March 16, 2009
By Claire McCarthy, M.D.
Boston Children's Hospital
It's a funeral I will never forget: A tiny white casket at the front of the church holds a beautiful baby boy I had seen for his 2-month check-up just days before. He had been perfect and healthy and full of smiles that day, the joy of his family. Then he died of Sudden Infant Death Syndrome or SIDS.
Every year about 2,000 babies in the United States die of SIDS. It is the leading cause of death for infants 1 to 12 months old. (The highest risk is for babies 2 to 4 months old.) Twice as many infants died before the Back to Sleep campaign began in 1992 and advised parents and caregivers to put babies on their backs to sleep. But this is still far too many lost lives and devastated families.
We don't know exactly what causes SIDS. In fact, SIDS is defined as the sudden death of an infant that can't be explained after it's been investigated. Maybe there are many different causes. It appears, though, that some babies don't react to having their mouths and noses covered by moving their heads so that they can breathe better. The brain doesn't send the message that it should, and the baby suffocates.
It's difficult to prevent something when you don't know exactly what causes it. But research has shown that parents can help lower their children's risk of SIDS. Here are some suggestions from the American Academy of Pediatrics:
- Always put your baby to sleep on his back. Until recently, it was thought that putting the baby on his side was okay, but the recommendation has changed to the back only. That's because babies can flip easily from their side to their belly when they start to become mobile. Some babies take a while to get used to sleeping this way (they startle themselves awake), but parents shouldn't give up. With practice, babies will learn.
- Make sure your baby has a safe place to sleep, such as a safety-approved crib or bassinet with a firm mattress and fitted sheet; no waterbeds, featherbeds or sheepskins!
- Babies should have their own space to sleep in rather than your bed. Having your baby within arm's reach may make nighttime breastfeeding easier, and helps you watch over her. But sleeping in your bed is not safe.
- Keep the sleeping space simple. Don't use fluffy quilts, crib bumpers or stuffed animals. They can cause suffocation. If you use a blanket, it should be firmly tucked in and shouldn't go above the baby's chest.
- Cooler is better. Resist the temptation to bundle up your baby. Overheating can increase the risk of SIDS. Use lightweight pajamas. Keep the room temperature comfortable, not warm.
- Ban the cigarettes. Don't smoke during your pregnancy, and don't let anyone in your house smoke. Both can increase your baby's risk of SIDS.
- Breastfeed! Not only is breastfeeding excellent for your baby's overall health (and Mom's, too), but a recent study showed that the risk of SIDS went down by 50% for babies who breastfed for as little as a month.
- Consider using a pacifier. Studies show that sucking on a pacifier may lower the risk of SIDS for some babies. It may keep them slightly more awake, or keep their breathing passages a bit more open. We don't know for sure. Some people feel that pacifiers can interfere with breastfeeding. So, the American Academy of Pediatrics recommends that breastfed babies shouldn't be given a pacifier for the first month of life. This will give breastfeeding a chance to get well-established.
- Make sure everyone who cares for your baby knows how to prevent SIDS! About 20% of SIDS deaths happen when babies are with caregivers other than their parents. Your baby should be put down on his back in a safe sleeping situation all the time, not just when he's with you!
Although babies should always be put to sleep on their backs, that doesn't mean they should never be on their bellies. Make sure your baby has "tummy time" every day to help strengthen the muscles in her shoulders and neck, and prevent flattening of the back of the head. (If not, don't despair. Once babies are a little bigger and learn to sit up, the head flattening gets better.)
The faces of those parents as they followed that white casket out of the church will stay with me for the rest of my life. If more parents follow the recommendations, we can hopefully save some lives while researchers figure out what causes SIDS and how to prevent all SIDS-related deaths.
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Claire McCarthy, M.D. is an assistant professor in pediatrics at Harvard Medical School, an attending physician at Children's Hospital of Boston, and medical director of the Martha Eliot Health Center, a neighborhood health service of Children's Hospital. She is a senior medical editor for Harvard Health Publications.