Bed-Sharing, Smoking Play Role in Sudden Infant Death

MONDAY, March 26 (HealthDay News) — Although the rate of Sudden
Infant Death Syndrome (SIDS) dropped by more than 50 percent following the
start of a U.S. campaign encouraging parents to put babies to sleep on
their backs, new research suggests that risk factors other than “tummy
sleeping” may explain why SIDS rates have not declined further.

Chief among those other risk factors are bed-sharing (where the baby
shares a sleeping surface with a parent or parents), smoking exposure
before and after birth, and having objects in the crib, the study
revealed.

“It’s not that there are new risk factors; it’s that now not all babies
are sleeping on their tummies, so other things can be uncovered,”
explained study co-author Felicia Trachtenberg, a senior research
scientist at New England Research Institutes, in Watertown, Mass.

The findings, culled from an analysis of 568 SIDS deaths that occurred
in San Diego between 1991 and 2008, appear online March 26 and in the
April print issue of Pediatrics.

Tummy sleeping is still the leading risk factor for SIDS, according to
study co-author Dr. Henry Krous, director of the San Diego SIDS/Sudden
Unexplained Death in Childhood Research Project at Rady Children’s
Hospital.

Nevertheless, the Back-to-Sleep program, started in 1994, has made a
huge difference.

“It has been the most successful program that one could imagine,” Krous
said. “The incidence rates from SIDS have dropped dramatically in the
United States, and similar public educational campaigns in Western Europe
and Australia and New Zealand have had similar dramatic declines.”

The study found that the percentage of infants who died of SIDS who
were found on their stomachs decreased from about 84 percent to 30
percent.

Certain environmental or genetic factors — including being black,
male, premature or exposed to alcohol or smoking in the uterus — also
made a baby more susceptible.

“Exposure to cigarette smoke, either when the baby is in utero or after
the baby has been born, is a very important risk factor for SIDS,” Krous
said.

Physical risks around the time of death included having the head
covered; sleeping on an adult mattress, couch or playpen; soft bedding;
bed sharing, and having cold symptoms.

Bed-sharing increased from 19 percent to almost 38 percent during the
study period.

Dr. Carl Hunt, a research professor of pediatrics at the Uniformed
Services University of the Health Sciences in Bethesda, Md., commented on
the findings.

“The most striking thing is that SIDS mortality rates have fallen
considerably over this period of time, and the prevalence of prone
sleeping has decreased significantly,” Hunt said.

He noted that bed-sharing increased the most with infants younger than
2 months of age. The issue of bed-sharing has been very controversial,
because of “concern that [an] across-the-board ban on bed-sharing could
impede or impair the chances of successful breast-feeding.”

And, he added, “with women who breast-feed, it’s associated with a
lower incidence of SIDS. It doesn’t mean that it’s causal, but there is a
strong association.”

The study noted that even if all babies were placed to sleep on their
backs from now on, SIDS would not be eliminated.

Overall, prevention efforts should shift in a new direction, the
researchers concluded.

“The most important finding of our study is to not focus on a single
risk factor to be avoided, but rather the avoidance of multiple risk
factors simultaneously,” Krous said.

“Babies should not be bed-sharing while they are on their stomach and
after they have been exposed or while they’re being exposed to cigarette
smoke,” Krous said. “They shouldn’t be placed in environments that are
excessively warm. They shouldn’t have their heads covered by a blanket.
They should not be put on a soft sleeping surface.”

And, Trachtenberg added, “babies should sleep on their backs alone in
the cribs, with nothing else in them: no blankets, pillows, bumpers,
stuffed animals.”

She advised using blanket sleepers or swaddlers to keep babies
warm.

“Even if you can’t achieve a perfect sleep environment for your baby,
getting rid of some of the risk factors goes a long way,” Trachtenberg
said.

Pacifiers might help, Hunt added. “The data would suggest that infants
that are provided a pacifier on a consistent basis have a lower risk of
SIDS.”

The experts agreed that despite gains, continuing awareness efforts are
needed to reduce SIDS rates even further.

“There are still a lot of families that are not aware of what
constitutes safe sleeping practices,” Hunt said. “These data would
reinforce that’s still an issue, and it’s still a public health problem,
that we need to do a better job of education.”

More information

The American Academy of Pediatrics offers a parent’s guide to safe sleep.

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