I guess it's ok to post the statement on SIDS now.  The embargo is expired.
For anyone who read my previous post of last Friday, I was not the person
who received this embargoed information.  Someone else broke the embargo,
which is how I got the statement early.  I looked on the AAP website to post
the link to it, but it's not up yet.  Some points I'd like to make.  1)
Please note that the terms "bedsharing" and "co-sleeping" should not be used
interchangeably.  The AAP is cautioning against bed-sharing, but advocating
co-sleeping, which means that they encourage putting baby in a bed in close
proximity to the parent's bed; i.e. in the same room.  While I am NOT happy
about the advice against bedsharing, I AM happy that they are at least
telling parents that baby should be in their room to sleep.  2) The thing I
don't get about the pacifier advice is that they are noting that pacifier
use may prevent SIDS, possibly by the interruption in sleep caused by
sucking on it, but then advocating that parents not replace the pacifier if
it falls out.  What kind of sense does that make?!  If the baby is too sound
asleep to suck on the pacifier, seems like that is when they would be most
vulnerable to SIDS, according to what they are saying the research shows.
So, why wouldn't you put it back in?  Seems like that's precisely when it
would be most needed!  Even the Editor's Note notes that the pacifier use
was "during sleep".  Sounds like the battle against pacifier use just got
kicked up a couple of notches and we'll be seeing even MORE malocclusion
(poor teeth alignment) in the future.  It is really disheartening to see
this tendency to grab on to any tidbit of research and portray it as THE
answer to a problem and fail to look further into WHY something happens or
what the context is.  Babies who nurse in a bedsharing or even modified
bedsharing environment sleep on their backs while sucking on and off a good
part of the night.  Problem solved.  Sheesh!

Marsha, where our local news reported this story with the SIDS director
telling her baby's story of dying of SIDS (not to make light of her loss)
but what is not revealed is that her bottle-fed baby died while in a crib in
a separate room, and she talks about the whole re-breathing explanation for
SIDS death, which is a theory and has NEVER been proven to occur!

AAP REVISES SIDS PREVENTION RECOMMENDATIONS 


WASHINGTON, DC -Despite major decreases in the incidence of Sudden
Infant Death Syndrome (SIDS) over the past decade, SIDS is still
responsible for more infant deaths beyond the newborn period in the
United States than any other cause of death during infancy.  In an
updated policy statement on  "The Changing Concept of Sudden Infant
Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the
Sleeping Environment, and New Variables to Consider in Reducing Risk,"
the American Academy of Pediatrics (AAP) addresses several issues that
have become relevant since they last published a statement in 2000.


The AAP no longer recognizes side sleeping as a reasonable alternative
to fully supine (lying on back) sleeping.  Studies have found that the
side sleep position is unstable and increases the chances of the infant
rolling onto his or her stomach.  Every caregiver should use the back
sleep position during every sleep period.  


Bed sharing is not recommended during sleep.  Infants may be brought
into bed for nursing or comforting, but should be returned to their own
crib or bassinet when the parent is ready to return to sleep.  However,
there is growing evidence that room sharing (infant sleeping in a crib
in parent's bedroom) is associated with a reduced risk of SIDS.  The
AAP recommends a separate but proximate sleeping environment.  


Research now indicates an association between pacifier use and a
reduced risk of SIDS, which is why the revised statement recommends the
use of pacifiers at nap time and bedtime throughout the first year of
life.  The evidence that pacifier use inhibits breastfeeding or causes
later dental complications is not compelling enough to discredit the
recommendation. However, it is recommended that pacifier introduction
for breastfed infants be delayed until one month of age to ensure that
breastfeeding is firmly established.  In addition, if the infant refuses
the pacifier, it should not be forced.  There is a slight increased risk
of ear infections associated with pacifier use, but the incidence of ear
infection is generally lower in the first year of life, especially the
first six months, when the risk of SIDS is the highest.  


The following have been consistently identified as risk factors for
SIDS: prone (lying on stomach) sleep position, sleeping on a soft
surface, maternal smoking during pregnancy, overheating, late or no
prenatal care, young maternal age, preterm birth and/or low birth weight
and male gender.  Consistently higher rates of SIDS are found in black
and American Indian/Alaska Native children - two to three times the
national average. 


The policy recommendations include:  
* Back to sleep: Infants should be placed for sleep in a supine (wholly
on back position) for every sleep.
* Use a firm sleep surface: A firm crib mattress, covered by a sheet,
is the recommended sleeping surface. 
* Keep soft objects and loose bedding out of the crib: Pillows, quilts,
comforters, sheepskins, stuffed toys and other soft objects should be
kept out of an infant's sleeping environment. 
* Do not smoke during pregnancy: Also avoiding an infant's exposure
to second-hand smoke is advisable for numerous reasons in addition to
SIDS risk.
* A separate but proximate sleeping environment is recommended such as
a separate crib in the parent's bedroom.  Bed sharing during sleep is
not recommended. 
* Consider offering a pacifier at nap time and bedtime: The pacifier
should be used when placing infant down for sleep and not be reinserted
once the infant falls asleep.  
* Avoid overheating: The infant should be lightly clothed for sleep,
and the bedroom temperature should be kept comfortable for a lightly
clothed adult. 
* Avoid commercial devices marketed to reduce the risk of SIDS:
Although various devices have been developed to maintain sleep position
or reduce the risk of rebreathing, none have been tested sufficiently to
show efficacy or safety. 
* Do not use home monitors as a strategy to reduce the risk of SIDS:
There is no evidence that use of such home monitors decreases the risk
of SIDS.
* Avoid development of positional plagiocephaly (flat back of head):
Encourage "tummy time."  * Avoid having the infant spend excessive
time in car-seat carriers and "bouncers." Place the infant to sleep
with the head to one side for a week and then changing to the other. 
* Assure that others caring for the infant (child care provider,
relative, friend, babysitter) are aware of these recommendations. 


END


[For an interview on this policy statement, contact John Kattwinkel,
MD, FAAP, at 434/924-5428 or via e-mail at [log in to unmask] or Rachel
Moon, MD, FAAP, at 202-884-4500 or via e-mail at [log in to unmask] or
Michael Molloy, MD, FAAP, at 409/772-2815 or via e-mail at
[log in to unmask] ]


EDITOR'S NOTE: In a related review article, "Do Pacifiers Reduce
the Risk of Sudden Infant Death Syndrome? A Meta-Analysis," found that
several studies show a significant reduced risk of SIDS with pacifier
use, particularly when used during sleep. For more information on this
article, contact Fern Hauck, MD, at 434-982-4153 or via e-mail at
[log in to unmask]

~~~~~~~~~~~~~~~~~Marsha Glass RN, BSN, IBCLC~~~~~~~~~~~~~~~~~~~~~
Mothers have as powerful an influence over the welfare of future generations
as all other earthly causes combined.
~~~~~~~~~~~~~~~~~~~~~~~~~John S. C. Abbot~~~~~~~~~~~~~~~~~~~~~~~~~

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