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Stressed About SIDS?

Even though Kelly Gambrell, 34, is an experienced mom, she still fears SIDS. While she's religious about putting her fourth child, 3-month-old Kullen, on his back to sleep and reminding caregivers to do the same, she can't get over her anxiety, recalling the horror she felt when a co-worker's baby died of SIDS in daycare a few years ago. "I know it could still happen," says the Alexandria, Virginia, administrative manager.

Any parent can relate to Gambrell's dread of Sudden Infant Death Syndrome (SIDS), the unexplained death during sleep of an otherwise healthy baby under 1 year of age. It's a tragic mystery that takes the lives of 2,200 infants a year. SIDS deaths peak between 2 and 4 months, and 90 percent occur before 6 months of age. More boys die from SIDS than girls, and African American and Native American babies are particularly vulnerable, as are preemies and infants whose mothers did not have prenatal care and babies whose mothers smoke.

Although SIDS remains the leading cause of death among children aged 1 month to 1 year, it's still a rare occurrence and babies born today are far less likely to succumb to SIDS than those born a decade ago. "We're nearing a sixty percent reduction in SIDS deaths," says Laura Reno, director of public affairs for the nonprofit First Candle/SIDS Alliance. What's more, research is revealing new ways to reduce your baby's risk. Here's how you can help keep your baby safe.

Put your baby "back" to sleep
Putting your baby on her back to sleep is still the most important way to reduce her SIDS risk. One possible explanation for why back sleeping lowers risk is that a baby who sleeps on her stomach is more likely to "rebreathe" the oxygen-depleted air that she just exhaled. Since 1992, when the American Academy of Pediatrics (AAP) and other health organizations recommended that doctors promote infant back sleeping, the number of SIDS deaths has been cut by more than half. At the time, 70 percent of U.S. infants were sleeping on their stomach; more than ten years later that number has plummeted to 14 percent. (Side sleeping is not recommended because infants can easily turn and end up on their stomach.) The only downside associated with back sleeping is a flattening of the head in some babies, but doctors say "tummy time," when the baby is awake and being supervised by an adult, can help prevent this. If a baby gets used to sleeping on his back from birth, he won't need any device to keep him on his back. In fact, so-called SIDS positioners are not recommended by the AAP, First Candle, or the National Institute of Child Health and Human Development.

Create a safe sleep environment

The safest place for your baby to sleep (whether he's at home, in daycare, or visiting relatives) is in a crib that meets the latest federal and voluntary safety standards. To make sure that yours does, check that it's been certified by either the American Society for Testing and Materials (ASTM) or the Juvenile Products Manufacturers Association (JPMA). It should have a firm, snug-fitting mattress and no loose bedding  -- a SIDS risk because a baby's head could become trapped against a soft surface, depriving him of oxygen. For the same reason, a baby should never be placed to sleep on a soft mattress, waterbed, sofa, quilt, or cushion, or any other soft bedding. Keep your crib basic: no plush stuffed animals (the stuffed toys you get as gifts can happily rest on a nearby shelf till he's old enough to play with them), pillows, or blankets.

Babies really don't need much in the way of bedding  -- use a "sleep sack" instead of a blanket. While Grandma may think they need to be "kept warm," doctors warn that overheating increases SIDS risk. Your baby usually will be comfortable at the same temperature that you are. Although the AAP does not have a position on crib bumpers, First Candle considers them a risk once a baby can roll over. If you use bumpers, opt for firm, not fluffy.

Research shows exposure to cigarette smoke before or after birth can increase the risk of SIDS. Don't let anyone smoke around you during pregnancy or around your baby. And, of course, if you smoke, do everything you can to quit, or at least, always avoid smoking around the baby.

Reconsider co-sleeping
Even moms who don't consider bed sharing a permanent arrangement are tempted to doze off with their baby occasionally for both comfort and convenience. But experts warn this can be dangerous. "A good dozen or so very well-controlled epidemiological studies show a relationship between bed sharing and SIDS," says John Kattwinkel, M.D., Charles Fuller Professor of Neonatology at the University of Virginia School of Medicine in Charlottesville and chairman of the American Academy of Pediatrics task force on SIDS.

Particularly worrisome as more of us put on extra pounds is new research showing that bed sharing with overweight parents may put babies at an even higher risk. First Candle already warns against sleeping with a baby, and at press time, the AAP was debating doing the same.

If you want to stay close to your baby safely, Reno and Dr. Kattwinkel suggest room sharing instead of bed sharing. Position your baby's crib or bassinet next to your own bed (or try a co-sleeper that attaches to your bed) for closeness and easy breastfeeding. Studies show that breastfed babies appear to be at a lower risk of SIDS, although research has not determined why.

Some advocates like La Leche League International and William Sears, M.D., believe co-sleeping can be done safely and offer suggestions for preparing your bed for safe co-sleeping. (To learn how, visit [TOUT_LINK {http://www.lalecheleague.org/} {LaLecheLeague.org}] or [TOUT_LINK {http://www.askdrsears.com/} {AskDrSears.com}].)

Educate caregivers

Parents can help protect their baby even when they aren't around. Because 20 percent of SIDS deaths occur when someone other than a parent is watching the baby (14 percent in daycare settings), SIDS experts say caregivers need to get the word on SIDS safety, particularly back sleeping. A baby who habitually sleeps on his back is even more vulnerable to SIDS if placed on his tummy to sleep, according to a recent Washington University Medical School study. Kelly Gambrell, motivated by her coworker's experience, has done just that. She took her mother with her to the pediatrician to hear firsthand how important back sleeping is. And with her mother-in-law, a nurse who was taught decades ago that tummy sleeping was best, "We pretty much told her she can't watch Kullen if she puts him to sleep on his stomach."

Skip the pacifier guilt
As unlikely as it sounds, a pacifier at night and nap time might help protect your baby: Research shows that babies who use pacifiers have a lower SIDS risk. "The data is very striking," says Dr. Kattwinkel. "Every study has shown a protective effect of pacifiers." One report, the 2003 Chicago Infant Mortality Study, cited not using a pacifier as a significant risk factor, along with soft bedding and stomach sleeping, in urban infants who died of SIDS.

Why might pacifiers help lower the risk of SIDS? That's another mystery. "Everyone has an idea," says Dr. Kattwinkel. Some theorize that it stimulates the airway and keeps it open, that it changes the sleep state of the baby (helping the baby to wake or shift if there is a breathing disturbance), or simply that pacifiers keep babies from rolling onto their faces.

You don't have to worry that "pacis" will cause dental problems as long as babies give up the habit by age 1, says Dr. Kattwinkel. But there are a few downsides. They may cause a slight increase in ear infections and, as a parent of a former pacifier-addicted baby, the giving-up process isn't always pretty. Then there's the "yuck" factor. More than one desperate mom has picked a pacifier off the floor of McDonald's or the grocery store and, after a quick pop into her own mouth, given it back to her baby.

Don't be too concerned that pacifier use will interfere with breastfeeding, says Dr. Kattwinkel. In fact, breastfeeding groups such as La Leche League aren't completely against pacifiers, as long as they are introduced after breastfeeding has been well established. And most experts now agree that "nipple confusion," or the fear that a baby adapted to pacifiers or bottles might prefer them to the breast, isn't a concern if a bottle or pacifier is introduced after the baby is experienced at nursing  -- usually after the first few weeks. You won't miss out on the potential safety benefits by waiting to introduce a pacifier  -- SIDS is very rare during the first month of life.

Try to relax

"Back to Sleep" has been so successful that it's easy to think that tummy sleeping, smoking, and soft bedding "cause" SIDS. But the truth is that some babies appear to be more vulnerable to these risk factors, while others are affected without being exposed to any. New research suggests this may be due to their genetic makeup or abnormalities in their brain.

Identifying these at-risk babies may help us protect them in the future. "Genetics appears to be a very important way of enhancing our understanding of SIDS," says Carl Hunt, M.D., director of the National Center on Sleep Disorders Research at the National Institutes of Health (NIH) in Bethesda, Maryland, and a prominent SIDS researcher. "As we continue to understand how genes differ in babies who die of SIDS, future tests could help us identify those who might be at risk  -- and even correct the abnormality." Here's some of the latest research:

* Infants who die of SIDS often have a malfunction of the brain stem (the part of the brain that regulates automatic activities like breathing and heart rate) in an area that stimulates certain respiratory functions during sleep, according to researchers at Harvard Medical School in Cambridge, Massachusetts. These babies may not respond properly (by turning their head, for example) if their air supply is cut off by a soft pillow.

* Some SIDS victims have gene abnormalities that contribute to potentially fatal heartbeat irregularities or that interfere with the control of serotonin, a chemical that helps regulate sleep, according to Dr. Hunt and other researchers at the NIH.

* While most infants easily survive minor illnesses, early research suggests that a sudden severe or unusual reaction to infection may explain some SIDS cases.

The good news, says Dr. Hunt, is that parents don't need to worry about their possible genetic vulnerability and wait for those future developments before taking protective action against SIDS. "The upbeat message for families is, genetics doesn't determine one's destiny," he says. "There is always an interaction between genetics and environment, and we already know about a variety of important risk factors that parents can control."

That's the approach Kelly Gambrell is taking. "I do exactly what the doctor says, I keep him on his back, and there are no stuffed animals or pillows in the crib," she says. Knowing she's doing all the right things helps keep her worry in check and lets her relax and enjoy her time with Kullen. "You can worry yourself to death," Gambrell adds. "You can't check the baby every five minutes."
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