Doctors still need to tell parents about safe infant sleep practices


Parents are more likely to follow safe infant sleep practices when doctors tell them clearly what to do and what to avoid, to minimize the chances of babies getting injured or dying during the night, a U.S. study suggests.

Researchers survey responses from more than 34,000 mothers on how often they followed four essential practices: placing infants to sleep on their back; putting babies to bed in a crib or other safe sleep surface; room sharing without bed sharing; and keeping soft objects and loose bedding away from sleeping babies.

Overall, 78% of mothers put babies to sleep on their backs, but just 57% kept babies in their room without sharing a bed with them. Only 42% of mothers avoided giving babies stuffed animals, pillows and other soft bedding, while just 32% used cribs or other safe sleep surfaces.

When mothers had been instructed on safe sleep practices by doctors, however, they were 12% to 28% more likely to put babies to bed in the safest ways, researchers report in Pediatrics.

“Placing infants to sleep on their stomach is the most widely known risk factor for sleep-related deaths, but there are other sleep-related risks that parents need to be aware of such as side sleeping, sleeping with blankets, pillows, or other soft objects, and sleeping on shared surfaces like adult beds and couches,” said Ashley Hirai, lead author of the study and a senior scientist at the Health Resources and Services Administration in Rockville, Maryland.

“The safest place for babies to sleep is on their backs, on separate firm sleep surfaces (crib, bassinet, or Pack ‘n Play) without any soft bedding (blankets, pillows, or bumper pads) and in the same room as caregivers,” Hirai said.

Sudden Infant Death Syndrome (SIDS) has become much less common in recent decades as doctors have urged parents to put infants to sleep on their backs without blankets or other soft bedding and toys that could pose a suffocation risk. But it remains a leading cause of infant mortality, according to the American Academy of Pediatrics (AAP).

In the current study, demographic factors like age, race, income or education levels appeared to explain some variation - about 5 to 10 percentage points - in the proportion of mothers who said doctors told them about safe sleep practices.

But demographics explained more of the variation - about 10 to 20 percentage points - in how often mothers followed the advice.

The survey questions didn’t distinguish routine habits that led to unsafe infant sleep from occasional or accidental unsafe practices.

“We don’t know why families are more compliant with some of these recommendations vs others,” said Dr Michael Goodstein, division chief of WellSpan Neonatology and director of the York County Cribs for Kids Program.

“I suspect that back sleeping is one of the more commonly followed practices because we have been promoting it the longest and the ‘back to sleep’ campaign has been so successful in saving lives,” said Goodstein, who wasn’t involved in the study.

Some knowledge gaps may also be cultural or generational, said Dr Lori Feldman-Winter of Cooper Medical School of Rowan University in Camden, New Jersey.

“Many caregivers, such as young mothers, or grandmothers, who may not have been reached by the ‘back to sleep’ (or safe to sleep) campaigns do not know about the importance of placing a baby on his/her back as a way to prevent SIDS,” Feldman-Winter, who wasn’t involved in the study, said.

© (c) Copyright Thomson Reuters 2019.

©2019 GPlusMedia Inc.

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No joke, my sister in law puts her baby to sleep face down on a body pillow to sleep. Literally her baby sleeps with its face directly in a giant pillow.

I told her it wasn't the best idea but she said 'I've never had a problem before!' and laughed.

Bed sharing can be safe as long as you have a large not too soft bed, the baby has no bedding near it, no pillows or heavy blankets and you place them on their back. We have a king sized bed and I shared with my daughter for her first two years. Granted she slept no where near me in the bed, and had no blankets or pillows, and also wore a breathing sensor attached to her diaper. When she napped alone I put a movement sensor underneath her and used a baby monitor.

Then again I definitely have anxiety problems. Maybe don't follow my advice lol

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'I've never had a problem before!'

That seems to be too common unfortunately. One woman I know who moved to Hawaii then back to Japan said she was shocked that so many people don't buckle their child seats down with a seat belt so kids going through windows in a crash is more common...

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What are the stats for SIDS in Japan? Co-sleeping used to be common - is that still the case?

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What are the stats for SIDS in Japan? Co-sleeping used to be common - is that still the case?

"...the highest SIDS rates (0.5 in 1000 live births) were in New Zealand and the United States. The lowest rates ( 0.2 in 1000) were in Japan and the Netherlands. "

So it would appear that co-sleeping is not an issue at all, as Japan has among the lowest SIDS rates in the world. It's not popular to say this, but these cases are often associated with mothers who have substance or alcohol abuse issues.

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In Britain we are told to put the baby to sleep on one side in case they vomit while sleeping. 70 years later I still can't sleep on my back which my J-wife does every night.

Had a very close friend who lost several children to Sudden Infant Death Syndrome (SIDS) and back then the authorities didn't understand that and usually blame the parents for deaths.

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Not so much. Has a lot more to do, also unfortunately, with overtired mothers, and single motherhood. If you go to work 8-10 hours a day and have to take care of a child (or children) alone all night it's easier to fall asleep with them in dangerous situations.

I was a researcher on global infant mortality rates for my friend who is the head of nursing at a university in Tokyo. The longer maternity leave and the more familial help you have with a newborn in the first year, the less likely a child is to die of SIDS. Also, the longer you are in the hospital after giving birth seems to be correlated.

In the US most women go back to work between 6 and 8 weeks after birth which is when the rate of SIDS skyrockets. Also, C-sections are much more common in western countries which leads to women having to go through intense healing for several months afterward which can add stress and exhaustion on already strained new mothers. Not to mention single parent households being much more common in the 'west' than in Japan.

There's a dozen other factors which, no, don't imply that westerners are just drugged up and accidentally killing their babies. Thanks.

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Has a baby ever died of SIDS while being held. Or did they always wait for isolation before giving up.

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Thanks for your answer. So substance abuse is an issue, but you are saying the greater issue is single motherhood. I'll defer to your expertise on that. But so much single motherhood doesn't sound like a ringing endorsement of the US lifestyle either. Either way, the US is one of he most likely countries for SIDS while Japan is one of the least likely. So there is a lesson to be learned.

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Not single motherhood in general, mother exhaustion, whatever the cause, seems to be the main cause.

Your claim that substance abuse is an issue in SIDs simply means that you don't understand what qualifies SIDS as SIDS. If a child dies because a mother is using narcotics or is drunk, it's classified as neglect resulting in accidental death, or manslaughter. There's not a test for SIDS, it's diagnosed by ruling out other possibilities. If a child dies because it suffocates on a teddy bear, the child died by suffocation, not SIDS.

Some of the higher rates of SIDS in the west can be attributed to a wider classification of what SIDS actually is. From what I've seen through personal research in Japan, a SIDS death is only assigned when absolutely no other cause can be identified (as it should be classified). A child with an unobstructed airway dying (seemingly) inexplicably during sleep. In the US they are far more likely to classify a child falling asleep on an exhausted mother on the sofa, suffocating and dying as SIDS than as accidental suffocation. An over-exhausted mother is more likely to put a baby to bed in a way that is quickest to get the infant to sleep (on its back, its side, in a swing, with a blanket, etc.) which is more likely to result in a SIDS classified death.

Probably the biggest improvement the Anglosphere could make is to expand maternity leave, extend hospital stays and encourage familial help, or the help of government funded post-natal doulas, perhaps, in the absence of such familial bonds. Also, because breastfeeding rates are also correlated, the US and UK in particular could stop their pushing of formula over breastmilk and stop demonizing mothers who choose to breastfeed in public.

Not to mention baby-wearing. While visiting the US when my daughter was 3 months old, I wore her in a carrier. Literally every time we left the house I had some comment from strangers about how back in their day they carried their babies in their arms, not like the lazy women today (or something similar). Baby wearing, babies napping (correctly!) in a proper baby carrier are FAR less likely to die of SIDS. A baby being as close to (a rested) Mom as they can for as long as they can is probably the best way to prevent SIDS. In the US there are stigmas against all of these things... breastfeeding, baby-wearing, stay at home mothers, etc... so if you're going to argue against anything, let it be these things. Don't blame poor mothers who lost their babies and call them drug users, substance abusers, etc. It's just factually wrong and quite cruel, actually.

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