|Abstract:||Guarding all infants in sleep
Rachel A. Gordon, Hillary L. Rowe, and Karina Garcia
The loss of a baby is an extremely traumatic event and has enduring effects that ripple out from parents to their extended families, friends, and co-workers. Educating parents and other infant caregivers about making infants’ sleep settings safer can help prevent these tragedies and the considerable resulting emotional despair and productivity loss.
A sizable racial disparity in rates of Sudden Infant Death Syndrome (SIDS) also troubles many people from a social justice perspective, spurring interest in understanding why the gap persists and how to reduce it. Although death rates from SIDS for both non-Hispanic white and non-Hispanic black babies fell during the back-to-sleep campaigns of the early 1990s, the gap between the two groups remains large. This is true in Illinois as well as the nation.
Understanding of SIDS has changed markedly from the times of heightened concern during the 1980s and early 1990s, when healthy babies mysteriously died in their cribs. Putting babies on their backs to sleep was a tangible protective factor with a clear and easy-to-implement behavioral change. Positioning offered a simple target for reducing SIDS risk; and, in its initial recommendation of 1992, the American Academy of Pediatrics (AAP) Task Force focused principally on this issue of positioning. Sleep positioning campaigns that followed in the United States and around the world were widely seen as producing sizable declines in SIDS deaths.
Strategies to further reduce SIDS are less clear-cut and more controversial. The latest AAP policy statement makes 18 recommendations, each with several subparts. One of the most controversial is AAP’s recommendation that adults not sleep in the same bed with an infant.
Other stakeholders perceive these recommendations as inhibiting breastfeeding, which they view as easiest when mothers spend the entire night on the same sleep surface as the infant. Some controversy also stems from subcultures that value and practice bed sharing, sometimes with very low SIDS rates. Yet other controversy stems from different reading of the evidence cited by the AAP, which some interpret as indicating that bed sharing should be recommended against only when other risks are present (e.g., soft bedding, maternal smoking, parental inebriation or exhaustion).
What next steps can help resolve the debate and advance evidence for policymaking? A collaboration between medical doctors, epidemiologists, anthropologists, and other SIDS researchers – including those prominent on both sides of this issue – would likely move more quickly toward resolving disagreements than would more research done independently by each side.