SIDS recommendations are ready to change again

Pediatricians who believe they know the latest on sudden infant death syndrome (SIDS) may be in for a surprise. The American Academy of Pediatrics plans to issue a new statement on the syndrome in 2005.

"This is the first look the public has had at the new statement," said John Kattwinkel, MD, chair of AAP's SIDS task force since 1992. "It's really in a fourth draft, but the statement is almost ready to go to other committees. This is the time for public input."

Prior AAP statements have had a significant impact on SIDS, Dr. Kattwinkel told pediatricians yesterday at the AAP National Conference and Exhibition. In 1991, SIDS was responsible for about 4,660 deaths annually in the United States - about 1.3 deaths for every 1,000 live births. By 2002, the last year for which reliable data are available, the toll had dropped 53%, to 0.56 deaths for every 1,000 live births - just over 1,800 infant deaths. The most significant decline began in 1992, when AAP initially called on parents and pediatricians to put infants to sleep on their back, not on their stomach.

AAP wants to see that downward trend continue.

Although the 2005 statement has not been finalized, it is likely to include several new points, Dr. Kattwinkel said, including:

• Putting infants to sleep on their side is significantly riskier than a fully supine position

• Infants accustomed to sleeping supine and who are then placed to sleep prone are at very high risk of SIDS

• Parents and pediatricians need to pay particular attention to secondary caregivers who may not be as cognizant of current recommendations as the parents of a child who has recently been discharged

• Code shifts may be partially responsible for the decline in SIDS mortality

• Soft bedding continues to pose a choking hazard to infants

• Bed-sharing can increase risk, especially when the mother smokes, uses drugs, or is overly tired; the highest-risk practice is sharing sleeping space on a couch (sharing a room without sharing bed space in fact reduces the risk of SIDS)

• Pacifiers appear to be protective, but may inhibit breastfeeding during the first month

• There does not appear to be a relationship between immunizations and SIDS