Four-month-old Reneja never woke up from her sleep. Her 24-year-old mother found her wedged between the wall and the soft mattress of the bed they shared in their Milwaukee home.
Each year, over 6,000 American parents go to greet their baby in the morning only to find them blue and lifeless. These infants die either from Sudden Infant Death Syndrome (SIDS) or from the increasingly common problem that befell Reneja, accidental suffocation. In sheer numbers, that's equivalent to a 9/11 tragedy every year for our youngest citizens.
In 1992, doctors discovered a key cause of SIDS: stomach sleeping. Shortly thereafter, public health groups (like the American Academy of Pediatrics, AAP) launched the Back to Sleep campaign. Back to Sleep reminds parents that the only safe sleeping position for babies is on the back. Over the past 20 years, we've also learned that parents can lower their baby's SIDS risk by avoiding smoking (during pregnancy or in the home after the baby is born), overheating and removing bulky, soft bedding from the baby's bed.
Today, these life saving recommendations are taught in hospitals, clinics and doctors' offices across the nation. And, we have cut SIDS deaths by over 50%. It's an enormous success and cause for celebration, but our work is far from done. For more than a decade, SIDS rates have stubbornly refused to drop. And, the U.S. Center for Disease Control has reported that, for the past 15 years, infant suffocation deaths, like Reneja's, have risen an alarming 14% per year.
A much stronger effort is needed to save the 3,000 infants who will die from sleep-related causes in 2012. This month, the AAP took a step in that direction by issuing a new set of guidelines to prevent these deaths. The recommendations, include:
• Back sleeping... only
• Room-sharing... but no bed-sharing
• Encouraging breastfeeding
• Routine immunizations
• Avoiding soft, saggy sleep surfaces (waterbeds, comforters, sofas, etc)
• Pacifier use when falling asleep
This is important advice. But, it overlooks one of the leading causes of unsafe sleep: infant irritability.
Many babies hate sleeping on the back. Exhausted parents often spend hours trying to ease these criers back to sleep. Frustrated, some simply give up and lay their babies down on the stomach (tummy-down babies tend to fuss less and sleep more). Or, overcome with fatigue, they accidentally fall asleep -- their baby nestled against their bodies -- on an unsafe surface, like their bed, a recliner or couch. Either way, too many parents are tempted into a situation where the risk of SIDS and suffocation death increases significantly.
A key solution for reducing fussing -- and thus promoting safe sleep -- is swaddling. When done correctly safe swaddling offers the potential to:
• Reduce the lure of placing babies on the stomach. (Swaddled babies sleep just as well on the back as unwrapped babies sleep on the stomach.)
• Reduce the chance of falling asleep with the baby on a dangerous surface. (Exhaustion causes similar brain numbness as being drunk. No wonder tired parents can put an arm over their baby's face without even realizing it.)
• Reduce the chance of rolling into a dangerous position (into a pillow, against a wall or onto the stomach).
• Increase breastfeeding success. (Breastfeeding cuts SIDS risk in half, but infant crying is one of the main reasons moms give up on the breast.)
• Reduce maternal cigarette smoking. (Smoking is a common trigger for SIDS and it is often related to the stress of exhaustion and infant irritability.)
And, the potential benefits of swaddling don't stop there. When combined with other calming techniques (like white noise, swinging motion and sucking) snug wrapping may reduce other serious problems triggered by infant crying/parental exhaustion, such as shaken baby syndrome, postpartum depression, breastfeeding failure, car accidents and maternal obesity. These problems place large emotional burdens on young families and significant economic burdens on communities. They result in lost productivity (due to worker exhaustion and absenteeism) and add well over $1 billion per year to health care costs.
Many children's health groups, such as the American Academy of Pediatrics and the Canadian Pediatric Society, recommend swaddling. But, like infant car seat use, we must teach correct swaddling so that it is done safely and effectively. The keys to safe swaddling are:
• Avoiding overheating
• Using the correct technique (to avoid unraveled blankets)
• Protecting the hips (allowing them to be flexed and open)
• Waking for regular feedings
• Never allowing stomach sleeping
In 2004, a national campaign was started to train hospitals to teach parents safe swaddling (along with the other calming /sleep promoting techniques used in the Happiest Baby on the Block approach). This approach offers a single, scalable, affordable, effective intervention that may reduce infant sleep deaths and simultaneously strengthen parental competence and confidence.
More than 2,600 certified Happiest Baby educators from Alaska to Alabama work with new parents, including over 1,000 educators who teach these classes to the most at-risk mothers and fathers (teens, abusers, drug users, incarcerated, impoverished, etc.) for the departments of health in Massachusetts, Pennsylvania, Minnesota, and Wyoming.
Baby Reneja's tragedy -- and many other infant sleep deaths -- can be avoided. This year, let us summon our national will and commit ourselves to saving at least 1000 more of our babies from SIDS and suffocation, starting today!
http://www.healthychild.com/toxic-sleep/has-the-cause-of-crib-death-sids-been-found/
Brominated flame retardants in so many infant products, including bedding, may be working with a common household fungus to disrupt normal breathing in infants, quietly and fatally gasing them as they sleep.
i know that in most countries the problem with the research is that when a baby dies and it's put down as unknown cause and no link with a vaccine is made then it won't appear in a vaccine injury statistic.
that seems to happen a lot regarding all sorts of negative events following vaccination.
both my children were not vaccinated before they were 1 year old.
...but that's just a guess.
However, not all recommendations work for all children. My daughter absolutely refused to sleep on her back. As soon as we laid her down, she'd wake up angry. Swaddling didn't work. She would start screaming the moment you wrapped her up. That started when the nurses at the hospital were demonstrating swaddling, too. Also, she needed to be wrapped in a biliblanket 24 hours a day for the first 3 weeks, and the cord for the blanket would have been in the way of the swaddling. She knew the swing would put her to sleep, so she cried if we put her in it if she was even slightly sleepy. I tried every technique I could find, everything my pedi recommended, and no matter what, if put on her back we got a max of an hour before she was up.
So, we switched to laying her on her belly. Result? She started sleeping 3-4 hours at a time, which gradually increased. She slept in a bassinet near my bed, and once I got over the fear that someone was going to find out and call CPS on us, we all slept much better. No more exhausted mommy and daddy. More quality time, as we weren't fighting the sleep battle constantly. Rested baby, which meant that meals and tummy time went better. At 2 1/2 years, she still sleeps on her stomach exclusively.
Well put...thanks for your contributions to the discussion. Intuition is important, but to move forward safely in our lives - even in our raising of children - we give great thanks to the light shed by science.
Dr. Karp
While co-sleeping (having the baby sleep in a bassinet right next to the parent's bed) has been shown to reduce SIDS/suffocation risk, sharing the bed is a much more murky issue. Most studies show it increases sleep deaths in babies under 3-4 months. Having said that, there are many things one can do to reduce the risk, but why take the risk when you can have the baby right next to you in a safe location?
Studies have also shown that side sleeping babies have a higher risk of SIDS than back sleepers..probably because it is easier for a side-sleeper to roll onto the stomach.
Not discrediting this study, but my daughter was laying on her back and began chocking on spit up. that was a very scary moment for me and since then i put her to sleep on her side. i think moms should just follow their instincts. SIDS is a factor of life. i would imagine if you dig deep enough you would find that there have been babies dying of SIDS in each and every position.
I realize that bed sharing isn't for everyone. And certainly swaddling is a good option for those who choose not to bed share. But if we really want to prevent unfortunate stories like the one at the start of your article, we will also educate parents on how to safely share sleep spaces so that we don't have exhausted parents falling asleep in unsafe places with their babies.
As for your comment about exhausted parents being about like intoxicated ones - I'd agree. But guess what? Because I bed shared, I was never exhausted, never sleep deprived. And my children woke numerous times a night to nurse (or rather they rustled since they drifted quickly back to sleep without fully waking since I was right beside them).
I would love to see some peer reviewed research on the claim that swaddling increases breastfeeding success (or that crying is a cause for breastfeeding failure for that matter!). I could write pages on why women aren't successful breastfeeding - and it has nothing to do with swaddling! Bed sharing (or co-sleeping for that matter) has been shown to improve breastfeeding success.
Finally, I'd be interested to hear your opinion on what constitutes "normal" infant sleep. It seems to me that we focus an awful lot on the mythical "sleeping through the night" milestone. And yet, human babies are biologically hardwired to wake at night. Could our reliance on "gimmicks" designed to increase infant sleep times (and thus promoting longer periods of deep sleep which some believe to be linked to SIDS) be a part of our SIDS problem?
Essentially, it's up to the parent(s) in question to make the best choices they can for their babies. Thanks for the informative article. Knowledge is power.
Thanks for your thoughtful response. I agree, our goal is not to lay blame on parents who have gone through this type of tragedy, it is to prevent the tragedy from occurring as best we can.
We don't yet know the cause/s of SIDS. Infants die can certainly of SIDS while sleeping on the back...on a flat, crib mattress...with no pillows or blankets around. But, 15 years of data show that risk factors like stomach sleeping, rolling to the stomach for the first time, smoking, bedsharing, couch/waterbed/recliner sleeping, parent drug/alcohol use, marked obesity, others sharing the bed, overheating, formula feeding, prematurity, etc. are not just unrelated associations. Multiple well-executed studies show these factors associated with SIDS/suffocation and that the elimination of these factors results in less SIDS/suffocation.
A couple of studies have not found increased SIDS risk with bedsharing (as long as other dangers, like smoking are absent). But, given that: 1) the strongest evidence shows bedsharing poses a significant a risk, 2) parents have safe/convenient alternatives, 3) the consequence while rare (in the approximate range of 1 in 400-2000) are extreme...It seems that doctors and parents would want to avoid the risks until clear proof of bedsharing's safety is shown.