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Crib Death Again Linked to Baby's Sleep Position

Study also finds higher SIDS rate in black families

MONDAY, Oct. 7, 2002 (HealthDayNews) -- In the most comprehensive American study of its kind, researchers have shown that one-third of all sudden infant deaths result from the child's sleep position, and that black babies are more than twice as likely to die in this manner.

The study, released today in the October issue of Pediatrics, adds evidence to the theory that infants should sleep on their backs for at least their first six months of life. A federal campaign in the early 1990s warned against prone sleeping, and the cases of sudden infant death syndrome (SIDS) have dropped by half -- from 5,400 a year in 1991 to under 2,700 now.

Still, the United States lags behind other developed countries in its rate of "crib deaths."

"In this country, there's still about 20 percent of parents who report using the stomach position. In other countries, where they've had these campaigns, the rate is more like 1 or 2 percent," says lead author Dr. Fern Hauck, director of research in the Department of Family Medicine at the University of Virginia Health System.

"We still have resistant pockets in this country," says Hauck, who was with Loyola University in Chicago when she collected the data.

Hauck and other researchers examined 260 cases of SIDS in Chicago, mostly among black families. Although the data was collected in the mid-1990s, it illustrates a striking disparity in how babies are put to sleep.

More than 40 percent of blacks in the control group put their infants on their stomachs, while just 12 percent of other racial groups chose that position. That difference in care accounts for the high rate of infant deaths among blacks, since researchers don't think genetics is a factor.

"It's a cultural issue how you put a baby to sleep," says Dr. Solomon Iyasu, team leader for infant health at the U.S. Centers for Disease Control and Prevention (CDC). In many groups, parents get child-rearing advice from their own parents rather than from their doctors, he says.

Part of the problem is that theories have flip-flopped for decades about the best sleep position for infants. Many doctors advised they should sleep on their stomachs because they sleep longer and spit up less. However, when more exacting studies showed the risks of prone sleeping in the 1980s, some parents and doctors resisted the advice, Iyasu says.

In black communities, researchers believe that message didn't reach enough doctors and parents. So in 1999, federal health authorities targeted those communities with a new publicity campaign.

"The cultural issues surrounding this are very important. It's a matter of trust and understanding," says Dr. Marian Willinger, a SIDS expert at the National Institute of Child Health and Human Development.

She pointed to a 2000 study, which showed that many parents resisted the change even after they were told about the dangers of the prone position.

"I hope this helps clinch things for people who are on the fence," Willinger says.

While some parents have resorted to Velcro and tying their infants in the bed to avoid sleep deaths, Hauck advises against it. Once children reach six months of development, the risk of SIDS drops dramatically.

"I recommend to parents that if your kids are flipping on their stomachs on their own, they're probably safe," Hauck says.

Still, she suggests parents avoid other potential causes of infant death: parental smoking in the house and loose or soft bedding.

The research was sponsored by the National Institute of Child Health and Human Development, the National Institute on Deafness and Other Communication Disorders and the CDC.

What To Do

For a fact sheet about sudden infant death syndrome, visit the National SIDS Resource Center. For information for new parents about the syndrome, visit the SIDS Alliance.

SOURCES: Fern Hauck, M.D., M.S., director, research, Department of Family Medicine, University of Virginia Health System, Charlottesville; Solomon Iyasu, M.D., team leader, infant health, U.S. Centers for Disease Control and Prevention, Atlanta; Marian Willinger, M.D., special assistant, sudden infant death syndrome, National Institute of Child Health and Human Development, Bethesda, Md.; October 2002 Pediatrics
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