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The Epidemic That’s Killing Our Babies

by Dr. Michael Goodstein
There is a silent epidemic killing babies across the United States.  You won’t read about it in the paper or hear about it on the nightly news.  But every year 4500 babies die suddenly and unexpectedly in their sleep from accidental suffocation, strangulation, and Sudden Infant Death Syndrome (SIDS).  This is the third leading cause of all infant mortality and the leading cause of death in infants after the first month of life.  Another baby dies every two hours of every day of the year.

It is every new parent’s worst nightmare, but nobody wants to talk about it when a family is experiencing the joy of a new baby.  Many years ago there was no reason to talk about SIDS because we didn’t know what caused it and there was nothing we could do about it.

Today we have a better understanding of both SIDS and suffocation deaths through the hard work of researchers studying the brains of these infants, as well as healthcare professionals and child death review teams studying the infant sleep environment.  Last week the American  Academy of Pediatrics summarized these findings with the release of their updated recommendations on SIDS and infant sleep safety.

Even before birth, the environment plays a crucial role.  Cigarette smoke alters the development of the breathing and airway reflexes of the brain stem.  Up to 1/3 of these cases could be prevented if women did not smoke during pregnancy!  Get good prenatal care to reduce the risk of prematurity and low birth weight infants.

Studies consistently show that in 90% of these deaths, the infant is found in an unsafe sleep environment.  Many of the environmental risk factors are the same in SIDS and accidental suffocations.  And accidents are preventable.   Do not use pillow, quilts, comforters, or other soft bedding.  Soft bedding increases the risk of death by five times.  Faces sink into pillows or get caught against heavy fabric resulting in suffocation.  Keep everything out of the crib except the baby.  This includes bumper pads, which can result in suffocation.  A crib is a safety device for your infant.  If you want, decorate the room, not the crib.

Remember to use a crib or other product approved by the Consumer Product Safety Commission.  Adult beds, couches, and recliners are all dangerous places for babies to sleep.  They can get wedged, entrapped, or rolled over, resulting in death.  Study after study shows that a baby sharing a sleep surface with another child or adult is dangerous,  even if the adult has not been smoking, drinking, or using drugs.  You can play with, cuddle, and breast feed a baby in an adult bed.  Breastfeeding is recommended- it can reduce the risk of SIDS by 50%!  But once the adult gets tired, the baby should be moved back to a safe sleep surface.  Research shows the safest arrangement is to have the baby in the same room, but on a separate sleep surface.

Overheating is also associated with sleep related deaths, so make sure the baby is not over-bundled.  Keep the room at a temperature comfortable for an adult.  Wearable blankets are very useful because receiving blankets that get loose become a danger for suffocation.

Whether you are a new parent, a babysitter, a relative, or a friend, you should know the facts.  We know that education works.  In less than 10 years after recommending back sleeping, the number of deaths dropped more than 50% in the US.

Many people still fear that babies will “choke to death” if they sleep on the back, but this is simply untrue.  When a baby spits up, much of the material comes out the mouth.  What remains will be forced by gravity to the lowest point in the throat- the esophagus.  The airway or trachea is above the esophagus and is protected by the same reflexes that adults have.  When we swallow a few drops “down the wrong pipe,” we cough forcefully to clear the fluid and protect our lungs.  This is not choking or aspirating- it is normal.  And babies have the same protective reflexes.

A special message to new grandmothers:  You hold a position of tremendous power because your children love and respect you.  Please do not try to convince them that what they have learned about infant sleep safety is wrong, because these are the facts.  Maybe your children slept on their bellies when they were babies and nothing happened- that’s great.  But there are thousands of families and babies who weren’t so lucky.

Nobody should have to go through the nightmare of losing a child, especially so early in life and in such an unexpected manner.  Share this information with friends and family.  Let’s make our community as safe as possible for our babies.  4500 deaths every year…it is time for us to end this epidemic.

Michael H. Goodstein, MD, FAAP
Attending Neonatologist
Clinical Assistant Professor of Pediatrics (Penn State U.)
Director, York County Cribs for Kids Program, York Hospital Office of Newborn Medicine

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