Four-month-old Reneja never woke up from her sleep. Her 24-year-old mother found her wedged between the wall and the soft mattress of the bed they shared in their Milwaukee home. Each year, over 6,000 American parents go to greet their baby in the morning only to find them blue and lifeless. These infants die either from Sudden Infant Death Syndrome (SIDS) or from the increasingly common problem that befell Reneja, accidental suffocation. In sheer numbers, that’s equivalent to a 9/11 tragedy every year for our youngest citizens. In 1992, doctors discovered a key cause of SIDS: stomach sleeping. Shortly thereafter, public health groups (like the American Academy of Pediatrics, AAP) launched the Back to Sleep campaign. Back to Sleep reminds parents that the only safe sleeping position for babies is on the back. Over the past 20 years, we’ve also learned that parents can lower their baby’s SIDS risk by avoiding smoking (during pregnancy or in the home after the baby is born), overheating and removing bulky, soft bedding from the baby’s bed. Today, these life saving recommendations are taught in hospitals, clinics and doctors’ offices across the nation. And, we have cut SIDSdeaths by over 50%. It’s an enormous success and cause for celebration, but our work is far from done. For more than a decade, SIDS rates have stubbornly refused to drop. And, the U.S. Center for Disease Control has reported that, for the past 15 years, infant suffocation deaths, like Reneja’s, have risen an alarming 14% per year. A much stronger effort is needed to save the 3,000 infants who will die from sleep-related causes in 2012. This month, the AAP took a step in that direction by issuing a new set of guidelines to prevent these deaths. The recommendations include:
Back sleeping… only • Room-sharing… but no bed-sharing • Encouraging breastfeeding • Routine immunizations • Avoiding soft, saggy sleep surfaces (waterbeds, comforters, sofas, etc) • Pacifier use when falling asleep
This is important advice. But, it overlooks one of the leading causes of unsafe sleep: infant irritability. Many babies hate sleeping on the back. Exhausted parents often spend hours trying to ease these criers back to sleep. Frustrated, some simply give up and lay their babies down on the stomach (tummy-down babies tend to fuss less and sleep more). Or, overcome with fatigue, they accidentally fall asleep — their baby nestled against their bodies — on an unsafe surface, like their bed, a recliner or couch. Either way, too many parents are tempted into a situation where the risk of SIDS and suffocation death increases significantly. A key solution for reducing fussing — and thus promoting safe sleep — is swaddling. When done correctly safe swaddling offers the potential to:
Reduce the lure of placing babies on the stomach. (Swaddled babies sleep just as well on the back as unwrapped babies sleep on the stomach.) • Reduce the chance of falling asleep with the baby on a dangerous surface. (Exhaustion causes similar brain numbness as being drunk. No wonder tired parents can put an arm over their baby’s face without even realizing it.) • Reduce the chance of rolling into a dangerous position (into a pillow, against a wall or onto the stomach). • Increase breastfeeding success. (Breastfeeding cuts SIDS risk in half, but infant crying is one of the main reasons moms give up on the breast.) • Reduce maternal cigarette smoking. (Smoking is a common trigger for SIDS and it is often related to the stress of exhaustion and infant irritability.)
And, the potential benefits of swaddling don’t stop there. When combined with other calming techniques (like white noise, swinging motion and sucking) snug wrapping may reduce other serious problems triggered by infant crying/parental exhaustion, such as shaken baby syndrome, postpartum depression, breastfeeding failure, car accidents and maternal obesity. These problems place large emotional burdens on young families and significant economic burdens on communities. They result in lost productivity (due to worker exhaustion and absenteeism) and add well over $1 billion per year to health care costs. Many children’s health groups, such as the American Academy of Pediatrics and the Canadian Pediatric Society, recommend swaddling. But, like infant car seat use, we must teach correct swaddling so that it is done safely and effectively. The keys to safe swaddling are:
Avoiding overheating • Using the correct technique (to avoid unraveled blankets) • Protecting the hips (allowing them to be flexed and open) • Waking for regular feedings • Never allowing stomach sleeping
In 2004, a national campaign was started to train hospitals to teach parents safe swaddling (along with the other calming /sleep promoting techniques used in the Happiest Baby on the Block approach). This approach offers a single, scalable, affordable, effective intervention that may reduce infant sleep deaths and simultaneously strengthen parental competence and confidence. More than 2,600 certified Happiest Baby educators from Alaska to Alabama work with new parents, including over 1,000 educators who teach these classes to the most at-risk mothers and fathers (teens, abusers, drug users, incarcerated, impoverished, etc.) for the departments of health in Massachusetts, Pennsylvania, Minnesota, and Wyoming. Baby Reneja’s tragedy — and many other infant sleep deaths — can be avoided. This year, let us summon our national will and commit ourselves to saving at least 1000 more of our babies from SIDS and suffocation, starting today!