October is SIDS Awareness Month

October has long been acknowledged as SIDS Awareness Month. While many states still use the month to raise awareness of SIDS, several have expanded to "Infant Safe Sleep Month," or "SIDS, Pregnancy and Infant Loss Awareness Month." In recognition, we thought it might be useful to provide an overview of the evolution of "SIDS".

History

A standardized definition of sudden infant death was developed in 1969 at the Second International Conference on Causes of Sudden Infant Death. Passage of the SIDS Act of 1974 marked the initiation of federal, state and local efforts to reduce SIDS deaths and to provide professional bereavement and educational services to grieving families. Legislation enacted in 1979 established the SIDS Program Office within the Office of Maternal and Child Health (later MCHB) in the U.S. Department of Health and Human Services. The SIDS definition was revised by Willinger, James & Catz (NICHD) in 1991 as " the sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history".

The "Back to Sleep" Revolution

In 1992, the American Academy of Pediatrics (AAP) released a statement recommending that healthy infants be placed for sleep on their sides or backs, rather than being placed prone to reduce the risk of SIDS. The recommendation was based on numerous reports from other countries that showed that the prone sleeping position was associated with a higher incidence of sudden infant death syndrome (SIDS). The statement was followed by a detailed report from the AAP Task Force on Infant Positioning and SIDS, which was published in the June 1992 issue of Pediatrics. The national "Back to Sleep" campaign was launched in 1994 by the National Institute of Child Health and Human Development as a joint effort involving the U.S. Public Health Service, American Academy of Pediatrics, Association of SIDS and Infant Mortality Programs, and First Candle/SIDS Alliance. In 2000, the AAP updated the recommendations re-enforcing inter alia that back sleep is the most protective, stating the risks associated with soft surfaces, and promoting supervised tummy time for the infant.

The 2005 AAP Policy Statement indicated that the AAP no longer recognizes side sleeping as a reasonable alternative to fully supine sleeping. The Policy Statement also stressed the need to avoid redundant soft bedding and soft objects in the infant's sleeping environment, the hazards of adults sleeping with an infant in the same bed, the SIDS risk reduction associated with having infants sleep in the same room as adults, with using pacifiers at the time of sleep, the importance of educating secondary caregivers and neonatology practitioners on the importance of "back to sleep," and strategies to reduce the incidence of positional plagiocephaly associated with supine positioning. Click to view the AAP Policy.

Changing Terminology: Is it SIDS or SUID?

Since 1994, it has been estimated that SIDS rates have declined by more than 50%. Although the SIDS rates continue to fall, some of the decrease may be a result of coding shifts to other causes of unexpected infant deaths. This might explain, in part, why postneonatal death rates for SIDS and non-SIDS have not changed significantly in the past decade.

A broader term, sudden unexpected infant death (SUID) has been proposed to describe these deaths. More than one-half of the sudden unexpected infant deaths can be attributed to SIDS. Examples of other types of SUID are: metabolic disorders, accidental suffocation, poisoning, neglect/homicide, hypothermia/hyperthermia and unknown. (See CDC's web site for more information.)

Safe Sleep Steps

Always place your baby on his or her back to sleep, for naps and at night. The back sleep position is the safest, and every sleep time counts.
Place your baby on a firm sleep surface, such as on a safety-approved* crib mattress, covered by a fitted sheet. Never place your baby to sleep on pillows, quilts, sheepskins, or other soft surfaces.
Keep soft objects, toys, and loose bedding out of your baby's sleep area. Don't use pillows, blankets, quilts, sheepskins, and pillow-like crib bumpers in your baby's sleep area, and keep any other items away from your baby's face.
Do not allow smoking around your baby. Don't smoke before or after the birth of your baby, and don't let others smoke around your baby.
Keep your baby's sleep area close to, but separate from, where you and others sleep. Your baby should not sleep in a bed or on a couch or armchair with adults or other children, but he or she can sleep in the same room as you. If you bring the baby into bed with you to breastfeed, put him or her back in a separate sleep area, such as a bassinet, crib, cradle, or a bedside cosleeper (infant bed that attaches to an adult bed) when finished.
Think about using a clean, dry pacifier when placing the infant down to sleep, but don't force the baby to take it. (If you are breastfeeding your baby, wait until your child is 1 month old or is used to breastfeeding before using a pacifier.)
Do not let your baby overheat during sleep. Dress your baby in light sleep clothing, and keep the room at a temperature that is comfortable for an adult.
Avoid products that claim to reduce the risk of SIDS because most have not been tested for effectiveness or safety.
Do not use home monitors to reduce the risk of SIDS. If you have questions about using monitors for other conditions talk to your health care provider.
Reduce the chance that flat spots will develop on your baby's head: provide "Tummy Time" when your baby is awake and someone is watching; change the direction that your baby lies in the crib from one week to the next; and avoid too much time in car seats, carriers, and bouncers. View NICHD's safe sleep information.

* For information on crib safety guidelines, contact the Consumer Product Safety Commission at 1-800-638-2772 or visit the CPSC Web Site.