New SIDS prevention recommendations from the AAP have caused
quite a stir in the parenting and health care communities this
month. The updates include these high points:
The AAP no longer recognizes side sleeping as a reasonable
alternative to placing a baby completely flat on his/her back
Bed sharing is not recommended during sleep. Infants may be
brought into bed for nursing or comforting, but should be
returned to their own crib or bassinet when the parent is ready
to return to sleep. However, sleeping in the same room is
recommended.
The revised statement recommends the use of pacifiers at nap
time and bedtime throughout the first year of life. However, it
is recommended that pacifier introduction for breastfed infants
be delayed until one month of age to ensure that breastfeeding
is firmly established. In addition, if the infant refuses the
pacifier, it should not be forced.
Perhaps the biggest opposition to the recommendations comes
among breastfeeding advocates, who note that pacifier use and
separate sleeping may present mothers with boundaries to
successful breastfeeding. In a press release out October 14th,
La Leche League International states, “the recommendations about
pacifiers and co sleeping in the statement reflect a lack of
basic understanding about breastfeeding management.” The release
goes on to quote Dr. Nancy Wight, President of the Academy of
Breastfeeding Medicine, as saying that the new policy,
“represents a truly astounding triumph of ethnocentric
assumptions over common sense and medical research. There are
many physician members of the AAP who do not agree with these
recommendations.”
In his response, Dr. Robert Sears expresses disagreement with
the AAP’s recommendation against co-bedding. “While the AAP
policy doesn’t say co-sleeping causes SIDS, it says the risk of
accidental suffocation of approximately 65 babies each year in a
parent’s bed (which isn’t SIDS - it’s accidental death) warrants
avoiding co-sleeping. What the AAP continues to ignore, however,
is the fact that virtually all of the 2500 cases of SIDS each
year in the U.S. occur in cribs.” According to Sears, babies are
less likely to be suffocated while co-sleeping than they are to
die from SIDS. The Sears pediatricians offer their own
guidelines on sleeping safely with your baby.
And about that pacifier… a year 2000 study linking heavy
pacifier use to increased incidence of ear infections was all
over the news media. Parents were warned to limit the time
babies spend using a pacifier. Dr. Alan Greene states that,
“stopping the pacifier alone can drop ear infections by 50
percent for children in day care.”
So who’s right? What’s a mom to do?
In the final section of the AAP statement, the authors explain
that the recommendations were developed to reduce the risk of
SIDS among the general population. They state that while SIDS
has been associated with certain risk factors, that does not
necessarily mean that those factors are proven to cause SIDS.
Doctors and scientist do not currently know what causes SIDS and
they believe that perhaps multiple preexisting conditions and
triggers may exist.
The authors of the new AAP policy statement say that, “when
considering the recommendations in this report, it is
fundamentally misguided to focus on a single risk factor or to
attempt to quantify risk for an individual infant. Individual
medical conditions may warrant a physician to recommend
otherwise after weighing the relative risks and benefits.”
Babies are unique individuals and families are unique entities.
One rigid guideline will never apply to all people in all
circumstances.
If you would like to read the report for yourself, it is
available online at <http://www.aap.org/ncepr/revisedsids.pdf>.
This article is intended for educational purposes only. It is
not intended to serve as medical advice or as a substitute for
professional medical advice and should not be interpreted as
recommendation for treatment. If you have questions or concerns
regarding your physical or mental health or the health of your
child, please seek assistance from a qualified health care
provider before using any health information.
© Christine Climer