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After a few drowsy moments, the couple realized he was trying to "tell" them that something was wrong. They shot out of bed to check their 9-week old infant and were heartsick to find her limp and blue. They quickly called the paramedics and -- thanks to their heroic dog -- Harper's life was saved. In 2012, over 2,000 U.S. families will suffer the shock of finding their little child crumpled and lifeless, a victim of Sudden Infant Death Syndrome (SIDS). And babies in another 800 families will fall victim to suffocation (in their parent's bed, on a couch, etc.). This terrible pattern repeats itself every single year in the U.S., like a relative 9/11 tragedy of just infants. And since most families don't have a guardian angel -- like Duke -- to protect them, concerned parents are desperate for information to help them prevent SIDS. Unfortunately, although we have uncovered many aspects about SIDS (for example, it peaks when babies are between 2 and 4 months of age and it rarely occurs past 6 months), the great unsolved mystery about this killer is 'why does it happen?'
For decades, doctors believed that choking on spit up was a cause of some of these deaths. We advised parents to only allow their babies to sleep on the stomach. The recommendation was universally popular (in part because laying on the stomach also increases a baby's sleep). But, 20 years ago, scientists discovered that we had made a terrible mistake: Stomach sleeping was not a danger, in fact it actually contributed to SIDS! Doctors quickly reversed gears and launched a worldwide campaign to stop stomach sleeping. Within just a few years the "Back to Sleep" initiative succeeded in reducing stomach sleeping by over 75%. Soon the SIDS rate had plummeted by 50-60%! "Back to Sleep" has been a great public health victory. But, despite it's success, two very troublesome trends have emerged: 1) SIDS rates are stuck at a plateau, refusing to drop any further for over a decade (despite constant reminders to parents to place their babies on the back) and 2) over the past 20 years the number infant suffocation deaths during sleep has quadrupled (and continues to rise 14%/year).
Last October, the American Academy of Pediatrics (AAP) acknowledged the pressing need to do more to reduce SIDS/suffocation deaths. So, they added several new recommendations to back sleeping, including smoking cessation, breastfeeding, avoiding bed sharing and bulky bedding, staying sober, using pacifiers and getting vaccines. (Contrary to the fears of some parents, fully vaccinated babies actually have less SIDS.) Earlier this month, the National Institutes of Health (NIH) began echoing the AAP's new advice in a new campaign called "Safe to Sleep." But, that is not enough! I believe the AAP and NIH are missing a critical part of the big picture. Although valuable, I think these programs overlook a key potential link in regard to the continued SIDS/suffocation deaths: Babies don't always sleep well on their backs! This poor sleep may lead desperately tired parents to use unsafe sleep practices -- like bed sharing and stomach sleeping -- in an effort to get a drop more rest. Exhaustion is the #1 complaint of new moms.
A recent BabyCenter survey found that over 50% of them sleep fewer than six hours per night. Parents are told that extreme fatigue is just an inevitable nuisance, like dirty diapers. But, chronic sleep deprivation is a very serious problem! It causes a type of cognitive fuzz that leads to depression, car accidents and the same poor decision-making that occurs with drinking. And, "drunk parenting" is just as dangerous as drunk driving! An NIH study found that over 80% of the moms who still practiced stomach sleeping said they did it because the baby "didn't like" back sleeping. In other words, they would sleep better/cry less on the stomach. Other weary parents walk their fussy babies in the dark hours of the night, only to fall asleep -- infant in arms -- in high-risk locations, like chairs or sofas. But, the #1 bad decision sleep-drunk parents make is sharing the bed with their baby. Since the launch of "Back to Sleep" there has been a dramatic rise in bed sharing (now over 50% of all families).
Bone-weary parents are ignoring medical advice because back sleeping babies tend to rouse with every startle and passing truck. So, instead, tired moms are cuddling and feeding their infants in bed... and then falling asleep together. Bed sharing has its advocates, but the safest place for infants to sleep is in a bassinet right next to mom (co-sleeping). Sleeping next to your baby lowers the SIDS risk, while sleeping with your baby increases the risk. About 70% of sleep deaths occur when babies share their parents' bed. Alarmingly, British researchers found that 70% of infants who bed share end up with blankets covering the face at some point during the night. A New Zealand videotape study also showed that -- for nearly one hour per night -- the faces of bed sharing babies were covered by a blanket. (The parents usually cleared the blanket away, but almost a third still had their tiny faces covered when they awoke the next morning.) And, the researchers found that bed sharing babies were kept on the side (an unsafe position) for most of the night (5.7 hours).
(Importantly, bed sharing babies also woke 3.7 times more often to eat and 20% of the dads actually left to sleep in another part of the house... defeating the whole idea of the family bed.) So, what's an exhausted parent to do? Should she listen to the AAP and NIH and keep her baby on the back... and suffer more exhaustion? Or, cross her fingers and take the risk of stomach sleeping or bed sharing? Well, the good news is that there is a third approach that solves this dilemma! Two simple steps -- swaddling plus white noise -- can quickly boost your baby sleep (often an extra 1-2 hours) while keeping her safely secured on the back (also called the supine position). Swaddling (snug wrapping in a blanket) keeps back sleeping babies from waking with startles or inadvertently whacking their own face. And, it helps keep babies from accidentally rolling onto the stomach. And, contrary to the concerns of skeptics, studies show that swaddling does not overheat babies (unless the head is covered or the room is hot) and it is perfectly safe for the hips (as long as they're are allowed to bend a little).
An article about swaddling, in the AAP's journal Pediatrics, noted, "Swaddled infants in the supine position have a lower risk for SIDS." It cited Australian and New Zealand studies that found 30% reductions is SIDS among infants who were sleeping swaddled and placed on the back. A recent study reported that moms who swaddle are significantly more likely to follow medical advice and put their babies to sleep on the back, than those who don't swaddle. The second sleep aid -- white noise -- has also been shown to increase sleep (although it is not as intensively studied as swaddling). Strong shushing sounds imitate the noise babies hear in the womb and they activate the calming reflex: a relative off-switch for crying and on-switch for sleep that all babies posses at birth. Swaddling and shushing are two of the five techniques (the 5 S's), described in The Happiest Baby on the Block. Recent studies have confirmed that the 5 S's increase sleep and reduce crying (and, may even help prevent obesity at one year of age).