Pediatrics studies SIDS risk in African American families

Lois Lee, MD, MPH

The excitement of decorating a baby’s room is a wonderful rite of passage for every parent. It’s also a big business for manufacturers. If you look in any baby related catalog, the choices for furniture, bedding and toys seems unlimited. But even though having so many options for matching sheets, blankets, crib bumpers and stuffed animals for your baby’s crib may seem appealing, these items put infants at increased risk for sudden infant death syndrome (SIDS)* as well as suffocation, strangulation and entrapment.

It is well known that there are significant disparities in some medical conditions between different races and ethnicities, and SIDS risks are no exception. In infants born to black mothers, the rate of SIDS is more than twice that of white, non-Hispanic infants.  In addition, black infants have much higher rates of death due to accidental suffocation and strangulation in bed, often caused by unsafe bedding items.

To better understand the reasons why the use of soft bedding is more prominent in black families, researchers from Children’s National Medical Center in Washington D.C. recently conducted a study of infant bedding practices in black mothers. It’s hoped that by compiling this type of data, the medical community can better identify and educate at-risk families, resulting in safer infant sleep surfaces in the United States.

Stuffed animals, pillows and blankets may make a crib look nice, but are actually dangerous for the infant inside

Although this study focused on children born to black parents because of their higher SIDS risks, it is not hard to imagine that parents of other races and ethnicities would have similar attitudes about infant bedding. Like many parents, the mothers in this study wanted their infant’s sleep surface to be comfortable and not too thin or hard. The medical community advocates for firm beds for infants, but the study found that the definition of a “firm” sleep surface was varied among the mothers studied. For example, many mothers in the study said they thought firm could mean a taut sheet on a soft mattress, when in actuality the recommendation for a firm sleep surface applies to the mattress itself, not the sheet stretched over it.

Another issue explored in the study was blanket use. Many mothers used blankets to keep their infant warm and some felt blankets were safe as long as they had holes for air to pass through, like a knit blanket or afghan. Others thought any type of blanket was fine, so long as it wasn’t kept near the infant’s head or neck.  Unfortunately, neither of the schools of thought is correct; any loose fitting blanket in a crib is dangerous.

The study found that pillows were often used to create a barricade that might keep the infant safer on a sleep surface, but these attempts are greatly misguided because pillows are a suffocation risk for infants. They found that crib bumper pads were also used to keep the infant from rolling into hard crib corners and sides. While crib bumpers may be helpful in preventing a small bruise or cut, they pose significant suffocation or entrapment hazards, which are far more dangerous.

Based on the responses gathered from the study, it’s clear that more needs to be done to help raise awareness about safe sleeping environments, both in the African American community and parenting communities at-large. The Back to Sleep campaign is a successful example of this kind of education raising campaign. Started by the National Institute of Child Health and Human Development (NICHD) in the mid 1990s, Back to Sleep has been successful in educating families and caregivers about the importance of placing infants on their backs to sleep. Since its induction the rate of SIDS has decreased by more than 40% in the United States.

Sparsely decorated cribs are the safest option for your newborn

It’s a great leap forward, but more needs to be done. SIDS is still the leading cause of infant death outside of the neonatal period. To help prevent SIDS the American Academy of Pediatrics (AAP) recommends the following:

  • Place the infant to sleep on their back. Side sleeping is not the recommended position, but if that is what the infant prefers, make sure to stretch forward the baby’s arm that touches the mattress. In doing so you provide a little extra balance to help prevent the infant from rolling onto their stomach.
  • Only use a crib that meets the standards of the Consumer Product Safety Commission. This summer the sale of drop-side cribs was banned because of the associated risk of entrapment and death for infants.
  • Infants should not sleep on waterbeds, sofas and/or soft mattresses.
  • Avoid soft materials in the infant sleep area:
  1. Pillows, quilts, comforters, sheepskins should not be placed under or around the sleeping infant.
  2. Loose blankets and sheets are not recommended. Instead, use sleep clothing to keep the infant warm. These are like blankets, but usually have sleeves to put the infant’s arms through and they cover the feet and zip up to the neck.  This prevents any loose material from getting near the infant’s face.

If a blanket is going to be used, tuck it in all around the crib mattress and place the infant’s feet at this end of the bed, making sure the blanket only reaches up the infant’s chest.

  • Avoid overheating the infant. The room temperature should be comfortable for a lightly clothed adult.

*An unexpected infant death is typically not called SIDS if a cause, like suffocation or entrapment, can be identified.  If there is no clear cause, then the infant death may be called SIDS. It is thought that rebreathing, when the infant breathes back in their own breath rather than fresh room air, may be a pathway causing SIDS, and the use of soft bedding increases the risk of rebreathing, especially when the infant is placed on their stomach.