Copyright 1995 The New York Times Company
The New York Times
March 15, 1995, Wednesday, Late Edition - Final
SECTION: Section C; Page 11; Column 1; National Desk; Health Page
LENGTH: 1129 words
HEADLINE: Personal Health;
Ignoring an easy way to cut risks of crib death.
BYLINE:
By Jane E.
Brody
BODY:
IN a letter published recently in The New York Times, a distressed grandmother
complained that she had been banished from baby-sitting for her 6-week-old
grandson after the parents caught her putting the baby to sleep on his stomach.
"Don't you know about
SIDS?" the equally distressed father hissed, referring to the growing evidence that
babies who sleep face down are at increased risk of sudden infant death
syndrome.
She had, and she knew of the current advice to avoid the prone position for
all but a relative handful of babies. But she replied that she could not get
the baby to settle down on his back and surely both baby and baby-sitter needed
some rest.
She is not alone. Despite strong warnings, millions of American infants are
being put to sleep in positions or on soft bedding now considered potentially
hazardous. As of last June, 45 percent of babies in the United States were
still sleeping on their bellies. Many parents and care givers have not heard
the advice, others choose for various reasons to ignore it and still others are
too poor to replace equipment now considered unsafe for their infants.
Meanwhile, in several countries where a vast majority of babies are now put to
sleep on their backs or sides
instead of their bellies, the rate of SIDS, or crib death as it was long
called, has dropped by 50 percent or more.
The SIDS rate in this country, about 1 in 800 live births, is much lower than
in these other countries, and experts here do not expect as large a drop in
unexplained infant deaths if most American babies are switched from the prone
position. But they insist that this is one of the simplest measures families
and care givers can adopt to reduce crib deaths, which each year claim the
lives of about 6,000 infants in this country.
Why Babies Die
Many factors have been associated with an increased chance that a seemingly
healthy baby might die without any apparent cause. Among them are exposure to
tobacco smoke both before and after birth, lack of prenatal care, premature
birth, a recent
infection and bottle feeding. The presence of any such factors adds to the risk
that a baby sleeping on its stomach will succumb to the syndrome.
Concern about sleeping position, followed by concern about the surfaces babies
sleep on, has been growing over the last two decades, but not until 1992 did
the American Academy of Pediatrics advise parents to avoid putting babies to
sleep on their stomachs. At the time, 75 percent of newborns here were sleeping
face down. Last June, with evidence mounting that prone sleeping was risky, a
coalition of Federal and private child health organizations began a national
education campaign,
"Back to Sleep," to persuade parents to put healthy babies to sleep on their backs or sides.
Dr. Bradley T. Thach, neonatologist at Washington University in St. Louis,
said,
"Throughout history,
most babies throughout the world have been placed on their backs, as was the
case in the United States up until the 1930's." Then, he said, American experts, including Dr. Benjamin Spock, promoted prone
sleeping, believing it would reduce the risk of babies' choking to death or
developing aspiration pneumonia if they vomited while asleep.
But there is no evidence for this, Dr. Thach said, and in Australia and
England, where babies have now been switched to sleeping on their backs, there
has been no increase in any cause of infant death, only a sharp decrease in
crib death.
There is even a suggestion that babies who sleep on their backs are healthier
than belly sleepers. Dr. Marian
Willinger, a leading researcher in the field at the National Institute of Child Health
and Human Development in Bethesda, Md., noted that in the Australian
state of Tasmania, where sleep position has been intensely studied since 1988,
the switch away from belly sleeping has been associated with a decline in
visits to child health clinics, colds and vomiting after feeding.
Complicating the issue of sleep position, however, is the type of material on
which the baby sleeps. The Consumer Products Safety Commission recently warned
against putting babies to sleep on soft bedding, which the commission's studies
indicated could be responsible for as many as 1,800 infant deaths a year.
Although bereaved parents have long been reassured that their babies who died
of SIDS did not suffocate, in fact many apparently do when sleeping face down.
Dr. James Kemp, a pediatric pulmonologist at Washington University, has studied
how various kinds of bedding materials might smother healthy infants. He has
shown that soft bedding, like sheepskins, natural-fiber mattresses and quilts, placed under a baby sleeping on its belly can trap
exhaled air and cause the baby to rebreathe it, resulting in a gradual rise in
carbon dioxide in the baby's blood.
For various reasons, including defects in the arousal mechanism or damage to
the part of the brain that detects rises in carbon dioxide, some babies may
fail to wake up in time to take lifesaving breaths that are richer in oxygen,
Dr.
Willinger explained.
Very young infants lying face down on a soft surface may be unable to raise or
turn their heads enough to breathe fresh air. Dr. Kemp said that 20 percent to
50 percent of SIDS babies die with their noses and mouths sunk into soft
bedding. And a new study of 200 SIDS
infants in California revealed that while 66 percent usually slept on their
stomachs, 80 percent of the victims were found lying face down.
What Is Safe?
Although the jury is still out on the role that prone sleeping may play in
SIDS deaths here, there appears to be little reason not to abandon it for most
babies. But there are important exceptions. The pediatrics academy says that
premature infants with respiratory tract disease, those with reflux of food
between the stomach and esophagus and infants with certain malformations of the
upper airway should sleep on their stomachs.
Dr. Kemp said the safest sleeping surface for infants was a firm mattress
covered by a tight-fitting sheet. A receiving blanket or quilt could be placed
on top of the baby, but nothing should be placed underneath, he advised, nor
should there be pillows or soft toys in the baby's
bed.
When a baby is put to sleep away from home, an infant seat or portable crib is
preferable to a quilt or rug. Also, babies should not sleep in bed with an
adult or older child. Some studies have found a large increase in the risk of
the syndrome among babies who sleep in their parents' bed, especially if one or
both parents smoke.
The peak age for SIDS is from 2 to 4 months. After about five months, it may
make no difference how babies are put to sleep, since many then learn to flip
over on their own, Dr.
Willinger observed.
GRAPHIC: Chart:
"For More Help"
The national
"Back to Sleep" information campaign has established a toll-free number, (800) 505-CRIB, or
505-2742, for those seeking more information on sleeping positions for infants
or free brochures developed for the campaign.
Several devices are now on the market to help keep infants sleeping on their
sides, and parents who have used them for newborns report that they work. The
products include Baby Sleep-EZ by Basic Comfort, Inc. of Denver and Prop-A-Bye
Baby by DEX Products of Danville, Calif.
However, an unpublished study from New Zealand suggested that sleeping on the
side is not as safe as sleeping on the back, and Dr. Kemp noted that the
devices are made of foam, a soft material that he would rather not see in a
baby's bed.
So far the pediatrics academy has not come out for or against their use, since
their effectiveness in preventing SIDS has not been scientifically studied.
Drawing.
LANGUAGE: ENGLISH
LOAD-DATE: March 15, 1995
