​​​Miriam E.Tucker

Crib Death Controversy
(American Health, January-February, 1994)

Each year about 6,000 American babies die of sudden infant death syndrome (SIDS), the name given to the unexplained deaths of apparently healthy, sleeping babies.
Last year the American Academy of Pediatrics recommended that infants sleep on their backs or sides, based on several studies suggesting that sleeping on their stomachs put babies at greater risk of SIDS. A new Australian study lends support to the AAP position but by no means ends the controversy that greeted the recommendation.
Researchers at the University of Tasmania compared 58 infants who died of SIDS with 120 healthy infants. Babies put to sleep on their stomachs were more than four times as likely to die of SIDs as infants placed on their backs or sides.  

But the researchers also found four other factors that seemed to contribute to the deaths of infants who slept on their stomachs:  Soft, natural-fiber matresses, swaddling clothes, a recent illness, and heated bedrooms.  
"It never made sense to talk just about the prone position," says pediatric pulmonologist Carol Rosen of Yale University, who agrees with the AAP recommendation.  "These four factors begin to explain just what it is about the prone position that might result in SIDS.  I don't think we're looking at a problem with just one cause." 
Many doctors believe that putting infants to sleep on their backs might cause them to choke when they spit up. "Babies on their backs have more episodes of stomach acid backing into their esophagus," says Dr. Susan Orenstein, a pediatric gastroenterologist at the University of Pittsburgh, who disagrees with the AAP's recommendation.  "I think the problems associated with this position have been underestimated." 
The experts do agree on certain points:  Babies should sleep on firm, smooth mattresses; they shouldn't be overbundled and their bedrooms shouldn't be overheated; and smoking around infants should be avoided because smoke may damage their vulnerable respiratory systems.  
As for sleeping position, it's probably best to talk with your pediatrician. Some infants, including preemies with breathing problems and those who spit up a lot, may do better on their stomachs. ###