Sudden Infant Death Syndrome (SIDS)
One of the greatest discoveries in pediatrics in the past century was the realization that by putting babies on their backs to sleep, parents can dramatically decrease the chance of their baby dying from sudden infant death syndrome (SIDS). This single piece of advice has saved more lives than any other recommendation made by pediatricians in modern medical history.
Before embarking on a detailed discussion about this practice, it is important to clarify the definition of SIDS. SIDS is when babies less than one year old who are completely healthy die in their sleep for no apparent reason. Even though SIDS can occur to any baby less than twelve months of age, it is most common in babies less than six months old. It happens to approximately one in every thousand babies. There are minimal autopsy findings from infants who have died from SIDS, and these findings are not very enlightening in revealing the cause of death.
Back to Sleep
From expert consensus on the topic, SIDS is most likely caused by rebreathing a small pocket of air. For some reason yet to be identified, some babies seem to be unable to turn their heads or shuffle their posture when they are sleeping. Usually, this doesn't pose any specific threat, unless the baby is lying face down and is repeatedly breathing a small pocket of air around the face. Over an extended period of time, the oxygen level in this small pocket is depleted and the carbon dioxide level builds up from exhaled air. It is hypothesized that this stale air ultimately suffocates the baby by depriving the baby's brain of oxygen.
Essential
Since 1992, the American Academy of Pediatrics has recommended that all babies under the age of one year be placed on their backs when they sleep. Since the announcement of this guideline, the number of babies dying from SIDS has dropped by more than 40 percent. There is no question that this single recommendation has made the biggest impact in the reduction of SIDS.
Assuming this explanation is the real cause of SIDS, it does make intuitive sense that by placing babies on their back, this rebreathing of air can largely be prevented. Nevertheless, there are still babies dying from SIDS despite the widespread use of this practice. This fact suggests that there is probably more than one cause of SIDS, and scientists have not yet identified all of them.
There are other risk factors associated with SIDS, including maternal smoking, soft bedding, the presence of toys in the crib, and cosleeping. As additional risk factors are being elucidated, some of these new findings are controversial. In all likelihood, SIDS has multiple causes. The propensity for SIDS is probably determined somewhat by genetics, but various other environmental factors can increase the risk for SIDS. Until the scientists can ascertain all the possible causes for SIDS, pediatricians recommend curbing all of these additional risk factors.
Cosleeping with Adults
This is among the most controversial topics in pediatrics. Recent studies have shown that the incidence of SIDS is higher for babies who sleep in the same bed with adults. It appears that the risk is particularly high when the adult involved is excessively drowsy, intoxicated, or is a smoker. The reason for this observation is not entirely clear, but it may have something to do with an overly sedated adult rolling over on top of the infant or accidentally turning the baby onto her stomach.
The evidence against cosleeping is pretty solid, but many parents insist on doing so because of cultural practices. To strike a compromise, you can pull the crib close to your bed, so the baby is still nearby but does not share the same bed with any adults. If you absolutely must sleep with your baby in the same bed, make sure that you do not consume alcohol or smoke during the day. You should not take any medication that might cause you to be excessively drowsy. Once again, a growing number of pediatricians strongly discourage parents from cosleeping with their infants under any circumstances.
Sleeping on the Side
Putting babies on their sides to sleep has been a controversial topic, but it shouldn't be. Clinical studies have proven beyond any doubt that by placing babies on their sides, the risk of SIDS is significantly higher than if they are put on their backs. The vast majority of healthy infants should never be put to bed on their sides. This practice should not be condoned, despite what some parental or medical organizations claim.
Question?
What should I do if my baby rolls onto her stomach, instead of lying on her back?
There is no reason to be alarmed. By the time the baby is coordinated and strong enough to roll over to her stomach on her own, she is more than likely able to shift her position when she is sleeping and avoid rebreathing the same stale air.
Some parents still allow their babies to sleep on their side because they fear that their babies might choke when they spit up if they're sleeping on their back. However, this concern has never been validated by any scientific studies. No healthy baby has ever been reported to choke to death because of spitting up during sleep. The main explanation for this is that the neurological system of a baby is actually quite advanced when it comes to protecting the lungs from being flooded with milk or saliva. Since such a reflex is crucial for survival, this sophisticated system is firmly in place by the time a full-term infant is born. Some premature babies and babies with serious neurological problems might not have this reflex intact, and these are the rare exceptions when parents should place their babies to sleep on their sides. Ask your doctor whether you should do so if you are unsure.
