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Biggest threats for sleep-related infant death change with age: study

By Kathryn Doyle

NEW YORK (Reuters Health) - Creating a safe sleep environment is important for all infants, but when it comes to preventing Sudden Infant Death Syndrome (SIDS), parents should be aware that the main sources of risk change over the first year of a baby’s life, according to a new study.

Up to four months of age, sharing a bed with an adult or pet was the most common factor involved in sleep-related deaths, the analysis found. For babies between four months and one year old, the biggest risk was rolling over into an object in the crib or on the bed.

“These findings make sense when taking into account an infant's development in the first year: Infants less than four months old do not have the strength to move their head when an adult moves in a way that covers the infants mouth,” said lead author Dr. Jeffrey Colvin.

“Infants at around the age of four months are beginning to roll over to their stomach and it is possible that the infants in our study rolled over, but into a soft object such as a pillow or stuffed animal and were suffocated,” said Colvin, a pediatrician at Children’s Mercy Hospitals and Clinics in Kansas City, Missouri.

The researchers looked at a national database of infant deaths in 24 states, including more than 8,000 babies who died from SIDS, accidental suffocation or strangulation in bed between 2004 and 2012.

They considered the age, gender and ethnicity of the baby as well as sleeping in a bed with another person or animal or having objects like a pillow, blanket or stuffed toy in the bed. The data also differentiated between babies sleeping in cribs, playpens, car seats or strollers, in adult beds or on a person.

About 70 percent of babies were sharing a bed at the time of death, according to the results published in Pediatrics. For younger infants, 74 percent of deaths were associated with bed sharing, compared to 59 percent of older infants.

About a third of the babies had an object in the sleeping environment, usually blankets or pillows. Objects were present for 40 percent of older infant deaths, compared to 34 percent of younger infant deaths.

All these factors are risks for all infants, but some are more likely for younger and some for older infants, Colvin said.

“And no matter what the age group, many infants die when exposed to risk factors such as bed sharing, soft bedding and the prone or side sleeping positions,” said Dr. Eve R. Colson, professor of Pediatrics at the Yale School of Medicine in New Haven, Connecticut.

“From my own practice I know that older infants can begin to roll and move around freely so we need to remind families to place infants in safe environments for the entire first year,” Colson, who was not part of the new study, told Reuters Health by email.

Little can be done to prevent an infant from rolling over in the crib, he said, since wedges, positioners and rolled towels can cause suffocation and entrapment and should not be used. But rolling over can be made safer.

When the infant is awake and playing, keep her on her stomach, which will help strengthen back and arm muscles so that when she is prone, she is able to turn her head and breathe, he said. Place her on her back for sleep.

Once children are old enough to turn over in the night, you can let them keep sleeping that way and should not reposition them, said Patricia G. Schnitzer, an associate professor at the Sinclair School of Nursing at the University of Missouri in Columbia.

Schnitzer also wasn't involved with the study.

“Equally important, parents should ensure that there are no objects in the sleep area, especially pillows, blankets, and stuffed toys,” Colvin said.

SOURCE: http://bit.ly/1mDjerK Pediatrics, online July 14, 2014.

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