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Nearly two decades ago, the phrase "Back to Sleep" became part of the baby-care lingo for new parents. It was a direct response to a crisis: As many as 6,000 U.S. babies were dying each year of sudden infant death syndrome, or SIDS. Then, research in Europe and Australia showed that putting babies to sleep on their back could reduce SIDS. One reason for the decrease may be because babies retain more body heat when they lie on their belly, so they may sleep more deeply and have trouble waking if their face gets pressed against bedding. Belly- and side-sleeping also increase a baby's risk of rebreathing exhaled carbon dioxide. As a result of the findings, federal child-health agencies in the U.S. initiated the Back to Sleep campaign to educate parents and caregivers. The message got through: Within ten years, back-sleeping rates escalated and SIDS deaths dropped by more than half. "It was one of the greatest public-health-education triumphs of the late-20th century," says neonatologist Michael Goodstein, M.D., a member of the American Academy of Pediatrics (AAP) Task Force on Sudden Infant Death Syndrome. "An estimated 30,000 children are alive today because of Back to Sleep."
The cause of SIDS remains unknown. It is the diagnosis given when a baby's death can't be explained by a complete autopsy, investigation, and family medical history. And while 70 percent of infants who die of SIDS turn out to have had some type of brain-stem abnormality that affects things like breathing, heart rate, and the ability to awaken, it's not a given that these same babies died because of that abnormality.
As forensic teams are more closely examining the beds, bedrooms, and surfaces where babies have died, a devastating trend has emerged: Many deaths that once looked like SIDS are turning out to be accidents that could have been avoided. Doctors consider SIDS to be only one part of a category of accidental deaths called Sudden Unexpected Infant Death (SUID). The other parts, according to the Centers for Disease Control and Prevention, are accidental suffocation and strangulation in bed, and sleep-related "ill-defined and unspecified" deaths. In 2010, the most recent year for which stats are available, a total of 3,610 U.S. babies under the age of 1 died of SUID. "It's very disheartening," says pediatrician Rachel Moon, M.D., of Children's National Medical Center, and a member of the AAP Task Force. "Most of the time, parents think that they're doing what's best for their baby. But the majority of those who die from SUID had been bedsharing or had a blanket or a pillow while sleeping. They didn't have to die."
That's why, when the AAP reviewed all recent safe-sleep research and updated its recommendations two years ago, it revised guidelines to address both the risk of SIDS and sleep-related deaths. The AAP report recommends feeding babies breast milk and offering pacifiers, both of which have been shown to help reduce the risk of SIDS. Parents should not expose babies to secondhand smoke, which is linked to higher SIDS rates. They should also avoid monitors or other devices marketed as reducing SIDS risk.
But it's how you put your baby to sleep that is most important, notes the AAP. Not only should babies be put to sleep on their back, but they should be placed in a crib without pillows, toys, blankets, or bumpers. Also, never lay a baby down on any soft surface. And because a significant number of deaths occur when parents inadvertently roll over on their baby or accidentally block their baby's mouth or airway, sleeping together is not recommended, whether in a bed or on a couch. A recent analysis of bedsharing studies, conducted by Dr. Moon, among others, found that sleeping with an infant under 3 months of age triples her risk of suffocation death.
Child-safety organizations and doctors are eager to spread the word about the expanded recommendations. The Eunice Kennedy Shriver National Institute of Child Health and Development announced a campaign called "Safe to Sleep" that includes SUID precautions. But many parents don't think of safe-sleep practices as a necessity. In fact, studies suggest that only 75 percent of parents put babies on their back. Many resist because they think their baby is particularly fussy or gassy, or requires special accommodations. In addition, despite ample evidence about the dangers, many parents share their bed with a young infant. Some swear by the ease of nighttime feeding, and the calming effects. Bedsharing is ingrained in countries such as Japan, Sweden, and the Philippines, and thought of as a way of developing family closeness.
"Every parent thinks their child is the exception to the rule," says Dr. Moon, adding that sleep-related accidents always take parents by surprise. "They never think it's going to happen to them." We spoke with several moms who have experienced either close calls or tragic losses. They shared the facts they desperately wish they'd learned sooner.