As always, thanks for taking the time from your busy schedule to listen to this edition of DocSmo.com… the pediatric blog that makes pediatrics portable, practical and fun… from the bassinette to the board room, this is the place for all things kid. I am your host and founder, Dr. Paul Smolen, a general pediatrician of 30 years practicing in Charlotte, NC. I was reading my weekly mortality and morbidity report published by the CDC and I came across some new information about infant positioners as they relate to Safe sleep in very small babies. I thought this information was so important that I needed to do a post on the subject. Since I am the creative editor of this blog, here we go.
The Back to sleep campaign is now 18 years old. It has been amazingly successful at reducing the incidence of crib death…who would have guessed that simply putting babies to sleep on their backs would cut the rate of crib death in half almost overnight. Thousands of baby’s lives have been saved each year. We need to give thanks to the epidemiologists who figured out that an infant sleeping on their backs, on a hard surface, had a far less chance of a crib death than those who slept on their stomachs. Up until that time, stomach sleeping was the norm in this part of the world.
Many pediatricians, including myself, were skeptical of babies sleeping on their backs. It seemed like if they spit up, which most do frequently, that they could have a serious choking event. The whole thing was counter-intuitive. A compromise was the side position where a child’s face was not in the bedding but spit up could roll out and not be aspirated. Sounds like a great idea, right? Well, that great idea turned out to be “dead wrong”. Side positioning turned out not to be safe at all and the AAP quickly redefined the back to sleep campaign to exclude the side position. “Back to sleep” truly meant back to sleep.
As time went on, the experts further defined the safest sleep environment for babies, which they termed a “Safe sleep surface”. For more on safe sleep, I refer you to my pedcast on this subject, which is cleverly titled, Safe Sleep Environment 2011. http://pediatrics.aappublications.org/content/early/2011/10/12/peds.2011-2284.full.pdf+html Unfortunately, almost 2 decades later, safe sleep is not the rule for babies in the US. In a phone assessment of families with babies, 1 in 4 were not sleeping on their backs in 2008. Furthermore, despite the AAP’s and FDA’s warnings, many babies are still being placed in infant positioners to maintain head or side position. I know this is true because I am asked all the time being asked about these devices by new parents. Although rare, side positioning with these devices has lead to 13 deaths from suffocation. Look at the illustration that the CDC provides and you can see what might happen.
So lets make sure things are clear. Back to sleep means exactly that, not side, not tummy but baby in the face up position on a safe sleep surface. No devices are to be used to aid infant sleep unless they are FDA approved and directed by a physician. And finally, please take the time to CAREFULLY review the safe sleep guidelines laid out experts. Just click and read!
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This is Dr. Paul Smolen, broadcasting from studio 1E hoping you find the right sleep equation for your little creation.
Until next time.