Of all causes of child death, Sudden Infant Death Syndrome (SIDS) may be the most devastating, because it often occurs without warning and because the exact etiology of SIDS is unknown. What researchers do know is that certain factors put infants at higher risk of SIDS, and that all caregivers, perhaps grandparents in particular, need to know how to reduce the risk of SIDS.
Why Is It Important to Educate Grandparents?
Why should grandparents be singled out as particularly in need of this education? Depending upon exactly when we reared our children, child care practices may have changed fairly radically. For years we were told to place our babies on their stomachs to sleep. Today parents are taught that babies should always sleep on their backs. We were urged to keep our babies warm and often used fleecy blankets to cover them. Today parents are taught to keep coverings well away from their babies' faces and to be sure that they do not become overheated.
According to a policy statement by the American Academy of Pediatrics (AAP), one-fifth of all SIDS deaths occur while the child is in the care of someone other than parents. This seemingly high number could be the result of caregivers, including grandparents, being uninformed about SIDS. Research further shows that babies who normally sleep on their backs are even more at risk when placed on their stomachs. It's easy to imagine a scenario in which a baby who is normally a back sleeper is left in the care of a grandparent, who places the baby on its stomach to sleep, with tragic results.
Another risk factor is sharing a bed with others. The best place for a baby to sleep is in its own crib that has been placed in its parents' or caregiver's bedroom. Since some grandparents do not have baby cribs, they may be more inclined to sleep with the baby, further increasing the risk of SIDS. At least one study limits the association to babies cosleeping with someone other than parents, but grandparents fall into that category.
Why Does Back Sleeping Help?
Most theories about SIDS relate it to some disruption in air supply. The AAP's definition reflects the mysterious nature of the syndrome: "The sudden death of an infant under 1 year of age, which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history." It has been widely posited that SIDS is caused when a baby rebreathes its own carbon dioxide, the "stale air hypothesis." Another possibility, according to the AAP, is that babies who die of SIDS have an anomaly in the brain stem or a lag in development which causes them not to rouse in the event of "life-threatening challenges during sleep." In other words, they may not wake up when their air supply is compromised.
Encouraging back sleeping has been highly effective in reducing SIDS. The AAP's 1992 policy statement was followed by the initiation in 1994 of a "Back to Sleep" education campaign, with the result that SIDS deaths were reduced 58% from 1992 to 2002. Although some decrease may be attributable to some infant deaths being coded differently, the switch to back sleeping has undoubtedly saved many lives and much heartache. One less encouraging statistic is that the percentage of SIDS deaths occurring under the care of someone other than parents has not decreased.
What Are the Other Risk Factors?
Exposure to secondhand smoke, both as a developing fetus and after birth, is a significant risk factor for SIDS. Obviously, no one should smoke around pregnant women or children. Grandparents who are going to be caring for grandbabies should not allow smoking in their homes or vehicles. Smoke-free environments should be chosen for outings.
Other risk factors for SIDS are outside the control of a grandparents. For example, having a young mother or a mother with little or delayed prenatal care puts a child at increased risk. In addition to back sleeping, however, grandparents and other caregivers should be aware of the best practices for caring for sleeping infants. These are:
- Put babies to sleep in a supine position, not on their sides, because babies sometimes roll from their sides to their stomachs.
- Put babies to sleep on a firm crib mattress covered only by a sheet with no other bedding, such as mattress pads or sheepskins, underneath.
- Keep blankets, stuffed animals and pillows out of the sleep environment.
- If using a blanket for any reason, tuck it in so that when the baby's feet are at the bottom of the crib, the top of the blanket will come only to the baby's chest.
- Do not put babies in bed with you.
- Do not overdress babies or overheat the room.
- Offering a pacifier appears to have some protective effect.
- One study has shown that a fan to circulate the air can be beneficial.
Some grandparents may think, "I shared a bed with my babies, wrapped them warmly and put them to sleep on their tummies, and they all escaped SIDS." It's important to remember that SIDS is relatively rare, occurring once in every 2000 or so live births. Still, it is the number one cause of death among infants once they leave the neo-natal period, defined as the first 28 days of life. Most of us are acquainted, at least distantly, with someone who has lost a child to SIDS. It is, therefore, the responsibility of all caregivers to follow those practices known to reduce its risk. A loving grandparent can do no less.
"The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk." Policy Statement. American Academy of Pediatrics. November 1, 2005. Accessed: January 26, 2009. http://aappolicy.aappublications.org/cgi/content/full/pediatrics;116/5/1245
Coleman-Phox, MPH, Kimberly; Roxana Odouli, MSPH; De-Kun Li, MD, PhD. "Use of a Fan During Sleep and the Risk of Sudden Infant Death Syndrome." Archives of Pediatric and Adolescent Medicine. Oct 2008. 162(10).
Secondhand Smoke Causes Sudden Infant Death Syndrome. Fact Sheet. Centers for Disease Control and Prevention. Oct. 2006. Accessed: January 26, 2009.