hope is on the way

Now there are steps parents can take to help prevent sudden infant death syndrome.

It’s the call every pediatrician dreads. Mine came at three o’clock on a cold morning in the winter of 1972. I picked up the receiver and heard a mother’s voice on the other end: “Doctor, my baby’s dead!” Incredulous, I rushed to her home and found devastated parents holding their lifeless child. The paramedics had just left. I will never forget the look of shock and disbelief on the faces of the parents. That was the first time I witnessed the grief caused by sudden infant death syndrome (SIDS).

Even though each year 4,500 to 6,000 babies in the United States go to sleep and never wake up, SIDS is one of the tragedies least likely to happen in a family. It only occurs in approximately 1 to 2 babies per thousand, meaning that 99.9 percent of babies go to bed each night and do wake up. Still, even the possibility can be shattering.

As I sat helplessly in front of the heartbroken couple, I hoped that some day I would be able to look confidently into the eyes of all parents and say, “Yes, here’s what you can do to lessen the chances of your baby dying of SIDS.”

My wish is now being fulfilled. In recent years new insights have taken the hopelessness out of SIDS. In many countries prevention programs have been shown to reduce the risk of SIDS by 50 percent and more. Here are five steps you can take to protect your baby.

1 Give your baby a healthy womb environment. Prematurity and low birth weight are two risk factors for SIDS, and what you do while pregnant has a direct effect on both. Although the SIDS risk in premature babies is higher, the good news is that 99 percent of premature babies don’t die of SIDS. Mothers who take good prenatal care of themselves and use prevention tips can reduce the risk, even if their babies are premature.

Grow your baby in a drug-free womb. Taking drugs while pregnant increases the risk of SIDS in two ways: First, it ups the chance of your baby being born prematurely. Second, researchers believe that drugs such as opiates and cocaine constrict blood vessels in the placenta and reduce oxygen supply to the respiratory control center in the brain that regulates breathing—a suffocation effect.

2 Do not allow smoking around your baby—pre- or postnatally. One of the most significant risk factors for SIDS is smoking around a baby—whether the baby is in the womb or simply in the same room. Studies show that exposure to cigarette smoking at least doubles the risk of SIDS. Any maternal smoking during pregnancy may more than triple the risk, and heavy maternal smoking (more than 20 cigarettes a day) increases this SIDS risk fivefold.

Nicotine narrows blood vessels, reduces blood flow to the baby, and robs Baby of oxygen. Anything that lowers oxygen to the baby may increase the risk of SIDS, probably by harming the development of Baby’s respiratory control system in the brain, and also by stunting overall growth. The risk of SIDS also increases if a pregnant woman is around secondhand smoke (especially if her partner smokes). Demand that your family and coworkers respect the life inside your womb. If your job requires working in a smoke-contaminated area while pregnant, know that this could be grounds for a reassignment to a baby-healthy environment. (Check with your state’s occupational safety and health administration.)

Simply smoking around babies after birth places them at increased risk of SIDS. You endanger your baby whenever you take him into a room frequented by smokers. Even sitting in the nonsmoking area in public places is helpful, but not always enough; it’s a little like trying to chlorinate half a swimming pool.

Among the many toxic ingredients other than nicotine in cigarette smoke are the oxygen blocker carbon monoxide; benzene (a potential carcinogen); ammonia; hydrogen cyanide (which is used in making rat poison); and formaldehyde (which is becoming a prime suspect in SIDS cases).

Smoking also interferes with natural mothering and is likely to sabotage breastfeeding (lack of breastfeeding is another risk factor for SIDS). Studies show that mothers who smoke have a lower level of prolactin, one of the “bonding” hormones that regulates milk production and affects mothering behavior. A mother with less prolactin may have less awareness of her infant, an especially worrisome situation when these infants are already compromised due to exposure to smoke.

3 Put your baby to sleep on her back, not her side or stomach. SIDS rates have fallen 40 to 70 percent in eight countries that instituted national Back to Sleep campaigns, similar to infant car seat campaigns. Since the American Academy of Pediatrics (AAP) issued its first recommendation on infant sleep positioning in 1992, then began its own Back to Sleep campaign in 1994, cases in the United States have declined 15 to 20 percent. Preliminary studies suggest that back-sleeping babies breathe more easily and arouse from sleep more readily. (Arousability from sleep is a healthy, protective mechanism and one that is thought to be diminished in infants at risk for SIDS.)

The AAP recommends that all infants be placed to sleep on their backs. If your baby refuses to sleep on his back, an alternative is sleeping on his side with the lower arm extended to lessen the chance of his rolling over on his tummy. Babies with certain medical conditions, such as small jawbones or structural abnormalities of the airway, or those who suffer from gastroesophageal reflux, breathe more safely when placed to sleep on their tummies. Discuss these conditions and safe alternatives with your doctor.

4 Breastfeed your baby if possible. New research confirms what mothers have long suspected: The risk of SIDS is lower in breastfed babies. A study from New Zealand shows that SIDS was three times higher in babies who were not breastfed. There are hundreds of health-promoting and immunity-building substances in human milk that aren’t in formula. These substances cannot be manufactured or bought. Also, nonbreastfed babies have been shown to have lower sleep arousability. If you choose not to or are unable to breastfeed, the other four steps become even more important.

5 Give your baby a safe sleeping environment. Place Baby to sleep on a firm surface. Don’t let her sleep on fluffy comforters, beanbags, cushions, or any other cushy surface that could obstruct her breathing passages. Keep pillows and plush toys out of her reach during sleep.

Also, don’t let her get too warm. Recent research from New Zealand shows that overheating from too much clothing, heavy bedding or a room that’s too hot has a detrimental effect on breathing and increases the risk of SIDS, especially for a baby who has a cold or infection. Signs of overheating are sweating, damp hair, heat rash, rapid breathing, restlessness and sometimes fever.

Whether sleeping with your baby can lower the risk of SIDS or not is currently a subject of debate. I personally believe that sleep-sharing does lower the risk of SIDS because the mother acts as a “breathing pacemaker” when sleeping next to her baby, especially during the vulnerable early months of life when the baby’s self-start breathing mechanism is immature. Also, because of a mother’s sensitivity when sleeping so close to her baby, she would be more likely to awaken if her baby’s well-being were threatened.

However, sleeping arrangements are a highly personal decision. If you do decide to sleep with Baby, do it safely. Do not sleep with your baby if you are under the influence of any drugs or alcohol. Don’t fall asleep with the baby on a couch, a free-floating waterbed, a beanbag or similar “sinky” surface.

Above all, don’t let the fear of SIDS ruin the enjoyment of your new baby. Follow as much of this risk-lowering advice as befits your family, and then sit back and enjoy your life together.