"SIDS" and its preventable risk factors: do parents know?

To the Editor: Sudden infant death syndrome (SIDS) is the leading cause of death in infants more than 1 month old. Infant sleeping position has been strongly linked with SIDS. (1,2) Despite the impressive decline in the incidence of SIDS since the nationwide "Back to Sleep" campaigns, and the recommendation to avoid the prone sleep position, SIDS remains a leading cause of death in the first year of life. In 1992, the American Academy of Pediatrics (AAP) issued a recommendation that "healthy term infants" be placed on their backs (supine) to sleep and to avoid the prone sleeping position. (3-6) Despite the success of the campaign, we believe that more can be done to reduce the incidence of SIDS.

At their children's routine health maintenance visits, 200 mothers of infants aged less than 12 months were interviewed regarding SIDS awareness. This study was conducted in the pediatric clinic in a public hospital located in a low-income inner city area with large Spanish-speaking and immigrant populations. The following questions were asked:

In what position do they usually put their babies to sleep?

Do they know about SIDS?

Do they know the risk factors for SIDS (prone position and smoking)?

Do they believe that sleeping on the stomach places infants at an increased risk for SIDS?

Do they know what the AAP recommendation is concerning infant sleep position for healthy infants?

We also compared sleeping position practice in terms of race and age of parents.

A total of 200 parents, who visited our pediatric clinic for routine appointments, participated in this study. Our population was predominantly Hispanic (60.5%) and African-American (30%). Of the 200 mothers interviewed, 108 (54%) were putting their infants in the supine position and 13 (6.5%) on their sides. Seventy-nine mothers (39.5%) had been putting their babies to sleep in the prone position. One hundred eleven mothers (55%) were unaware of the term "SIDS." Ninety-two (46%) were not aware that the prone position is a risk factor for SIDS. One hundred forty-nine (74.5%) did not know that smoking was a risk factor for SIDS.

When parents were asked whether they believed that sleeping prone increases the risk for SIDS in healthy infants, 54% stated that there is a definite risk to sleeping prone and 46% did not believe that the prone position increases the risk of SIDS. Forty-one percent (41.9%) of the parents were aware that the AAP recommends the supine position for healthy sleeping infants, but 19.5% believed that the recommendation is that the side or back position is better. More than a third (39.5%) did not know what the recommendation was.

There was no significant difference in regards to the mother's race. However, when comparing the parents' ages, 43% of parents older than 20 years were using the prone position for their babies compared with 31% of parents younger than 20 years.

Almost half (46%) of the parents surveyed were unaware of the association between SIDS and infant sleep position. The prone position is still commonly used (39%). Younger parents were more knowledgeable regarding this condition. There is still a lack of awareness of SIDS and its risk factors. More education is needed in this area to save lives.

Make everything as simple as possible, but not simpler.
--Albert Einstein

References

1. Willinger M, Hoffman HJ, Hartfors RB. Infants sleep position and risk for sudden infant death syndrome. Pediatrics 1994;93:814-819.

2. Gibson E, Cullen JA, Spinner S, et al. Infant sleep position following new AAP guidelines. Pediatrics 1995;96:69-72.

3. Dwyer T, Ponsonby AL, Blizzard L, et al. The contribution of changes in the prevalence of prone sleeping position to the decline in sudden infant death syndrome in Tasmania. JAMA 1995;273:783-789.

4. Centers for Disease Control. Sudden infant death syndrome--United States, 1983-1994. MMWR 1996;45:859-863.

5. Taylor JA, Krieger JW, Reay DT, et al. Prone sleeping position and sudden infant death syndrome in King County, Washington: a case control study. J Pediatr 1996;128:626-630.

6. Mitchell EA, Thach BT, Thompson J, et al. For the New Zealand Cot Death Study. Changing infant's sleep position increases risk of Sudden infant death syndrome. Arch Pediatr Adolesc Med 1999;153:1136-1141.

Muhammad Waseem, MD

Sagarika Nallu, MD

Joel Gernsheimer, MD

Departments of Emergency Medicine and Pediatrics, Lincoln Medical and Mental Health Center, Bronx, NY