March 21, 2001
it comes to safe sleeping, back is best
I watched my baby nephew breathing softly in his sleep, I thought,
"Thank goodness he's past that hurdle." As a doctor I recognized
that, at age 12 months, Brian had survived the critical first year
of life, when most cases of sudden infant death syndrome (SIDS)
occur. I breathed a sigh of relief.
Ounce of Prevention
Elizabeth Smoots, M.D.
Our good fortune probably has something to do with how Brian's
parents have been putting him to sleep. Every night and naptime
when they tuck him in, he's lying on his back. I wish more parents
did the same.
But a recent survey conducted by the U.S. Consumer Product Safety
Commission (CPSC) says the majority do not. According to the survey,
only 43 percent of American parents put babies to sleep on their
back, as recommended by health and safety officials to reduce the
risk of SIDS. The survey also indicates that, in general, too many
parents still follow unsafe infant sleep practices, further increasing
SIDS risk. Out of a total of almost 500 families polled, 51 percent
of parents said they placed babies to sleep on their stomachs or
sides, and 67 percent said they regularly used soft bedding in cribs.
Among African American parents, the numbers are even more alarming
-- only 31 percent put babies to sleep on their back, and 85 percent
use soft bedding in their baby's crib. This may help explain why,
according to the American Lung Association, African American babies
are more than twice as likely to die from SIDS.
We know tragic deaths from SIDS are largely preventable. But as
the survey points out, much work remains to be done.
Solving the mystery of SIDS
So far we're making progress. In the spring of 1992, based on scientific
evidence available at the time, the American Academy of Pediatrics
(AAP) first began recommending that healthy infants sleep on their
back to reduce the risk of SIDS. Then, in June 1994, the AAP and
U.S. Public Health Department launched a national "Back to Sleep"
campaign aimed at spreading this sound advice. The rate of SIDS
deaths in the United States has since dropped by a dramatic 40 percent.
Some parents fear babies will choke if they sleep on their
back, but evidence has not borne this out. Studies show
the highest risk of SIDS is associated with stomach sleeping.
We still have a ways to go, however. In countries where stomach
sleeping has been reduced to no more than 5 to 10 percent, reductions
in the SIDS rate have approached 70 to 80 percent.
Expert still can't explain exactly why an infant's sleeping position
might affect the risk of SIDS. Many theories focus on breathing
problems. Studies suggest that stomach sleeping may increase SIDS
risk by forcing babies to rebreathe their own expired air -- leading
to carbon dioxide build-up and low oxygen levels. This is especially
likely to happen if soft bedding becomes molded around a baby's
head while the baby is lying face down. Belly sleeping also interferes
with a baby's ability to dissipate body heat; this may contribute
to overheating, which could inhibit the baby's ability to awaken
if he or she had trouble breathing.
From a SIDS risk-reduction point of view, I usually counsel parents
that "back is best." Some parents fear babies will choke if they
sleep on their back, but evidence has not borne this out. Studies
show the highest risk of SIDS is associated with stomach sleeping.
The side-lying position hangs in the balance because babies have
a tendency to roll toward their tummy.
This advice holds for healthy infants, like my nephew Brian. Be
sure to consult your health care provider if your baby has a medical
condition. Then safely put a babe under age 12 months to sleep with
the following recommendations from AAP and CPSC:
your infant in a crib that meets current safety standards and
has a firm, tight-fitting mattress and snug-fitting bottom sheet
specifically made for crib use.
all pillows, quilts, comforters, fluffy bumper pads, sheepskins,
stuffed toys, and other soft products from the crib.
using a sleeper, with no other covering, as an alternative to
using a blanket, put your baby with his or her feet at the foot
of the crib. Tuck a thin blanket around the crib mattress, only
as high as the baby's chest.
sure your baby's head remains uncovered during sleep.
not place your baby on a waterbed, sofa, soft mattress, pillow,
or other soft surface to slumber.
Now you can sleep soundly, knowing you've helped ensure a safe
slumber for your baby.
Send feedback on this article.
Smoots, M.D., F.A.A.F.P., is a board-certified family physician in
Seattle, Washington. A fellow of the American Academy of Family Physicians,
Dr. Smoots specializes in prevention and primary care medicine.