DOCTORS’ LOUNGE
SAFE INFANT SLEEP: 2016 UPDATE
Elizabeth A. Amin, MD
DOCTORS’ LOUNGE
As a grandmother of three with a fourth grandchild expected in February, I try to be alert to new recommendations regarding infant and child safety. A few days ago, my attention was drawn to a brief announcement indicating that the American Academy of Pediatrics had updated its safe sleep recommendations for newborns and infants through the first year of life.( 1) For those of us whose visits to the pediatrician’ s office are a distant – and in my case a rather blurry – memory, there are numerous sites where this information can be accessed. The American Academy of Pediatrics website( aap. org) is the ground source, heavy on detail and the fine distinctions between Sudden Infant Death Syndrome( SIDS) and other causes of Sudden Unexpected Infant Death( SUID) during sleep. There are some charming, informative and non-threatening public announcement videos on the National Institutes of Health website( nichd. nih. gov)( 2) where the new mother-to-be is explaining to her mom, the new grandmother-to-be, how and why things have changed. These, I am sure, will be available in different forms in the many magazines and online blogs that parents have access to nowadays.
The abstract to the 2016 recommendations indicates that,“ Approximately 3,500 infants die annually in the U. S. from sleep-related infant deaths. This includes SIDS and accidental suffocation and strangulation in bed.” Reading through the list of 19 recommendations, I noted that the last four(# 16, # 17, # 18, # 19) are directed to health care providers, researchers and other professional groups. However, 15 recommendations are directed to parents / caregivers. Many of these are common
-sense risk avoidance measures related to daily issues of modern life. Some of them are more complex, and I was struck by a certain rigidity in some of the latter. The objective of the new guidelines is to eliminate accidental causes of infant death during sleep; such things as avoidable entrapment, suffocation and asphyxiation. Also, they aim to reduce and eventually eliminate SIDS. SIDS is defined as, " the sudden death of an infant that is unexpected by history and unexplained by a post-mortem examination that includes a case investigation, complete autopsy and examination of the death scene." SIDS is therefore considered a subset of SUID. The fear of SIDS is omnipresent whenever a new baby joins a household. Rules that are clear and reasonably easy to implement go a long way towards alleviating the anxiety of new parents. Recommendations that may be confusing or harder to implement may add to parental anxiety, especially if two parents / caregivers don’ t see eye to eye. SIDS is devastating to all involved. In my opinion, parental guilt should never be implied.
The first clear guidelines on infant sleep safety were published in the early 1990s. There followed a measurable and significant reduction in SIDS. Apparently, the incidence of SIDS has leveled out during the last decade and updating the recommendations a) brings them back into focus and b) adds some new information- although this comes with caveats that are important. First and foremost is the now well-accepted Back To Sleep rule. Soon after this was first instituted in 1994 I remember learning from friends that one of the problems associated with always putting babies to sleep on their backs was the development of positional plagiocephaly; flattening of the occipital bone at the back of the skull. The remedy at that time was for the infant to wear a custom designed little helmet. I believe it was worn for 23 out of 24 hours a day. I am not sure what the average duration of that treatment was. I had given it no thought until 2009 when our first granddaughter was born. When I received my instructions the day I was going to babysit for the first time I mentioned this to our daughter-in-law. She had heard about the condition but per her pediatrician, providing the baby with enough tummy time during waking hours, and when a caregiver was present, was adequate to prevent it. The updated guidelines are very clear on this. Nevertheless, when it was time for me to put this tiny little creature down for the night, on her back, hopefully with her swaddling not too loose and not too tight but just right, I had a knot in my stomach.
Our first son was born in 1977. He slept face down. I am not sure if it was just my paranoia at the time, that he would regurgitate, aspirate and die before morning. Part of my brain says that that was a“ safe” recommendation at the time but I don‘ t pretend to remember. In reviewing these new recommendations, I am relieved to know that“ face down” sleep was not a risk factor for suffocation but the evidence is in that it is one of the factors associated with SIDS.
A lot of other things have changed since 1977. I know how dangerous our drop-sided crib was. Shopping for our granddaughter’ s crib in 2009, I walked around the showroom several times trying to figure out how I would be able to lay a baby gently on the CPSC( Consumer Product
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