Are There Ways to Reduce the Risk of SIDS?
Currently, there is no way to prevent SIDS, but there are things that parents and caregivers can do to reduce the risk of a SIDS death. For example, researchers now know that the mother's health and behavior during her pregnancy and the baby's health before birth seem to influence the occurrence of SIDS.
Scientists also know that certain environmental and behavioral influences (called risk factors) can make an individual more susceptible to disease or ill health. Although risk factors are not necessarily the cause of a condition, by studying risk factors, scientists are able to better understand a disease or condition, which often leads to detecting a cause.
SIDS researchers and clinicians continue to try to identify risk factors that can be modified or controlled to reduce an infant's risk for SIDS. For example, SIDS experts now know that the baby's sleep position, exposure to smoke, and becoming overheated
while asleep can increase the infant's risk for SIDS.
Infant Sleep Position
In April 1992, the American Academy of Pediatrics (AAP) Task Force on Infant Sleep Position issued a statement recommending that infants be placed on their backs to sleep to reduce the risk of SIDS. Then, in 1994, the U.S. Public Health Service, AAP, the SIDS Alliance, and the Association of SIDS and Infant Mortality Programs cosponsored the Back to Sleep campaign, a national public service initiative to disseminate AAP's recommendation that infants be placed on their back to sleep.
Between 1992 and 1998, among U.S. infants, stomach (prone) sleeping decreased from more than 70 percent to approximately 20 percent. During that same time frame, the number of SIDS deaths declined by more than 40 percent (Willinger et al., 1998; AAP, 2000; NICHD, 2001). Not surprisingly, most researchers, policymakers, and SIDS professionals agree that this significant decline occurred largely as a result of changing sleep position (AAP, 2000).
Rates of SIDS are over twice as high among American Indians and African Americans compared with Whites. Prone sleeping was found to be a significant risk factor for SIDS in an African- American urban sample (Hauck et al., 2002). These authors recommend educational outreach to the African-American community.
Another recent study of the relationship between infant sleep position and SIDS concluded that infants placed in an unaccustomed prone or side sleeping position are at a higher risk of SIDS (Li et al., 2003). This ethnically diverse, populationbased, case-controlled study was conducted in 11 counties in California. The health message from this research is that babies should be on their backs for all sleep, including naps.
Exposure to Smoke
Researchers have concluded that if a mother smokes during or after pregnancy, she is placing her infant at a greater risk for SIDS (AAP, 2000). Some studies suggest that exposure of the newborn to tobacco smoke (whether or not the mother smokes) may be associated with increased risk for SIDS. In a 1997 policy statement, AAP cautioned, "Exposure of children to environmental tobacco smoke is associated with increased rates of lower respiratory illness and increased rates of middle ear effusion, asthma, and SIDS" (AAP 1997).
According to AAP (2000), some evidence points to an association of the amount of clothing or blankets on an infant, room temperature, and the time of the year with an increased risk for SIDS. The increased risk associated with overheating is particularly clear when infants are placed on their stomachs (prone).
AAP cautions that the possible relationship between clothing and climate as stand-alone factors (or as a cluster of environmental risk factors) is less clear. Moreover, although the number of recorded SIDS deaths has been higher in the winter months, that increase may be due to the greater frequency of colds, flu, and other infections during the winter.
Researchers and consumer safety advocates continue to look for a possible link between SIDS and soft bedding (Scheers, Dayton, and Kemp, 1998). During 2000, seven major retailers joined with the U.S. Consumer Product Safety Commission (CPSC) to kick off a nationwide campaign promoting safe bedding practices for infants. Many retailers are developing public service campaigns to spread this message to parents and other infant caregivers. The hope is that by circulating this information, infant deaths will be reduced and that those responsible for infant care will receive one consistent message about ensuring a safe sleeping environment for babies.
In recent safety alerts, CPSC has warned parents to guard against unfounded claims from manufacturers of some infant bedding materials that the use of certain products can reduce SIDS. Parents and other caregivers need to be aware that there is no product currently available that can guarantee prevention of a SIDS death.