Ever accidentally take a continuing education course that does not apply to your professional license/continuing ed? Yes, me?

Despite this unlucky incident, I still gained a great deal of useful information. A few months ago, I took a CEU course called Infant Positioning Strategies: Progressing Development while Promoting Safe Sleep. While it covered baby development and how positions can cause or reduce certain neck or head conditions, like torticollis or flathead syndrome, I was most intrigued by the topic of SIDS (sudden infant death syndrome). Sounds dark, but the intel presented was too fascinating not to share.

Let’s be honest. For new parents, the idea of SIDS is TERRIFYING. Doctors tell you in a professional manner, “Hey, make sure your baby is sleeping on their back to prevent SIDS. Yeah, we don’t really know the cause of it, but make sure they’re on their back while sleeping for the first 6-8 months.” Like, WTF?!

That fear has caused many worried parents to frequently check if their baby is breathing when they’re asleep, constantly return their infants on their back if they rolled over, purchase Owlet socks to monitor their vitals, or have a mini panic attack if their baby has been quiet for too long. It may sound a bit excessive, but the concern makes sense. There are so many unanswerable questions. Additionally, two studies cited mass media as the main source of SIDS-related information for most parents, not doctors. If that’s the case, here is what I learned from this CEU course and hopefully it can ease any anxiety on the matter.

Sudden Infant Death Syndrome (SIDS) is exactly how it sounds. It is defined as a sudden, unexplained death of an infant younger than a year old. The term “syndrome” indicates that there is a singular cause, but that’s still to be determined. But this is what we do know.

SIDS is not:

• The cause of every sudden infant death
• The same as suffocation or asphyxiation, nor are they the reason
• Caused by vaccinations
• The result of neglect or abuse
• Caused by cribs
• Contagious

If we’re unsure of what causes SIDS, how did we figure out ways to reduce it?

Back to Sleep

In 1992, a global two-year analysis on SIDS was conducted by the US, the UK, and Australia. Their findings identified the major risk factors associated with the diagnosis:

• Soft bedding – 5 times the risk compared to firm bedding, regardless of sleep position
• Stomach sleeping – 2.4 times the risk as opposed to back sleeping
• Soft bedding while sleeping on stomach – the highest risk (21 times more)
• Bed sharing – 5.4 times the risk

With these results, the Back to Sleep program was launched in 1994 in the US and in eight other countries. The campaign provided a laundry list of recommendations on ways to prevent SIDS. However, what did parents recall most from that initiative? Put babies on their back so they don’t get SIDS. Yes, the cases of SIDS went down, but the number of developmental delays went up.

Into the Unknown

The research to figure out the root cause of SIDS has been going on for about 50 years and counting. There’s good reason too as the condition is unpredictable and occurs during sleep. Our best working model is the Triple Risk Hypothesis which proposes three potential contributions to these deaths:

• Vulnerability. This includes all the internal risk factors, from prematurity to an underlying abnormality. A popular theory is that there may be a neural defect in the brainstem, which is responsible for heart and lung function. A study found that SIDS babies had low levels of serotonin which not only affects mood but alters heart rate, breathing, and sleep. Because serotonin is made in the brainstem, it suggests that these infants may not have had the capacity to respond to breathing challenges. 
  
  
• The critical period of development. SIDS occurs the most between 2-4 months of age. This may be due to the development of the sleep/wake cycle in babies. This can result in less waking and resettling during sleep.
  
  
• Environmental stressors. This comprises of sleep position, bedding, bed sharing, and overheating.

Skewed Data

SIDS is a diagnosis of exclusion, meaning it is medically used when no obvious cause is present prior to investigation. So, when a medical examiner cannot determine the difference between SIDS and suffocation, they might say the cause of death is SIDS when it might not have been. In 2007, a nine month investigation reviewed 4,000 unexpected infant deaths nationally and found that coroners were not following investigation methods recommended by the CDCP (Centers for Disease Control and Prevention), resulting in incorrect diagnoses of SIDS. Many of these cases were actually from suffocation or asphyxiation. This means that the number SIDS may have been inflated.

The Thing About Tummy Sleeping

Before 1994, no one really paid attention to their baby’s sleep position so long as they were sleeping. But the Back to Sleep campaign gave tummy sleeping such a bad rap. When my son was in the NICU (he was an early baby), I saw that he was snoozing on his belly. Sure, he was on monitors to check his vitals, but I was curious as to why the nurses allowed this position since it’s heavily associated with SIDS. Turns out that prone sleep increases oxygen saturation throughout the body, allowing for better sleep. This is because the weight of the heart and rib cage aren’t pressing down on the lungs, making breathing easier.  Sounds great. So, what’s the problem with babies sleeping on their belly?  When 2- to 4-month-olds sleep on their belly, an air pocket forms that causes them to breathe in the same air (more carbon dioxide, less oxygen). SIDS can occur if an infant isn’t internally prompted to seek fresher air (waking, adjusting/turning their head, resettling back to sleep).

While it’s recommended that your little one is placed on their back for sleep, don’t fret if they can roll themselves over to doze off to bed. Once they can actively move around and roll both ways, they are absolutely fine to sleep on their stomach, if they so choose.

The Bed Sharing Debate

Bed sharing is not recommended for babies 12 months and under, citing that it greatly increases the risk of SIDS. Research studies state that this practice results in overheating, rebreathing of poorly oxygenated air, airway obstruction, and so on. Research has also found that 69% of infant deaths occurred while bed sharing. However, countries where bed sharing is commonplace have among the lowest SIDS rates in the world, like Japan. What gives?

It’s the bed. Most of these countries sleep on firm surfaces and are well ventilated compared to Western countries (softer mattresses, thicker blankets, fluffy pillows, etc.). It’s not so much about sleeping with parents as it is about the sleeping environment itself. Side note: Most likely, the research study did not include newer baby bed products, like the Dock-a-Tot.

Welcome to the Rebrand

SIDS has declined considerably since the 1990s. Much of this is due to research, establishing protocols, streamlining medical coding, and educating the public.

The American Academy of Pediatrics has since renamed the Back to Sleep campaign to Safe to Sleep with an issuance of new recommendations to reduce SIDS, shifting its focus from back sleeping to a safe sleep environment:

• Place babies on their back for naps or sleep at night in the first 6 months
• Their sleep surface should be firm and flat and covered with only a fitted sheet
• Share a room with baby, but give them their own sleep space for at least the first 6 months
• No loose items in infant’s sleep area, including stuffed animals
• Keep baby’s head and face uncovered during sleep

The overall risk of SIDS is low (like, about 39 deaths per 100,000 live births), so statistically, you don’t need stress too much. As studies continue with their discoveries on the matter, continue to reduce the risk factors by following the Safe to Sleep guidelines.

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Related Posts:
Two Sides of Sleep, Part 1
The Baby (Development) Registry
Tummy Time Revisited
Rolling 101

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