Sudden Infant Death Syndrome (SIDS) is the name given to unexplained deaths of apparently healthy, sleeping babies younger than the age of 1. The deaths remain unexplained even after a thorough investigation, an autopsy, death-scene examination and review of the child’s medical history. The syndrome usually strikes swiftly during sleep; as the name implies, there are no signs that the baby is ill. Most SIDS deaths occur in infants from 2 to 4 months old. It is the leading cause of death between the infant’s first four weeks of life and first birthday. Researchers believe that SIDS are linked to such environmental factors as sleeping position, soft bedding, low birth weight and exposure to cigarette smoke.

On the basis of the New Zealand Cot Study and European data, in 1992 the American Academy of Pediatrics (AAP) recommended that infants no longer sleep in the prone position (on their stomachs). They introduced the Back to Sleep program educating caregivers to put infants to sleep on their back. Over the next 10 years the rate of sudden infant death fell 53 percent as there was an increase in exclusive supine (back) sleep from less than 10 percent to 78 percent.

Although doctors can’t say what causes SIDS, they can say what doesn’t cause it. It is not the result of suffocation, choking, allergies, immunizations or child abuse. It is not contagious or hereditary.

While the AAP is careful to point out that sleep position in and of itself is not a cause of SIDS, the organization nonetheless endorses the “back to sleep” method when the baby is napping or going to bed for the night.

However, it’s not always recommended for infants to sleep on their backs. Such instances include: premature infants experiencing respiratory disease, infants with gastroesophageal reflux, and infants with certain upper airway malformations. Premature infants who are healthy and sufficiently mature to be cared for at home should be placed on their backs to sleep. Babies should also sleep on firm, smooth mattresses. They shouldn’t be over bundled and their bedrooms shouldn’t be overheated; and smoking around infants should be avoided because smoke may damage their vulnerable respiratory systems.

However, the National Infant Sleep Position study showed little progress has been made in mothers exclusively placing their infants to sleep on their backs in the last 15 years and recommend extending educational outreach to all populations and cultures including friends, child care providers and family members, especially grandmothers.

SIDS remains a mystery, one that leaves unpredictable tragedy, unanswered questions and unavoidable grief in its wake. However, it must be remembered that SIDS is an unusual event occurring in only about one in 1,000 live births. The best thing you can do is to be aware of the ways to help prevent it and to stay informed. Putting infants to sleep on their backs is a start.

Sally Robinson is a clinical professor of pediatrics at UTMB Children’s Hospital. This column isn’t intended to replace the advice of your child’s physician.

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