One nurse's opinion
Mar 13 '00 (Updated May 22 '00)
As a NICU nurse, I see lots of babies at risk for sudden infant death. Not all sudden death is SIDS - that name currently applies to a sudden infant death for which no cause can be identified.
Back to Sleep Campaign
When I started working in Neonatal ICU and Well Baby nurseries, over 20 years ago, we taught parents to place their babies on their side or stomach to sleep -- with stomach being the preferred position. That all changed in the early 1990's. Because of a number of very convincing studies, we began teaching parents to place infants on their backs to sleep.
The incidence of SIDS has dropped by at least 50% (depending on the study) since we started teaching parents to put babies to sleep on their backs and remove heavy bedding from the crib. SIDS still happens, and we may never know all the risk factors, but at least this may save some parents from that horrible experience.
One caution, babies used to sleeping on their backs are at higher risk of SIDS if inadvertently placed on their stomachs to sleep -- this means higher risk than babies who always sleep on their stomachs, according to the latest research. Grandparents and babysitters need to be informed of this increased risk, since they are the ones most likely to make this change in sleeping position.
Other Possible Risk Factors
Smoking during pregnancy and around the baby does increase the risk of SIDS. The reasons for this aren't fully understood, but increased carbon monoxide levels and irritation of the respiratory tract may be factors. Moms who aren't able to quit smoking may decrease their baby's risk by limiting their smoking to outdoors, or at least in a room where the baby isn't. Never permit anyone to hold the baby while smoking and don't be shy about inviting your friends and relatives to smoke on the porch rather than indoors. My DH put up a shelter outdoors for my smoking relatives.
There is some evidence that breastfeeding may reduce the incidence of SIDS as well - so some of the decline in SIDS may be because of the upsurge in breastfeeding in this country.
SIDS is definitely seasonal -- occurring more often in the winter than in spring or summer, perhaps related to heavy bedding, but even with the new teaching on that subject I don't think this statistic has changed. The recommendation is to remove all heavy quilts, blankets and comforters from the infant's bed. Babies should be dressed in blanket sleepers to keep them warm and the room temperature may be adjusted if necessary.
A more controversial subject is the family bed. Some people feel strongly that parents might roll over and suffocate the baby, others that by sleeping with mom & dad they can reduce the risk of SIDS. One former pediatric ER nurse I know believes the former, but in all her years of ER nursing, she only saw one case of a baby dying in bed with the parents (they thought they rolled on him, but was it really SIDS?) and many babies who'd died in their cribs. This isn't a statistically valid sample, just one nurse's experience.
My kids all slept with me from time to time, so I'm biased on this point. The older ones also slept on their tummies, since that research hadn't been published (or perhaps even done) when they were born. The boys are 19 & 17. My middle child, who slept through the night from the day we brought him home, was apparently in a high risk class for term babies because of his deep sleep pattern -- something I'm glad I didn't know at the time.
Apnea Monitors
Apnea monitors are useful in limited situations, particularly high risk infants, like preemies with ongoing apnea of prematurity and for children with congenital syndromes that affect the airway. Strictly speaking, infants with these problems are at risk for sudden death, but it's not considered SIDS since we KNOW what their problem is. The neonatologists at my hospital prefer to keep our preemies until they outgrow apnea of prematurity, if at all possible. We offer infant CPR classes to the parents of every baby in our NICU, and a few have actually had to use CPR to save their babies.
The biggest problem with home apnea monitors is false alarms. Parents can become nervous wrecks, not sleeping or even bathing, for fear that they won't hear the alarm if it goes off -- or they can take the opposite approach and put the monitor in a closet (as happens with more than half of home apnea monitors, according to the research). Different monitors have different levels of sensitivity and a newer monitor may have fewer false alarms. If the baby has a medical problem, your insurance may cover part or all of the cost.
Babies often learn how to trigger false alarms, too, since mom or dad ALWAYS answers when that alarm goes off. Living with an apnea monitor requires nerves of steel and a sense of humor, but the alternative for really high risk kids is unthinkable.
Bottom line, you can reduce the risks, but you can't completely eliminate them. Research is ongoing and as we learn more, we can protect more babies.
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