stomachs or sides! So make sure these nurses know that this is not okay with you.

What if your baby learns to roll over onto her stomach from her back?

Congratulations! This is a great developmental milestone that generally occurs around 4 to 6 months of age, sometimes earlier. Even the sleep experts agree that you don't have to reposition your baby onto her back once she has learned to roll over. (I actually did try to reposition my first child when he first started rolling over, but he quickly thought it was a game and would roll right back over again on his belly. To him, it was fun; all I wanted was for him to go back to sleep.) The good news is that the risk of SIDS significantly decreases between 4 and 6 months of age, right around the time that a baby generally reaches this milestone.

What if your baby gets a flat head?

  • Doctors have definitely seen an increase in infants with flat heads since we began emphasizing that parents place them on their backs to sleep. When they sleep in this position, the backs of their heads get pressed against the mattress and can become a bit flat.
  • For most infants, this flattening corrects over time; besides, it is not deadly--SIDS is.
  • We recommend laying the baby on her tummy for some time every day when she's awake. This might only be for a couple of minutes at a time, since many babies hate tummy time, but this position will give the backs of their heads some time off.

While you and your baby might not be sleeping through the entire night yet, if you follow the guidelines above you can at least rest assured that your baby is getting the safest sleep possible.
 
For more information, you can visit the website of the American Academy of Pediatrics.

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