Safe to Sleep

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A plot of SIDS rate from 1988 to 2006 Back to sleep plot.png
A plot of SIDS rate from 1988 to 2006

The Safe to Sleep campaign, formerly known as the Back to Sleep campaign, [1] is an initiative backed by the US National Institute of Child Health and Human Development (NICHD) at the US National Institutes of Health to encourage parents to have their infants sleep on their backs (supine position) to reduce the risk of sudden infant death syndrome, or SIDS. The target age group of the campaign is 0–1 years of age, because this is when babies are at the greatest risk of experiencing SIDS. [2] Since "Safe to Sleep" was launched in 1994, the incidence of SIDS has declined by more than 50%. [2] However, there has been a rise in infant sleep-related suffocation events. Consequently, the campaign has broadened its goal to focus on safe sleep conditions and further preventative measures.

Contents

History

In 1992, the American Academy of Pediatrics (AAP) recommended [lower-alpha 1] that babies sleep on their backs or sides to reduce the risk of SIDS (a revised statement in 1996 retracted the side-sleeping option). NICHD launched the "Back to Sleep" campaign in 1994 to spread the message. [2]

The campaign was successful in significantly reducing the percentage of babies sleeping on their stomachs (prone position). It was found, however, that a significant portion of African-American babies were still sleeping on their stomachs; in 1999, an African-American baby was 2.2 times more likely to die of SIDS than a white baby. Thus, then Secretary of Health and Human Services Donna Shalala and Tipper Gore refocused the "Back to Sleep" campaign on minority babies. [2]

Campaign

In 1985 Davies reported that in Hong Kong, where the common Chinese habit was for supine infant sleep position (face up), SIDS was a rare problem. [4] In 1987 the Netherlands started a campaign advising parents to place their newborn infants to sleep on their backs (supine position) instead of their stomachs (prone position). [5] This was followed by infant supine sleep position campaigns in the United Kingdom (as "Back to Sleep"), [6] New Zealand, and Australia in 1991, the U.S. and Sweden in 1992, and Canada in 1993. [5] [7]

This advice was based on the epidemiology of SIDS and physiological evidence which showed that infants who sleep on their back have lower arousal thresholds and less slow-wave sleep (SWS) compared to infants who sleep on their stomachs. [8] Thus, these infants are more easily awakened. However, the arousal thresholds have been shown to be higher during SWS causing infants to be less easily awakened. [8]

In human infants, sleep develops rapidly during early development. This development includes an increase in non-rapid eye movement (NREM) sleep – which is also called quiet sleep (QS) – during the first 12 months of life, in association with a decrease in rapid eye movement (REM) sleep – which is also known as active sleep (AS). [9] [10] [11] In addition, slow wave sleep (SWS) – which consists of stage 3 and stage 4 NREM sleep – appears at 2 months of age, [12] [13] [14] [15] and it is theorized that some infants have a brain-stem defect which increases their risk of being unable to arouse from SWS (also called deep sleep) and therefore have an increased risk of SIDS due to their decreased ability to arouse from SWS. [8]

Studies have shown that preterm infants, [16] [17] full-term infants, [18] [19] and older infants [20] have greater time periods of quiet sleep and also decreased time awake when they are positioned to sleep on their stomachs, meaning these babies are harder to wake when sleeping on their tummy. In both human infants and rats, arousal thresholds have been shown to be at higher levels in the electroencephalography (EEG) during slow-wave sleep. [21] [22] [23]

In 1992, [24] a SIDS risk reduction strategy based upon lowering arousal thresholds during SWS was implemented by the American Academy of Pediatrics (AAP) which began recommending that healthy infants be positioned to sleep on their back (supine position) or side (lateral position) instead of their stomach (prone position) when being placed down for sleep. In 1994, [25] a number of organizations in the United States combined to further communicate these non-prone sleep position recommendations and this became formally known as the "Back To Sleep" campaign. In 1996, [26] the AAP further refined its sleep position recommendation by stating that infants should only be placed to sleep in the supine position and not in the prone or lateral positions.

Since the launch of the campaign, the incidence of SIDS has declined by more than half. However, 3,400 babies (ages 0–1) still die per year from SIDS and sleep-related suffocation events despite the implementation of this campaign. [27] The AAP and further research has shown that there are preventative measures that can be taken to control environmental factors to prevent such adverse events. [28]

SIDS risk factors

Risk factors for SIDS can be divided into three major categories: maternal, infant, and environmental factors. [28] The factors mentioned below are modifiable and preventable to help decrease the occurrence of SIDS and sleep-related suffocation events.

Maternal factorsInfant factorsEnvironmental factors
  • Young maternal age
  • Smoking during pregnancy
  • No prenatal care
  • Late prenatal care
  • Preterm birth
  • Low birth weight [29]
  • Prone sleeping position
  • Sleeping on a soft surface
  • Sleeping with loose blankets, pillows, or stuffed toys
  • Bed-sharing/co-sleeping
  • Sleeping in car seats, rocking seats, or inclined chairs
  • Overheating

Preventive measures

Several precautions focused on controlling environmental factors can be taken to minimize the risk of SIDS and sleep-related suffocation events. [2] [28] [30] [31] Per the safe to sleep campaign, these preventive measures can be taken to decrease the rate of SIDS and sleep-related suffocation events: [2]

See also

Footnotes

  1. ↑ Although recommended by AAP, it was apparently followed in some other countries too. For instance, a study from France from 1999 reports that after this campaign, the incidence of SIDS in France fell from 1464 to just 358 within a period of 1991-1997. [3]

Related Research Articles

<span class="mw-page-title-main">SIDS</span> Sudden unexplained death of a child who is less than one year of age

Sudden infant death syndrome (SIDS), sometimes known as cot death, is the sudden unexplained death of a child of less than one year of age. Diagnosis requires that the death remain unexplained even after a thorough autopsy and detailed death scene investigation. SIDS usually occurs during sleep. Typically death occurs between the hours of midnight and 9:00a.m. There is usually no noise or evidence of struggle. SIDS remains the leading cause of infant mortality in Western countries, constituting half of all post-neonatal deaths.

<span class="mw-page-title-main">Brachycephaly</span> Short, broad head

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<span class="mw-page-title-main">Plagiocephaly</span> Skull malformation such that one side is flattened

Plagiocephaly, also known as flat head syndrome, is a condition characterized by an asymmetrical distortion of the skull. A mild and widespread form is characterized by a flat spot on the back or one side of the head caused by remaining in a supine position for prolonged periods.

<span class="mw-page-title-main">Shaken baby syndrome</span> Medical condition

Shaken baby syndrome (SBS), also known as abusive head trauma (AHT), is a medical condition in children younger than five years old, generally caused by blunt trauma, vigorous shaking, or a combination of both. The concept is controversial and remains scientifically disputed.

The American Academy of Pediatrics (AAP) is the largest professional association of pediatricians in the United States. It is headquartered in Itasca, Illinois, and maintains an office in Washington, D.C. The AAP has published hundreds of policy statements, ranging from advocacy issues to practice recommendations.

Co-sleeping or bed sharing is a practice in which babies and young children sleep close to one or both parents, as opposed to in a separate room. Co-sleeping individuals sleep in sensory proximity to one another, where the individual senses the presence of others. This sensory proximity can either be triggered by touch, smell, taste, or noise. Therefore, the individuals can be a few centimeters away or on the other side of the room and still have an effect on the other. It is standard practice in many parts of the world, and is practiced by a significant minority in countries where cribs are also used.

<span class="mw-page-title-main">Pacifier</span> Rubber, plastic or silicone nipple for infants or toddlers to suck upon

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<span class="mw-page-title-main">Infant bed</span> Small bed for infants and very young children

An infant bed is a small bed especially for infants and very young children. Infant beds are a historically recent development intended to contain a child capable of standing. The cage-like design of infant beds restricts the child to the bed. Between one and two years of age, children are able to climb out and are moved to a toddler bed to prevent an injurious fall while escaping the bed.

<span class="mw-page-title-main">Swaddling</span> Practice of wrapping infants so as to restrict movement

Swaddling is an ancient practice of wrapping infants in blankets or similar cloths so that movement of the limbs is tightly restricted. Swaddling bands were often used to further restrict the infant. Swaddling fell out of favour in the 17th century.

<span class="mw-page-title-main">Supine position</span> Lying horizontally with the face and torso facing up

The supine position means lying horizontally with the face and torso facing up, as opposed to the prone position, which is face down. When used in surgical procedures, it grants access to the peritoneal, thoracic and pericardial regions; as well as the head, neck and extremities.

<span class="mw-page-title-main">Tummy time</span> Colloquialism related to child-rearing

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<span class="mw-page-title-main">Infant sleep</span>

Infant sleep is an act of sleeping by an infant or a newborn. It differs significantly from sleep during adulthood. Unlike in adults, sleep early in infancy initially does not follow a circadian rhythm. Infant sleep also appears to have two main modes - active, associated with movement, and quiet, associated with stillness - exhibiting distinct neurological firing patterns. Sleep duration is also shorter. As the infant ages, sleep begins to follow a Circadian rhythm and sleep duration increases. Infants nap frequently. Infants are also particularly vulnerable during sleep; they are prone to suffocation and SIDS. As a result, "safe" sleep techniques have been the subject of several public health campaigns. Infant sleep practices vary widely between cultures and over history; historically infants would sleep on the ground with their parents. In many modern cultures, infants sleep in a variety of types of infant beds or share a bed with parents. Infant sleep disturbance is common, and even normal infant sleep patterns can cause considerable disruption to parents' sleep.

References

  1. ↑ Safe to Sleep Public Education Campaign
  2. 1 2 3 4 5 6 7 "Safe to Sleep".
  3. ↑ Rambaud C, Guibert M, Briand E, Grangeot-Keros L, Coulomb-L'Herminé A, Dehan M (August 1, 1999). "Microbiology in sudden infant death syndrome (SIDS) and other childhood deaths" . FEMS Immunol Med Microbiol. 25 (1–2): 59–66. doi:10.1111/j.1574-695X.1999.tb01327.x. PMID   10443492.
  4. ↑ Davies DP (December 1985). "Cot death in Hong Kong: a rare problem?". Lancet. 2 (8468): 1346–9. doi:10.1016/S0140-6736(85)92637-6. PMID   2866397. S2CID   37250070.
  5. 1 2 Högberg U; Bergström E (April 2000). "Suffocated prone: the iatrogenic tragedy of SIDS". Am J Public Health. 90 (4): 527–31. doi:10.2105/AJPH.90.4.527. PMC   1446204 . PMID   10754964.
  6. ↑ Perkins, Anne (26 August 2016). "Back to sleep: the doctor who helped stem a cot death epidemic". The Guardian. Retrieved November 1, 2024.
  7. ↑ Rusen ID; Liu S; Sauve R; Joseph KS; Kramer MS (2004). "Sudden infant death syndrome in Canada: trends in rates and risk factors, 1985–1998". Chronic Dis Can. 25 (1): 1–6. PMID   15298482.
  8. 1 2 3 Kattwinkel J, Hauck F.R., Moon R.Y., Malloy M and Willinger M (2006). "Infant Death Syndrome: In Reply, Bed Sharing With Unimpaired Parents Is Not an Important Risk for Sudden". Pediatrics. 117 (3): 994–996. doi:10.1542/peds.2005-2994. S2CID   219210568.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  9. ↑ Louis J; Cannard C; Bastuji H; Challamel MJ (May 1997). "Sleep ontogenesis revisited: a longitudinal 24-hour home polygraphic study on 15 normal infants during the first two years of life". Sleep. 20 (5): 323–33. doi: 10.1093/sleep/20.5.323 . PMID   9381053.
  10. ↑ Navelet Y; Benoit O; Bouard G (July 1982). "Nocturnal sleep organization during the first months of life". Electroencephalogr Clin Neurophysiol. 54 (1): 71–8. doi:10.1016/0013-4694(82)90233-4. PMID   6177520.
  11. ↑ Roffwarg HP; Muzio JN; Dement WC (April 1966). "Ontogenetic Development of the Human Sleep-Dream Cycle". Science. 152 (3722): 604–619. Bibcode:1966Sci...152..604R. doi:10.1126/science.152.3722.604. PMID   17779492.
  12. ↑ Anders TF; Keener M (1985). "Developmental course of nighttime sleep-wake patterns in full-term and premature infants during the first year of life. I". Sleep. 8 (3): 173–92. doi:10.1093/sleep/8.3.173. PMID   4048734.
  13. ↑ Bes F; Schulz H; Navelet Y; Salzarulo P (February 1991). "The distribution of slow-wave sleep across the night: a comparison for infants, children, and adults". Sleep. 14 (1): 5–12. doi: 10.1093/sleep/14.1.5 . PMID   1811320.
  14. ↑ Coons S; Guilleminault C (June 1982). "Development of sleep-wake patterns and non-rapid eye movement sleep stages during the first six months of life in normal infants". Pediatrics. 69 (6): 793–8. doi:10.1542/peds.69.6.793. PMID   7079046. S2CID   245107809.
  15. ↑ Fagioli I; Salzarulo P (April 1982). "Sleep states development in the first year of life assessed through 24-h recordings". Early Hum. Dev. 6 (2): 215–28. doi:10.1016/0378-3782(82)90109-8. PMID   7094858.
  16. ↑ Myers MM, Fifer WP, Schaeffer L, et al. (June 1998). "Effects of sleeping position and time after feeding on the organization of sleep/wake states in prematurely born infants". Sleep. 21 (4): 343–9. PMID   9646378.
  17. ↑ Sahni R, Saluja D, Schulze KF, et al. (September 2002). "Quality of diet, body position, and time after feeding influence behavioral states in low birth weight infants". Pediatr. Res. 52 (3): 399–404. doi: 10.1203/00006450-200209000-00016 . PMID   12193675.
  18. ↑ Brackbill Y; Douthitt TC; West H (January 1973). "Psychophysiologic effects in the neonate of prone versus supine placement". J. Pediatr. 82 (1): 82–4. doi:10.1016/S0022-3476(73)80017-4. PMID   4681872.
  19. ↑ Amemiya F; Vos JE; Prechtl HF (May 1991). "Effects of prone and supine position on heart rate, respiratory rate and motor activity in fullterm newborn infants". Brain Dev. 13 (3): 148–54. doi:10.1016/S0387-7604(12)80020-9. PMID   1928606. S2CID   4763777.
  20. ↑ Kahn A; Rebuffat E; Sottiaux M; Dufour D; Cadranel S; Reiterer F (February 1991). "Arousals induced by proximal esophageal reflux in infants". Sleep. 14 (1): 39–42. PMID   1811318.
  21. ↑ Ashton R (April 1973). "The influence of state and prandial condition upon the reactivity of the newborn to auditory stimulation". J Exp Child Psychol. 15 (2): 315–27. doi:10.1016/0022-0965(73)90152-5. PMID   4735894.
  22. ↑ Rechtschaffen A; Hauri P; Zeitlin M (June 1966). "Auditory awakening thresholds in REM and NREM sleep stages". Perceptual and Motor Skills. 22 (3): 927–42. doi:10.2466/pms.1966.22.3.927. PMID   5963124. S2CID   43435940.
  23. ↑ Neckelmann D; Ursin R (August 1993). "Sleep stages and EEG power spectrum in relation to acoustical stimulus arousal threshold in the rat". Sleep. 16 (5): 467–77. PMID   8378687.
  24. ↑ "American Academy of Pediatrics AAP Task Force on Infant Positioning and SIDS: Positioning and SIDS". Pediatrics. 89 (6 Pt 1): 1120–6. June 1992. doi:10.1542/peds.89.6.1120. PMID   1503575. S2CID   6692631.
  25. ↑ U.S. Department of Human Services. "BACK TO SLEEP" CAMPAIGN SEEKS To Reduce Inicidence of SIDS In African American Populations PressRelease. https://www.hhs.gov/news/press/1999pres/991026.html Tuesday, October 26, 1999
  26. ↑ "Positioning and sudden infant death syndrome (SIDS): update. American Academy of Pediatrics Task Force on Infant Positioning and SIDS". Pediatrics. 98 (6 Pt 1): 1216–8. December 1996. doi:10.1542/peds.98.6.1216. PMID   8951285. S2CID   12399873.
  27. ↑ "CDC SIDS". 7 September 2022.
  28. 1 2 3 4 5 6 TASK FORCE ON SUDDEN INFANT DEATH SYNDROME (2016-10-24). "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment". Pediatrics. 138 (5): e20162938. doi: 10.1542/peds.2016-2938 . ISSN   0031-4005. PMID   27940804. S2CID   4930719.
  29. ↑ Bigger, Harold R.; Silvestri, Jean M.; Shott, Susan; Weese-Mayer, Debra E. (July 1998). "Influence of increased survival in very low birth weight, low birth weight, and normal birth weight infants on the incidence of sudden infant death syndrome in the United States: 1985-1991". The Journal of Pediatrics. 133 (1): 73–78. doi:10.1016/s0022-3476(98)70181-7. ISSN   0022-3476. PMID   9672514.
  30. 1 2 3 4 5 6 TASK FORCE ON SUDDEN INFANT DEATH SYNDROME (2016-10-24). "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment". Pediatrics. 138 (5): e20162938. doi: 10.1542/peds.2016-2938 . ISSN   0031-4005. PMID   27940804. S2CID   4930719.
  31. 1 2 3 4 5 6 Hauck, Fern R.; Thompson, John M. D.; Tanabe, Kawai O.; Moon, Rachel Y.; Vennemann, Mechtild M. (2011-07-01). "Breastfeeding and Reduced Risk of Sudden Infant Death Syndrome: A Meta-analysis". Pediatrics. 128 (1): 103–110. doi:10.1542/peds.2010-3000. ISSN   0031-4005. PMID   21669892. S2CID   1257376.
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