A quarter-century after the “Back to Sleep” campaign dramatically reduced infant deaths, research shows parents are neglecting simple steps that could save young lives.
About 3,500 babies die in their sleep each year from Sudden Infant Death Syndrome (SIDS) and related causes, according to the Centers for Disease Control and Prevention.
“We don’t have a way to prevent SIDS. But we do have a way to reduce the probability if you provide a sleep environment that’s safe for the baby,” said Dr. Marian Willinger, special assistant for SIDS at the National Institute for Child Health and Development.
These steps include consistently placing infants on their backs to sleep on firm surfaces with no other objects nearby.
Since the American Academy of Pediatricians launched what became “Back to Sleep” in 1992, SIDS deaths have fallen by 70 percent.
But most of that progress occurred before 2005.
For the past decade, the combined death rate for SIDS and related causes, including accidental suffocation in bed and unexplained death while sleeping – collectively known as Sudden Unexpected Infant Death -- has hit a plateau.
Meanwhile the death rate for black infants has remained persistently high, consistently twice the death rate for white infants.
The Back to Sleep campaign caught parents’ attention. A 2009 study in a medical journal found mothers and fathers quickly learned and adopted the namesake strategy. In 1993, according to a nationwide telephone survey, just 16.9 percent of parents put their infants to bed on their backs. By 1996, a majority did. By 2006, 76.8 percent did.
But other recommendations by the American Academy of Pediatrics never caught on – although specialists considered them just as vital.
Researchers at Penn State College of Medicine video-recorded infants and their parents at night.
Among their findings, published in September: Almost every parent in the study placed their infant to sleep among potential hazards, including loose bedding, pillows and stuffed animals. If parents moved the infant during the night, there was a good chance the infant would be placed on its side or stomach and a high chance the baby would share the space with someone else.
Their conclusions: Despite knowing that they were being recorded, parents placed their infants in unsafe sleep environments. And in the middle of the night they often moved those infants to places that were even less safe.
“We clearly have a lot more work to do,” said Dr. Rachel Moon, a professor of pediatrics at the University of Virginia. “One of the biggest barriers is (parental) fatigue and exhaustion.”
Moon is the lead author of the American Academy of Pediatrics’ just-released policy statement on “SIDS and other sleep-related infant deaths”.
Moon links parental exhaustion, and the poor middle-of-the-night decisions that it causes, to the United States’ comparatively restrictive parental leave policies. Parents of infants are desperate for sleep, she said, because they must go to work in a few hours, a situation that “doesn’t happen in any other country.”
While public health experts “made a big dent” in persuading parents to put babies to sleep on their backs, making the case against soft bedding and bed-sharing is proving much tougher, Willinger said.
“A lot of these deaths are in bed-sharing,” she said. But discouraging bed-sharing while encouraging breastfeeding, another priority of the safe sleep campaign, risks sending a mixed message. And it’s an especially difficult message to send to black mothers, who “tend to think it’s safer to keep an eye (on their infants) if they have the baby in bed with them.”
Infant sleep deaths “are rare events and the probability you’ll be affected is low, (so) it’s easy to dismiss it,” Willinger said. “But when it affects you it’s devastating.”