Children's Voice May/June 2007

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Children's Health Care

The Back to Sleep Campaign: Promoting Safe Snoozing for More than a Decade

Although babies tend to sleep better and longer when lying on their stomachs, placing them on their backs reduces the risk of Sudden Infant Death Syndrome (SIDS). That has been the message of the Back to Sleep campaign for 13 years, targeting the medical community, parents, grandparents, and child care providers.

Sponsored by the National Institute of Child Health and Human Development, the Maternal and Child Health Bureau, the American Academy of Pediatrics (AAP), the SIDS Alliance, and the Association of SIDS and Infant Mortality Programs, the Back to Sleep campaign has seen the rate of SIDS drop more than 50% since the campaign began in 1990. From 1992 to 1997, the percentage of babies sleeping on their stomachs dropped from 70% to 21%.

Unfortunately, the SIDS rate among African American infants is 2.5 times higher than among white infants, according to Rachel Moon, a researcher at Children's National Medical Center in Washington, DC. And data from 2001 found that 21% of African American babies were sleeping prone, compared with 11% of white infants.

Moon isn't sure why the campaign has not been as successful in the African American community, citing "social and cultural factors that influence behavior that are different than [for] Caucasians. We're still trying to figure out which influences are most important." She says the campaign has developed media and outreach materials specifically geared toward African American families, and has partnered with many black organizations to reach out.

Although cases have dropped overall, SIDS is still the leading cause of death for all infants younger than 1 year; most deaths occur between 1 to 4 months of age. According to the U.S. Department of Health and Human Services, approximately 2,000 infants die of SIDS in the United States each year.

Moon says public misconceptions about sleep position have been an obstacle in getting people to put the message into practice. She says the campaign has done a good job of getting the message out, but whether people believe that sleep position has any effect on SIDS is the problem. "We're going against decades of culture," she points out. "For years and years, people were told to put babies on their stomachs because they sleep better and longer."

In 1992, AAP recommended all babies be placed on their backs to sleep after research from European countries showed that infants who slept on their backs were less likely to die of SIDS.

Moon says the Back to Sleep campaign will continue to disseminate information about SIDS as long as the campaign has funding. The message is still the same--infants should not be placed on their stomachs to sleep unless there is a medical reason--but the campaign is trying to reach more people, targeting child care providers and other caregivers, such as grandparents. "In general, child care providers are happy to get the information," Moon says. "What they do with the information is up to them."

--Stephanie Robichaux, Children's Voice Contributing Editor

Translating Safety into Policy

The American Academy of Pediatrics recommends child care providers, parents, and other caregivers create and use a safe sleep policy that includes the following:
  • Healthy babies should always sleep on their backs. Side sleeping is not advised.
  • Require a physician's note for non-back sleepers that explains why the baby should not use a back-sleeping position.
  • Use safety-approved cribs and firm mattresses.
  • Keep cribs free of toys, stuffed animals, and extra bedding.
  • If using a blanket, place the child's feet to the foot of the crib and tuck in a light blanket along the sides and foot of the mattress. The blanket should not come up higher than the infant's chest.
  • Sleep only one baby per crib.
  • Keep the room at a comfortable temperature for a lightly clothed adult.
  • Visually check sleeping babies often.
  • Never allow smoking in a room where babies sleep. Smoke exposure is linked to an increased risk of SIDS.
  • Supervise "tummy time" for awake babies to help them strengthen muscles and develop normally.
  • Teach and regularly review safe sleep practices with caregiving staff.
 More information.




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