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SIDS Recommendations Revised


New recommendations today to reduce the risk of sudden infant death syndrome, or SIDS. The American Academy of Pediatrics says parents should sleep in the same room but not in the same bed with their newborn. It also says that pacifiers can reduce the risk of sudden infant death. As NPR's Richard Harris reports, those recommendations are not too popular with advocates of breast-feeding.


The number of sudden infant deaths has dropped from about 5,000 a year to about half that since health officials recommended in 1992 that all babies be put to bed on their backs. But, still, children die every day from this mysterious condition, so the American Academy of Pediatrics regularly reviews research to fine tune its advice. Dr. John Kattwinkel, a professor of pediatrics at the University of Virginia, announced the new recommendations today at the academy's annual meeting in Washington, DC.

Dr. JOHN KATTWINKEL (University of Virginia): Keeping a baby in the same room with you in a separate environment is actually protective against SIDS. But taking a baby into the bed with you when you go to sleep is hazardous, and we're recommending against that.

HARRIS: The academy also recommends against putting a baby on its side at bedtime. Dr. Rachel Moon is a SIDS researcher at the Children's National Medical Center in Washington, DC, and on the academy's review committee.

Dr. RACHEL MOON (SIDS Researcher, Children's National Medical Center): The problem with the side position is that it's unstable, and when a baby's on the side, there's a good chance that the baby could roll over onto the stomach, which puts the baby at very high risk for SIDS.

HARRIS: To Dr. Moon, the biggest surprise in the review was this: It turns out babies who use pacifiers when they are falling asleep are at substantially lower risk of SIDS.

Dr. MOON: We have no idea why pacifiers work. And the interesting thing is that they work even when the pacifier falls out of the mouth after the baby falls asleep. And you don't get this protective effect with thumb-sucking or digit-sucking.

HARRIS: These recommendations are based on observational studies, so they don't link cause and effect. And they are not entirely popular. Dr. Joan Meek, who is the academic chairman of pediatrics at Orlando Regional Healthcare, says the recommendations are causing some stir among breast-feeding advocates, such as herself, who generally frown upon pacifiers.

Dr. JOAN MEEK (Academic Chairman of Pediatrics, Orlando Regional Healthcare): I would still recommend that we delay introduction of any artificial nipples, whether that's a pacifier or a bottle nipple, until breast-feeding is well-established, which is typically beyond the first three to four weeks of the infant's life. And then if the parent chooses to introduce a pacifier in order to satisfy some of the sucking needs or to comply with the guidelines, then it would be less likely to interfere with optimal breast-feeding.

HARRIS: Advice against bed-sharing also touches a raw nerve. Some advocate it for psychological reasons. And Dr. Meek says sharing a bed also encourages breast-feeding, which has well-established health benefits of its own.

Dr. MEEK: For many, many, many years breast-fed babies have traditionally slept very close to the mom and usually that means in the bed to facilitate good breast-feeding. So I think there are a number of problematic issues in terms of how to best support the mom and the baby in the breast-feeding process and still comply with recommendations.

HARRIS: The academy has tried to strike a balance with this. Dr. Moon agrees it's important to encourage breast-feeding while at the same time protecting children from SIDS.

Dr. MOON: We recommend that if the baby is breast-feeding, that pacifiers not be started until the baby is at least two, three, four weeks old when breast-feeding has been fully established.

HARRIS: Ultimately scientists like Dr. Moon would like to understand the cause of sudden infant death. But, she says, the good news is that they now know enough to find ways to reduce the risk of SIDS, even though they don't know why these recommendations actually work. Richard Harris, NPR News, Washington. Transcript provided by NPR, Copyright NPR.

Richard Harris
Award-winning journalist Richard Harris has reported on a wide range of topics in science, medicine and the environment since he joined NPR in 1986. In early 2014, his focus shifted from an emphasis on climate change and the environment to biomedical research.