Safe Sleep Environments for Infants

Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected Infant Death (SUID) are two tragic situations for families that have only been a focus in the medical field for about 25 years.  I chose this topic because it has been a current topic discussion in the consultation work that I do.  These conversations have come to life in my own professional journey this past year due to the recent recommendations from the American Academy of Pediatrics concerning infant sleep environments (Task Force on Sudden Infant Death Syndrome, 2011).

High quality child care programs in Pennsylvania that serve infants now have strict guidelines that include recommendations to not have soft bedding in cribs and to not allow children to sleep in car seats or any other surface that is not flat.  Most providers have been placing infants on their backs to sleep for a very long time.  The additional recommendations are a bit of a cultural change, since many providers look at me, puzzled, and say things like “but the baby will be cold,” or “babies need to be swaddled,” or “parents aren’t going to go for that!”  Even when examining the recommendations from the American Academy of Pediatrics (Task Force on Sudden Infant Death Syndrome, 2011) which is based on solid data, some people are hard to convince.

When I reflect on my own daughters’ infancy, I was not aware as a parent of the research on SIDS and recommendations to prevent it.  In all honesty, we had our girls sleeping on their bellies with bumper pads, infant quilts and stuffed animals in the crib with them.  We didn’t receive any recommendations from our pediatrician to tell us otherwise.  I am so grateful that they turned out to be healthy and thriving children!  In some ways I feel guilty, considering the research that is available to us now.  My approach as a grandparent (someday…) will be much different!

In researching the SIDS data in other countries, much data concludes that the SIDS rates have decreased in the past 20 years (Hauck and Tanabe, 2008).  The research conducted in this article was collected from mostly developed nations with the purpose to examine the rates of SIDS or SUIDS related deaths in comparison from roughly 1980 to 2005 (Hauck and Tanabe, 2008).  The rate of SIDS related deaths decreased in all countries for which data was collected during that time period, mainly due to the “Back to Sleep” Campaign, which started in the United States in 1994.  The “Back to Sleep” Campaign recommends infants up to one year of age placed on flat surfaces on their backs. (Task Force on Sudden Infant Death Syndrome, 2011).

Hauch and Tanabe (2008) also discovered discrepancies and possible factors that might not have given a true picture of the statistics.  They discovered that the collection of data regarding SIDS might have been based on varying definitions and criteria of SIDS of SUID.  They also suggested that based on the culture of the country, the investigations immediately after the infant death might have different protocols.  They suggested that some of the SIDS or SUID related deaths might have been caused by other risk factors.  “In addition to infant sleep positioning, other well-established risk factors should receive attention such as maternal smoking in pregnancy, infant overheating, and soft bedding” (Hauch and Tanabe, 2008).  This research also noted that in developing countries, “resources are severely limited, autopsies and scene investigations are not routinely performed, and other causes of infant mortality, such as infectious diseases, predominate” (Hauch and Tanabe, 2008).

The Task Force on Sudden Infant Death Syndrome (2011) gives strong recommendations, based on many years of research, for families and caregivers of infants regarding safe sleep environments for infants.  I have not shared this actual report with the providers that I work with, I have only discussed it.  I plan on offering to share this technical report with those providers who question the shift from what practices they did in the past to what current research says what’s best for children.  This technical report provides information about many factors that affect the entire infant sleeping environment, not just sleeping on bellies versus sleeping on backs (Task Force on Sudden Infant Death Syndrome, 2011).  My hope is that these recommendations are shared with countries across the globe to serve the best interests of ALL infants and families.

References:

Hauck, F. and Tanabe, K.O. (2008). International Trends in Sudden Infant Death Syndrome: Stabilization of Rates Requires Further Action.  Pediatrics. 122 (3), 660 -666.

Task Force on Sudden Infant Death Syndrome (2011).  Technical Report SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment.  Pediatrics.  128 (5), e1341-e1367.