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Monday, October 20, 2008

SIDS (Sudden Infant Death Syndrome) -- How To Reduce Your Infant's Risk: AAP Recommendations and Analysis of The New Study on Fan Use While Sleeping

Sudden Infant Death Syndrome (SIDS) has been in the media again this month as a new study showed a correlation between fan use in the bedroom and a reduction in the rate of SIDS.

SIDS is a horrifying possibility for any new parent. It is by definition a sudden and unexplained death of a previously healthy infant. To be classified as a death due to SIDS, the infant has to have been less than 1 year of age at the time of death and no cause of death found after a thorough investigation. SIDS rates peak at 2-3 months of age and drop off considerably after 6-8 months.

SIDS rates have dropped by over 50% since the start of the "Back to Sleep Campaign," however; it remains a leading cause of death in infants. The "Back to Sleep Campaign was initiated by the American Academy of Pediatrics (AAP) in 1992 to educate parents that the safest sleeping position for infants is on their backs. Despite the wonderful success of lying children on their backs, instead of their sides or stomachs while sleeping, with 1 in every 2000 infants still dying from SIDS annually, research continues to be done to better understand how to further reduce infant's risk.

The most recent study, which was published in the October 2008 issue of Archives of Pediatric and Adolescent Medicine, shows a correlation between using a fan in the room where the infant is sleeping and a reduction in the rate of SIDS. The authors quote a 72% reduction in SIDS risk when a fan is used in the bedroom. However, the study is poorly controlled which may bias the results. When the authors set up the two groups of mothers and their infants (one group of mothers whose infants died from SIDS and one group of mothers whose infants were healthy, called controls) for comparison, they allowed for many differences between the groups.

The infants used for the controls in this study were less often pre-term or low birth weight and more often children of older, married, more educated, non-smoking mothers, who had earlier prenatal care. These infants were more often put to sleep on their backs, on firm surfaces, without bulky bedding and with a pacifier. Since every one of the above is associated with decreased risk of SIDS, the infants who died of SIDS and the controls in this study were not well matched.

That being said, children with risk factors for SIDS did seem to benefit from a fan in the room. These benefits were less pronounced in infants without additional risks for SIDS.
A fan in the bedroom can be used to try to further reduce an infant's risk of SIDS but it should not be done in place of the many other recommendations to reduce SIDS risk.

The following is list of the AAP recommendations to reduce an infant's risk of SIDS:
1. Back To Sleep: Every Caregiver, Every time: It is extremely important for parents not only to put their infant to sleep on his back but also to ensure that every caregiver does the same. That means reinforcing it with relatives, babysitters, daycare and nannies. Infants who are normally put to sleep on their backs who then are switched to their stomachs are at an even greater risk for SIDS during that period.

2. Firm bedding surface: Mattresses for cribs, bassinettes, pack 'n plays etc. need to be firm. Compress the mattresses and sleep surfaces with your hands, it should feel firm. Do not add pillows, blankets, sheets, etc. to the sleep area. Anything that can move up over the infant's head increases the risk of SIDS. Any bedding product that states that it conforms to the back of the infant's head so that it reduces the risk of a flat head, will also conform to the infant's face and is not firm.

In order to decrease the chance of the skull becoming flattened by lying on it for an extended period of time, the position of the infant's head should be varied when he is put down to sleep, so that sometimes he lies on the right side of his head and sometimes the left. Infants should also have tummy time daily; when not sleeping, they should be allowed to lie on their stomachs on the floor. It should be noted that car seats, bouncers etc. also put pressure on the back of the head and can increase the risk of a flattened head.

3. No bed sharing. No couch sharing: Infants should not share beds with adults or other children. It is safe for infants to be brought into the bed to breastfeed or bond, but the safest place for an infant to sleep is in a crib in the parent's room for the first 6 months of life. Sleeping with an infant on a couch has been found to be even more dangerous than sleeping with an infant on a bed.

4. Don't over wrap or over dress infants for bed: Overheating is a risk factor for SIDS. A room temperature of 70 degrees F is optimal. Infants should be lightly clothed for sleep.

5.Offer a pacifier: Pacifiers have been found to reduce SIDS risk, although, the mechanism of this reduction is still unclear. An infant should never be forced to take a pacifier and if it falls out during sleep it does not need to be reinserted. Breastfeeding mothers may want to wait a month until breastfeeding is well established before introducing the pacifier. Pacifier use can, unfortunately, also increase the risk of ear infections; therefore, after 1 year of age, when the risk of SIDS has diminished, it is best to try to decrease their use.

The complete statement from the AAP on SIDS and risk reduction can be found on their website.