Prevent Crib Death

By Christine Gorman

Sometimes the simplest solutions are the most effective. Six years ago, the American Academy of Pediatrics surprised doctors everywhere by urging that all healthy infants be placed on their sides or backs when they sleep. The physicians' group was responding to reports from Europe that showed that babies who sleep on their backs are much less likely to succumb to sudden-infant-death syndrome, also known as crib death, than those who sleep on their stomachs.

Now we know just how vital that recommendation was. According to a study in last week's Journal of the American Medical Association, only 24% of American infants sleep on their stomachs, down from 70% in 1992. And the SIDS rate, which hadn't budged in more than a decade, has plummeted from about 5,000 deaths a year to fewer than 3,000.

"We've seen the change in every segment of society: blacks, non-Hispanic whites and Hispanics," says Marian Willinger, director of SIDS research at the National Institute of Child Health and Human Development and a co-author of the JAMA study. Much of the credit goes to a public-health campaign begun in 1994 under the slogan Back to Sleep. But not everyone has got the message. Those who are still more likely to place their infants on their stomachs include mothers ages 20 to 29, African Americans in the inner city and families who live in Middle Atlantic or Southern states. Note to the civic-minded: Willinger is looking for volunteers who can help get the word out to any of these communities.

Why does lying on the back make such a difference? Researchers suspect the answer has more to do with physics than pathology. As anyone who has ever held one knows, babies are weak. But what you may not realize is just how weak their lungs, in particular, are. If by lying on his stomach, a baby's face becomes mashed against the mattress cover, he can have his breathing passage blocked or can breathe from a small pocket of air until it is depleted of oxygen. Babies' lungs just aren't strong enough to suck in air through the sheets, quilts or mattress covering. Sleeping on his back, of course, leaves his nose and mouth open and ensures freer access to fresh air.

But even if you already place your baby on his back to sleep, there is still more you can do to lower his risk of SIDS. Make sure the mattress is firm, so if your child rolls onto his stomach, his face won't settle into the bed. Remove all fluffy pillows and stuffed animals from the crib. And never let your baby fall asleep on a sheepskin--even on his back. A number of infants have died when the sheepskin or other soft bedding wound up covering their faces. Apparently, the material can cause just enough of a pocket to form around the baby's face that the air inside it is exhausted of oxygen.

You may want to consider what the Europeans are up to now. They've become convinced that overheating also plays a role in triggering crib death. Some parents in Holland, for example, don't even keep sheets on their baby's bed. Instead, they dress the infant in a one-piece "baby sack," which leaves plenty of room for the child to move around without fear of sweltering or suffocating. That may be going a bit far, but there's no denying that taking a few simple steps so that your baby will breathe more easily in his sleep can prevent a terrible heartache later on.