Jan. 16, 2004 -- By now most parents know to put their infants to sleep on their backs to prevent sudden infant death syndrome (SIDS). The advice is credited with cutting infant sleep deaths in half in the U.S., but new research suggests that taking other steps could prevent even more infant deaths.
The European analysis found that inappropriate bedding, sleeping in the same bed with the baby, and maternal smoking were all independent risk factors for SIDS.
Most SIDS Cases Preventable
London School of Hygiene and Tropical Medicine epidemiologist Robert G. Carpenter, PhD, who led the research team, tells WebMD he believes up to 90% of SIDS deaths could be avoided by taking appropriate precautions.
Carpenter and colleagues compared 745 SIDS cases with more than 2,400 live babies for comparison and concluded that just under half of all deaths were attributable to infants sleeping on their stomachs or sides.
For unknown reasons, bed sharing was particularly risky when the mother smoked. Roughly 16% of SIDS deaths were linked to bed sharing, but the risk was confined to the first few months of life and was very small when mothers did not smoke during pregnancy.
According to Carpenter, maternal smoking alone was associated with a doubling in SIDS risk. The risk was 17 times greater, however, for babies who bed shared and had mothers who smoked. The findings are reported in the Jan. 17 issue of The Lancet.
"The safest thing to do is to put the baby to bed on his back with no bedcovers in the same room with parents who don't smoke," Carpenter says.
University of Virginia Pediatrics Professor John Kattwinkel, MD, agrees. Kattwinkel, who leads the American Academy of Pediatrics task force on SIDS, says it has become clear in the last decade that infant sleep deaths are largely preventable.
In its latest policy statement, released in 2000, the AAP task force recommended that babies be put to sleep only on their backs -- never on their stomachs or sides. Other recommendations include:
- Infants should not sleep on waterbeds, sofas, soft mattresses, or other soft surfaces. Likewise, soft materials like pillows and quilts should not be placed under an infant.
- Pillows, stuffed toys, or loose bedding should be kept out of an infant's bed because they can obstruct the infant's airways.
- Babies need a certain amount of supervised "tummy time" during the day to lower the risk of developing flat spots on their head.
The group did not take a stand on infants sleeping in the same beds with their parents. But Kattwinkel says the task force will probably revisit the issue soon because of the growing evidence linking it to infant deaths.
"The family bed is a very controversial and emotional issue," he tells WebMD. "Advocates are very firm in their belief that it promotes breastfeeding and has other positive benefits."
One in 5 SIDS Cases Occurs in Day Care
Although it is not clear why, Kattwinkel says smoking is emerging as an important risk factor for SIDS. Other than putting babies to sleep on their backs and keeping loose bedding out of the crib, he says stopping smoking is probably the most important intervention for preventing infant sleep deaths.
It is also very important to make sure day-care providers and other caregivers are educated about SIDS risks. Research has shown that back-sleeping infants who occasionally sleep on their stomachs have a much greater SIDS risk than other babies -- roughly 20 times that of babies who always sleep on their backs and 15 times that of babies who sleep only on their stomachs.
This may explain why as many as 20% of SIDS cases occur in day-care settings. A recent study showed that fewer than half of day-care providers questioned knew to put babies to sleep on their backs.
"A mother can know the risks and follow all the rules, but it may not mean anything if the day-care worker, grandparent or other caregiver isn't educated about this," Kattwinkel says.