From: sg@tredysvr.Tredydev.Unisys.COM (Susanne Gilliam)
Newsgroups: misc.kids
Subject: Wall Street Journal on SIDS
Date: 16 Apr 92 12:51:42 GMT
Article-I.D.: tredysvr.2205
Organization: Unisys Corporation, Tredyffrin, PA


  The following article appeared in the Wall Street Journal this morning
(April 16th, 1992).  I thought it might be of general interest.  It is
reproduced without permission, and any and all errors are most likely mine!
 
"Babies Should Sleep on Backs or Sides, Pediatricians Say"
By Cathy Trost
Staff Reporter of the Wall Street Journal

  Washington - Citing safety concerns, the influential American Academy of
Pediatrics is recommending that healthy babies should sleep on their backs
or sides and not on their stomachs.
  The academy's recommendation could spur a big change in one of the most
common child rearing practices in the U.S.  The majority of U.S. infants
sleep on their stomachs, pediatricians say, because doctors have recommended
that position and many babies seem to prefer it.
  But extensive research reviewed by an academy task force shows a strong 
association between infants sleeping in the prone position, or on their
stomachs, and Sudden Infant Death Syndrome, or SIDS.  "The weight of
evidence implicates the prone position as a significant risk factor for
SIDS," warns the report of the AAP Task Force on Infant Positioning and
SIDS.
  "When we looked at all the data, the association was a very consistent
message," says John Brooks, a member of the task force that spent several
months reviewing more than 100 publications and 10 studies from other
nations.  "Unless we could find reasonably strong evidence that there 
would be something bad about turning babies over, we felt it would be
wrong not to advise people about this."
  Sudden Infant Death Syndrome is a sudden and unexpected death involving
an infant under age one that typically can't be explained after a 
post-mortem examination.  There are about 1.5 cases of SIDS per 1,000 live
births in the U.S., or about 6,000 babies who die every year from SIDS.
The syndrome is the biggest cause of infant death after the neonatal
period, but the risk typically tapers off after six months. 
  Putting babies to sleep on their stomach has long been thought to be
more comfortable for them, and to reduce their chances of choking on 
vomitus if they spit up.  But the task force found "no evidence that
aspiration is a more frequent complication in infants lying supine
when compared to other positions."  In other nations, notably parts of
Europe and Asia, sleeping on the back or side is more common.
  John Kattwinkel, chairman of the task force, says the group isn't 
pushing for a national campaign to change infants' sleep position but
is "making the information available."  He adds that for the "thousands
of parents who lost babies to SIDS, the message is this is not the cause
of SIDS, and turning babies over is not going to eliminate SIDS."  Indeed,
doctors don't really understand the mechanism that causes the syndrome.
  Nonetheless, the academy's move is sure to arouse controversy among
doctors and parents.  Such "policy statements" from the academy carry
weight among pediatricians, who will now choose how to advise parents of
the recommended change.  There will also be a ripple effect on everything
from hospital newborn nurseries to baby-rearing advice books.
  "We must deal with this with extreme caution because the fact is that the
great majority of babies not only prefer but insist on sleeping on their
stomachs," says Benjamin Spock, author of the classic "Dr. Spock's Baby
and Child Care" handbook.  The parenting bible currently advises that
"it is preferable to accustom babies to sleeping on the stomach from the
start, if they are willing."
  "Dr. Spock says the academy's report, which he hadn't yet seen, should be
read "with extreme criticalness to make sure that the case has been 
proven."
  Michael Rothenberg, the co-author of Dr. Spock's book and a professor
emeritus of pediatrics and psychology at the University of Washington
School of medicine, says he wants to review the data carefully before
deciding whether to revise the handbook.
  "I think this is going to upset a lot of parents," he says.  "They'll look
at the baby sleeping on its stomach and say 'Oy! The great American
Academy of Pediatrics in its infinite wisdom told me if I do this I'm
increasing this child's chances of dying of SIDS.'  You have to keep in 
mind that even though this is a pretty dramatic announcement, it doesn't
mean that it will change the way people do things overnight."
  Adds Dr. Spock: "Try putting the baby on its back, but if it insists on
crying or otherwise shows extreme displeasure...I certainly wouldn't let a
baby cry for an hour while insisting on its lying on its back."
  Karla Harris, a mother of two young daughters in Milwaukee, Wis., says
the academy's recommendation would have been "traumatic" when the older
one was a baby.  "She had to sleep on her stomach or she wouldn't fall
asleep," Ms. Harris says.  "She would lie on her back and cry for hours.
But if someone had told me she had to sleep on her back for fear of SIDS,
I would have done anything they told me to."
  "Every parent is worried about SIDS in the back of their mind," says Mary
Ellen Conway, a mother of two and a nurse who runs two pediatric offices in
the Washington D.C. area.  "If someone told me there was less of a risk to
do this, I might do it."
  Richard Ferber, director of the Center for Pediatric Sleep Disorders at
Children's Hospital in Boston, maintains tht infants don't generally have
difficulty adjusting to new sleep positions, and most parents probably
won't face problems switching babies from stomach to back, particularly in
the newborn months.
  The task force members emphasize that some babies should still be put to
sleep on their stomachs, including premature infants with respiratory distress,
infants with gastroesophageal reflux and those with upper airway problems.
They also don't advocate forcing any child onto its back if that upsets
the child.  "It should be stressed that...the actual risk of SIDS when
placing an infant in a prone position is still extremely low," the
report says.
  The group also notes that many other factors have shown to be associated
with SIDS, including maternal smoking and prematurity, and that efforts to
change these conditions could reduce the incidence of SIDS.
  The task force was appointed to review what it called "a growing body of
literature" from Europe, Australia, and New Zealand that suggested that
the stomach position was linked with a higher incidence of SIDS.  For
instance, after an abrupt increase in SIDS in the Netherlands in the 1970's,
researchers speculated that the cause was a change in the predominate infant
sleeping position from back to stomach.
  In two nations that started formal campaigns to encourage parents to
avoid putting their infants to sleep on their stomachs - New Zealand and
the United Kingdom - there were decreases in the incidence of SIDS of 
more than 50%.
  At a recent meeting held by the National Institute of Child Health and
Human Development, experts from the U.S. and overseas were divided on
whether a recommendation on sleep position should be made.  Because of
differences in the U.S. in such factors as types of bedding, house
heating methods and maternal smoking habits, it's "unknown whether a
change in infant sleeping position will change the incidence of SIDS
in this country," says a statement from the institute, which nevertheless
concurs that the evidence supporting a change is "compelling."
  Though the foreign studies had "methodological limitations" and were
conducted in countries with different practices than the U.S., the task
force says that "taken as a group the studies are convincing."  It also
calls for further study on the issue.