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Too many parents need heeding warnings about SIDS - Ogden Clinic provided source, Standard-Examiner 5/19/2014

(Standard-Examiner) OGDEN -- Parents are still putting their infants to sleep on their stomach, despite a campaign aimed at reducing the risk of sudden infant death syndrome by placing them on their backs.

Many families are not following recommended sleep practices for infants, according to a study at Boston Children's Hospital and South Shore Hospital in Massachusettes. The federal government, the American Academy of Pediatrics and child advocacy groups have urged parents for the last 20 years to place infants on their backs for sleep for the first year to reduce the risk of SIDS. But the new research found that nearly thirty percent of all infants do not sleep on their backs.

Dr. John G. Allred, an Ogden Clinic/Grand View pediatrician, said The American Academy of Pediatrics states to reduce the risk of SIDS, infants should be placed for sleep in a supine position (wholly on the back) for every sleep by every caregiver until the age of one. Side sleeping is not safe and is not advised.

However, Allred said, the guidelines also state once an infant can roll from the back to the stomach and vise versa, the infant can be allowed to remain in the sleep position that he or she assumes.

"When a baby can readily and easily roll from tummy to back and back to tummy, it is safe for them to remain in their position to sleep," Allred said. "Don’t confuse that with a baby who was on her side and fell to her tummy. That is not readily able to roll back and forth."

The AAP policy further recommends that children up to one year of age be placed to sleep on their back while acknowledging the older a child gets, the more likely he or she may be to wind up in different positions from the initial sleep placement.

Dr. Nathan Forbush, a pediatrician at Tanner Clinic in Layton said SIDS is a term used to describe unexplained death during sleep in an infant under one year of age. While not completely understood, there seems to be a problem in the brain of some babies that inhibits to normal regulation of breathing, heart function and sleep arousal.

"The peak age of SIDS is between two and four months old. Ninety-five percent of cases of SIDS occur before nine month old," Forbush said. "Most babies begin rolling around 4 month old. I prefer to avoid tummy sleeping until age one, but ... some babies will roll to their tummies, and if they do this repeatedly, it's not practical to constantly monitor them and immediately roll them to their backs again. But yes, it's ideal that a baby sleep on her tummy until the age of one."

SIDS remains the leading cause of death among infants between one month and one year of age, according to the study. Just over 2,000 infants died of SIDS in the U.S. in 2010, the last year of available data.

Back sleeping increased dramatically after the “Back to Sleep” campaign was first introduced 20 years ago, from 13 percent of infants in 1992 to 72 percent in 2001, according to data from the National Infant Sleep Position Study. The incidence of SIDS was cut in half over that same period, from 120 deaths to 56 deaths per 100,000 live births.But improvement in the SIDS rate since then has been minimal as well as little change in the share of infants who are put to sleep on their backs.

But sleep position is just one of the causes of SIDS. Unfortunately, there are many others, Allred and Forbush said.

"There exist exogenous triggers or stressors such as prone sleep position, over bundling, airway obstruction and intrinsic vulnerability that lead to a failure of protective responses," he said. "Convergence of these factors ultimately results in a combination of progressive asphyxia, low heart rate, hypotension, metabolic acidosis, and ineffectual gasping, leading to death."

In addition, Forbush said, babies born to a teenage mothers are at a high risk as well as sleeping with soft bedding, loose blankets, stuffed animals or pillows and overheating baby.

Vulnerable infants who die from SIDS are also more likely to be born at a low birth weight or are growth restricted," Allred said. Some growth restricted infants could be the product environmental conditions such as exposure to nicotine or other components of cigarette smoke and alcohol.

"I have offended some of my parents because of my insistence that they stop smoking. Period. Smoking is never ever ever good for a mother or her baby. Nor is the baby benefitted in any way if dad smokes," Allred said. "Conversely, maternal smoking during pregnancy is a major risk factor in almost every epidemiologic study of SIDS. Smoke exposure adversely affects infant arousal. In addition, smoke exposure increases risk of preterm birth and low birth weight, both of which are risk factors for SIDS. It is estimated that one-third of SIDS deaths could be prevented if all maternal smoking during pregnancy were eliminated."

Bed sharing is also a no no. Infants may be brought into the bed for feeding or comforting but should be returned to their own crib or bassinet when the parent is ready to return to sleep, Allred said. There is evidence that this arrangement decreases the risk of SIDS by as much as 50 percent.

Forbush also said using a fan in the room is protective as is use of a pacifier, even if it falls out of the baby's mouth once asleep. Breastfeeding and immunizing your baby also reduces the risk of SIDS.