Education may reduce SIDS risk

"Sudden Infant Death (SIDS) is responsible for more infant deaths in the U.S. than any other cause of death during infancy beyond the neonatal period."

So states an American Academy of Pediatrics Task Force Report.

They published their first policy statement regarding SIDS in 2000 and updated it in 2005.

The AAP tells us there has been a major decrease in the incidence of sudden infant death syndrome, but more education is needed to bring the death rate down further.

It is hoped by this article to give everyone the latest information about what we can do to prevent SIDS.

When an infant dies, it affects the whole community. Parents and relatives are devastated.

The nine months of waiting and preparation to welcome this new life seem empty and useless. The hopes for this new generation are dashed.

The grief can be overwhelming as can be the guilt.

What did we do wrong? Could we have prevented this? How do we go on?

Besides the parents and relatives, the Emergency Workers who are the first responders, feel frustrated that they were not able to revive what looks to be a healthy infant.

The police have to be called and will need to start an investigation.

In addition, an autopsy will be necessary as the hospital doctor who examines the infant can see no obvious reason for the death.

Also, according to State Law, an investigation into any sudden, unexpected, or unexplained death of a child must be conducted by the Department of Family and Children and the Child Fatality Review Team. Everyone involved comes to a renewed commitment to prevent this from happening.

What do we know about Sudden Infant Death Syndrome? How can we reduce the incidence in the future? We all want to raise infants to be happy, healthy, lively children.

Recommendations from the American Academy of Pediatrics:

*Since 1992, "Back to Sleep" has been the instruction given to new parents. This is credited with the steep decrease in SIDS. Many of us learned through a national campaign some new information in 1994 : DO NOT PUT INFANTS TO SLEEP ON THEIR TUMMIES.

This was re-emphasized in the 2005 report. Placing infants on their backs lowers the risk of SIDS and is the preferred sleep position for a new infant.

Side sleep position was declared unstable as the baby can roll over too easily. So the AAP no longer recognizes side sleeping as an acceptable alternative to BACK TO SLEEP!

* Use a firm sleep surface: a firm crib mattress with a sheet is the best. DO NOT USE SOFT MATERIALS OR OBJECTS LIKE PILLOWS, QUILTS, OR COMFORTERS TO PLACE UNDER THE BABY. Risk for SIDS increases in the winter because of these materials.

* As a matter of fact, KEEP SOFT OBJECTS LIKE STUFFED ANIMALS AND LOOSE BEDDING OUT OF THE INFANT'S BED.

If a bumper is used, it should be thin, firm, not pillow like, and securely tied.

If a blanket is used, it should be tucked in around the crib mattress at the bottom and sides and come no higher than the baby's chest.

Better to use sleep clothing or an infant sleep sack that keeps the baby warm without the hazard of head covering.

*DO NOT SMOKE DURING PREGNANCY.

In almost every study of SIDS, this is a major risk factor.

Further in the 2005 report we are instructed to AVOID AN INFANT'S EXPOSURE TO SECOND HAND SMOKE (parents and others smoking in the infant's presence).

"Smoking in the infant's environment after birth has emerged as a separate risk factor in some studies." Other new factors in 2005 include late or no prenatal care, young maternal age, and premature birth with low birth weight.

Parents with these factors need to be especially vigilant.

* A SEPARATE BUT CLOSE-BY SLEEPING ENVIRONMENT is recommended. The incidence of SIDS is reduced when the infant sleeps in the same room as the mother, but BED SHARING IS NOT RECOMMENDED.

"Close by" enables the mother to more easily breast feed, and comfort, but infants should BE RETURNED TO THEIR OWN BED/CRIB WHEN THE PARENT IS READY TO FALL ASLEEP.

Infants should not bed-share with other children either.

6) PACIFIERS SEEM TO HAVE A PROTECTIVE EFFECT ON THE INCIDENCE OF SIDS.

Offer the pacifier at nap time and bedtime.

The evidence of reduced risk of SIDS with a pacifier is compelling, and it has not been shown to interfere with breast feeding or to cause dental problems if used only during the first year of life.

Pacifiers should be cleaned often, and replaced regularly.

Firmly establish breast feeding for about one month before offering the pacifier and don't insist if the infant refuses it.

*AVOID OVERHEATING.

Overbundling should be avoided. Lightly clothe the infant for sleep and keep the bedroom temperature comfortable for a lightly clothed adult.

The infant should not feel hot to your touch.

*Commercial devices have NOT been shown to be helpful in preventing SIDS, nor are they efficient or safe.

Only use medical electronic or cardiorespiratory monitors if you have been so instructed by your doctor in cases where your child has cardiorespiratory instability.

Home monitors (non medical) can help you know when your infant is awake, needs company, or otherwise wants to be held. The AAP has recommended that these home monitors NOT be used as a strategy to prevent SIDS.

*"TUMMY TIME" can be used when the infant is AWAKE AND BEING OBSERVED.

This will help with motor skill development. CHILD CARE GIVERS MUST BE INSTRUCTED about this as SIDS deaths occurring in child care have remained constant.

Twenty to 28 percent of child care centers continue to place infants on their stomachs being unaware of "BACK TO SLEEP" and/or misinformed about risks of various sleep positions. Inform grandparents and babysitters.

*UPRIGHT "CUDDLE TIME" IS IMPORTANT.

Avoid excessively using bouncers, pumpkin chairs, and car seat carriers.

To avoid the "flat back of head," vary the head position when placing the infant on his/her back, For one week turn the infant's head to the right and then change to the other side for a week.

Reverse the baby's position in the crib (head of the baby to foot of the bed occasionally) so if he/she watches the door for a response, the head will receive equal time on either side.

Let's hope these recommendations help prevent the tragedy of SIDS in our community!

Ann Kelly Watson is a retired school social worker who has lived in Greencastle for more than 50 years. She currently serves on the Putnam County Hospital's Tobacco Cessation Committee and the Putnam County Family Support Services' Domestic Violence Prevention Committee. She is a member of the Child Protection Team for the State of Indiana, and is also active with the local chapters of the NAACP and League of Women Voters.