Put baby on her back to sleep
MANY Caribbean families, despite new recommendations, continue to practise setting their babies to sleep on their stomachs — a position which paediatrician Dr Anona Griffith says the International Pediatric Association has described as unsafe. She said that parents and caregivers who continue to reject advice to put their babies to sleep on their backs could be putting infants at an increased risk of sudden infant death syndrome (SIDS).
“All infants should be placed on the back to sleep at all times, as it is the safest position. This also applies to premature infants,” Dr Griffith advised.
She said that this is the recommended sleeping position for a healthy infant, as issued by the American Academy of Paediatrics (AAP) task force on infant position and SIDS recommendations, published in 1992 and confirmed in 1994, 2000 and 2005.
She said that the decision was made and the recommendations published following very high incidences of sudden infant deaths that were directly linked to incorrect sleeping positions, the main being sleeping on the stomach.
“SIDS is a condition in which an infant dies suddenly, without warning, while they are asleep, and where the infant’s death remains unexplained even after investigation and autopsy. The increasing number of children who have been categorised as SIDS casualties resulted in public education campaigns in many countries, which yielded [a significant] reduction in the number of infant deaths attributed to SIDS,” Dr Griffith said.
She pointed out that while statistics are not readily available for all countries, in Australia there was an 83 per cent decline over 20 years ranging 1985 to 2005, while in the United States of America the decline has been more than 50 per cent.
She said that many parents who have argued against the safety and effectiveness of sleeping on the back have done so for several reasons. One of the concerns is the matter of choking.
“Many parents think that choking might be easier when the babies are sleeping on their backs, and their question is a valid one; however, the body is programmed to protect the airway at all times and so babies will automatically swallow or cough up whatever they throw up while on the back,” Dr Griffith explained.
She reasoned, however, that when sleeping on the stomach anything regurgitated or refluxed (vomited) from the stomach can collect at the opening of the trachea or windpipe, making it easier for that fluid to be aspirated or enter into the lungs and cause choking. She also noted that the common alternative practised by many parents and caregivers — sleeping on the side — should also be avoided because it is unstable, as the chance of rolling over onto the stomach is high and thereby increases the risk of SIDS.
She warned that the only time parents should deviate from the recommended position of sleeping on the back is if instructed to do so by the child’s physician.
“There are special medical conditions involving airway abnormalities that may require the infant to be placed in a specific position to improve oxygenation. These positions will be taught to parents or caregivers by their physicians,” Dr Griffith advised.
She also discouraged putting an infant who is accustomed to sleeping on his back on the stomach or side, because studies have also shown that there is an increased risk of SIDS in these cases.
Other AAP recommendations include:
• The sleep surface should be firm, such as an appropriate mattress with a fitted sheet. Sleep surfaces should not include pillows, quilts or other soft surfaces.
• Sleep area should not be cluttered with toys, soft objects and loose bedding. The area around the infant’s face should remain clear.
• Infants’ sleep area should be separate from but close to that of others. After feeding, the infant should be placed in a separate sleep area and not between other individuals.
• Smoking must not be allowed around infants.
• The baby should be dressed in light sleep clothing and the room temperature kept comfortable.
