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Researchers Gain New Insights Into SIDS

FRIDAY March 7, 2008 -- While new research suggests that putting a baby to sleep with a pacifier may reduce the risk of sudden infant death syndrome, putting your baby to sleep on his or her back and not exposing the baby to smoke before or after birth are the two most important steps parents can take to reduce the risk of SIDS, according to child care experts.

"We can't guarantee that we can prevent SIDS deaths, but we can reduce the risk as best as possible," explained Dr. Fern Hauck, an associate professor of family medicine and public health sciences at the University of Virginia Health System.

About 2,250 American babies still succumb to SIDS each year, according to the U.S. Centers for Disease Control and Prevention. That number is half of what it was in 1990, before the U.S. government began the "Back to Sleep" campaign that encouraged parents to put their babies to sleep on their backs instead of their stomachs, according to the CDC.

The exact cause of SIDS remains unknown, although Dr. Bobby Batra, a pediatrician with the Detroit Medical Group, pointed out, "We do know that SIDS isn't caused by immunizations, and it's not caused by vomiting or choking."

Harvard researchers have recently found what they believe to be evidence of a genetic basis for these deaths, according to Hauck. But, even if a baby does appear to have a genetic susceptibility to SIDS, "it doesn't necessarily destine that baby to a SIDS death," she said. Hauck added that SIDS is likely a "multi-factorial" disorder, and that a combination of genetic susceptibility or a defect acquired in the womb -- from something like maternal smoking or drug use -- combined with environmental risks is probably what causes SIDS, she said.

And, while parents can't change the genes they pass on to their children, there are steps they take to reduce a baby's risk of SIDS.

"Putting babies to sleep on their back and not smoking are the two most important things to do," said Hauck, who recently completed a review of past research done on SIDS and the use of pacifiers.

Hauck's review found that for every 2,733 babies who slept with a pacifier, one SIDS death could be prevented.

"We don't know for sure why pacifiers reduce risk, but it may be that the infants who have a pacifier during sleep may be more arousable. They don't sleep as soundly. There are also some who believe it could be direct mechanical influence, that pacifiers might open the airway up," Hauck said.

Bottle-fed babies can start using a pacifier immediately, but the American Academy of Pediatrics recommends that breast-feeding mothers wait until breast-feeding is well established before introducing a pacifier, at about one month, according to Hauck.

Batra emphasized that while pacifiers might have a slight protective effect, parents should focus on the baby's sleeping environment, both at home and in any other place the baby sleeps, such as a grandparent's home or at day care. He said about one in five SIDS deaths occurs outside the home.

"There are a few easy steps to reduce SIDS risk," said Batra. "Babies should always sleep on their backs. Tummy and side sleeping is not advised." Babies should sleep on firm mattresses with only a light covering. The room temperature should be comfortable for an adult, because overheating is a risk factor for SIDS.

Hauck said some parents are concerned that if they put their babies to sleep on their backs they might choke if they spit up, or they might develop a flat spot on the head from always sleeping in the same position. Both Batra and Hauck said there's no increased risk of choking for back-sleepers. And, if flat spots are a worry, Batra suggested that when the baby's awake to keep him or her out of the car seat and swing as much as possible. Hold the baby, or supervise tummy time when the baby's awake.

"The other way that's simple to do is alternate which end of the crib you place the baby to sleep in. They'll naturally turn their heads to noise and light," Hauck said.

Posted: March 2008

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