Sept. 5, 2000 -- Cuddle, snuggle, and bond, but put infants in their own beds when it's time to sleep. That advice isn't entirely new -- but it is controversial. And when little lives are at stake, warnings bear repeating.
New research shows that three out of four babies who died of sudden infant death syndrome, or SIDS, were found on a sleep surface not designed for them, such as chairs, hide-a-beds, sofas, or makeshift beds. The findings were reported in the September issue of the journal Pediatrics.
While SIDS is a rare event, nearly 3,000 babies die in their sleep each year from the puzzling phenomenon. The highest occurrence is in infants under four months of age.
Previous studies have suggested that sleeping on the stomach or sleeping on surfaces not designed for infants increases the risk of SIDS. Other studies have also found an increased risk of SIDS when bedsharing or when an infant's face or head gets covered by bedding.
The latest findings show that most sudden unexpected infant deaths involve sleep practices that should not have been used, according to lead author James S. Kemp, MD. "We emphasize that sleeping on a couch or adult bed with a child -- as we do in the U.S. -- should be discouraged because [adult] sleep surfaces are not safe for this purpose," he tells WebMD. Kemp is associate professor of pediatrics at St. Louis University School of Medicine and Cardinal Glennon Children's Hospital in St. Louis.
In their review of 120 infant death cases, Kemp and his colleagues found infants were lying face down in more than half of the cases. Three-quarters of the babies were found on a sleep surface not intended for them, and nearly half of the deaths occurred when the infant shared a sleep surface with one or more bedmates, including parents or siblings. In one-third of the deaths, bedding covered the infant's head or face.
In less than 10% of the death cases reviewed were babies found in the recommended sleeping position, on proper surfaces, with their faces uncovered.
Based on their findings, Kemp and colleagues conclude "that the deaths may not have occurred if certain high-risk sleep practices had been avoided, and that the majority of deaths were preventable."
If there's any good news, it's that the rate of SIDS has dropped drastically in the last 10 years, according to Betty McEntire, PhD, executive director of the American SIDS Institute in Atlanta. The reason, she tells WebMD, is that "one of the big emphases has been in placing babies in a safe sleep environment, and that's a very simple thing."
McEntire stresses that babies be placed face up in their own bed on a firm mattress, with nothing around their face. That means no bumper pad, no toys, and no pillows.
In addition, Kemp says, "Parents should not fall asleep on couches or chairs with their infants, or sleep in the same bed with the infant if they use blankets or pillows. And always put infants on their back to sleep."
Experts agree that intensifying the public health message to parents, guardians, and day care providers about safe sleep is crucial. Still, the issue remains controversial because many parents and organizations encourage bonding in bed with the baby.
"I love the thought of [bedsharing] with a baby," McEntire says. But to safely bond with baby, she suggests that parents "take the baby in the bed to cuddle; then, before you or the baby goes to sleep, place him in a safe bed."
Andrew H. Urbach, MD, believes the "back-to-sleep" message has become increasingly clear over time, despite the controversy. "All [experts] now recommend babies be placed on their backs for sleep," he tells WebMD. "And bedsharing is a behavior I personally discourage and many pediatricians do, too. Still, it's controversial. At one time, sharing a bed is how we lived and how we slept, with our children next to us." But that's definitely a practice to be questioned now, because of the substantial risk of SIDS, says Urbach, professor of pediatrics at the University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh.
"We've got to get the message out to all parents and caregivers," McEntire says. "If 3,000 adults were dying each year and we didn't know why, it would be in the paper every day. We've been successful in having fewer and fewer infants die, but ... this last part of the road to find the cause and prevention of SIDS is going to be toughest," she adds.
For more information, call 1-800-232-SIDS or visit www.SIDS.org.