Baby Sleep: A Research Spill to Dispel SIDS Myths
Submitted by juliannepigeon
Fellow parents,
Fed up with the AAPs' and Back to Sleep Campaign's current SIDS scaremongering, I've decided to write an informed post about the issue of SIDS, particularly where it fits in with prone vs. supine sleeping. I, too, was bamboozled and hoodwinked by the current global "Back to Sleep" propaganda. A small amount of research, however, and I found that most of this is horse feathers. Let me begin with busting some myths:
Myth I, "Supine sleeping has greatly reduced the incidence of SIDS since 1992.": FALSE. The absolute incidence of SIDS prior to the Back to Sleep Campaign was already dropping in the US, from 1.511 per 1000 in 1979 to 1.301 per 1000 in 1991 (cdc.gov).
SIDS deaths in the U.S. decreased from 4,895 in 1992 to 2,247 in 2004 (source). But, during a similar time period, 1989 to 2004, SIDS being listed as the cause of death for sudden infant death (SID) decreased from 80% to 55% (source). According to Dr. John Kattwinkel, chairman of the Center for Disease Control (CDC) Special Task Force on SIDS "A lot of us are concerned that the rate (of SIDS) isn't decreasing significantly, but that a lot of it is just code shiftingâ (source).
Myth 2, "There is a regulated, standard, routine procedure for determining an infant death as SIDS. I can be confident that the statistics match actual SIDS deaths.": FALSE. Deaths that are determined to be SIDS deaths are as variable as the doctor or coroner determining the cause of death. There is currently no legislation (law) regulating the national standards for investigation (source). The Scripps review of 40,000 infant deaths going back to 1992 revealed that the quality of infant death investigations, the level of training for coroners, and the amount of oversight and review vary enormously across the country. In many cases, professional bias â both for and against a diagnosis of SIDS â trumps medical evidence (source). President Obama and the CDC are only just (as of this year, 2009) beginning to make legislation to standardize these investigations.
Myth 3, "Supine sleeping, prevents SIDS.": FALSE. No one thing prevents SIDS. It is a mysterious occurrence that the medical world only has theories about. It seems to be an environmental incident, closely related to the infant's home environment, environmental exposures, pre and antenatal care, among other factors. This is Wikipedia's list of possible SIDS causes.
Myth 4, "Because I know that supine sleeping prevents SIDS, it must be safe to place my baby to sleep this way." Not entirely false, not entirely true. There are several current completed and working studies that indicate that supine sleeping may be dangerous.
Dr. Rafael Pelayo from Stanford University and a number of other pediatric sleep researchers in the U.S. have stated that they believe that the American Academy of Pediatrics' recommendations regarding cosleeping and pacifier use may have unintended consequences. They have stated that the SIDS prevention strategy of the American Academy of Pediatrics which keeps infants at a low arousal threshold and reduces the time in quiet sleep may be unhealthy for children. They state that slow wave sleep is the most restorative form of sleep and limiting this sleep in the first 12 months of life may have unintended consequences to both the sleep and the infant (source).
According to a 1998 study by British researchers that compared back sleeping infants to stomach sleeping infants there were developmental differences at 6 months of age between the two groups. At 6 months of age the stomach sleeping infants had higher gross motor scores, social skills scores, and total development skills scores than the back sleeping infants. The differences were apparent at the 5% statistical significant level. But, at 18 months the differences were no longer apparent. The researchers deemed the lower development scores of back sleeping infants at 6 months of age to be transient and stated that they do not believe the back sleeping recommendations should be changed (source). Other scientists have stated that the conclusion that the negative effects of back sleep at 18 months of age is transient is based upon very little evidence and that no long-term randomized trials have been completed (source; This source, by the Scientific World publication offers a challenge to the Back to Sleep Campaign (BTSC) from two perspectives: (1) the questionable validity of SIDS mortality and risk statistics, and (2) the BTSC as human experimentation rather than as confirmed preventive therapy).
Other side effects of the back sleeping position include increased rates of shoulder retraction, positional plagiocephaly (flattened back of the head) and positional torticollis (source). A research study on children with plagiocephaly found that 26% had mild to severe psychomotor delay. This study also showed that 10% of infants with plagiocephaly had mild to severe mental development delay (source). Because of the delays caused by back sleep some medical professionals have suggested that the "normal" ages at which children had previously attained developmental milestones should be pushed back. This would enable medical professionals to consider children who previously were considered developmentally delayed as "normal" (Stevens P, "The Flip Side of Back to Sleep", The O&P Edge.)
Additional studies have reported that the following negative conditions are associated with the back sleep position: increase in sleep apnea, decrease in sleep duration, strabismus, social skills delays, deformational plagiocephaly, and temporomandibular jaw difficulties (source). Other studies have reported that the prone position prevents subluxation of the hips, increases psychomotor development, prevents scoliosis, lessens the risk of gastroesophageal reflux, decreases infant screaming periods, causes less fatigue in infants, and increases the relief of infant colic (source). In addition, prior to the âBack to Sleepâ campaign many babies self-treated their own torticollis by turning their heads from one side to the other while sleeping in the prone position (Graham J, Gomez M, Halberg A, Earl D, Kreuzman J, Cui J, Guo X. Management of Deformational Plagiocephaly: Repositioning Versus Orthotic Therapy. The Journal of Pediatrics. 2005;10.016:258-22).
Since 1998 there have been several studies published which report that infants placed to sleep in the supine position lag in motor skills, social skills, and cognitive ability development when compared to infants who sleep in the prone position (source, source). In a 1998 article entitled âEffects of Sleep Position on Infant Motor Development.â by Davis, Moon, Sachs, and Ottolini, the authors state âWe found that sleep position significantly impacts early motor development.â The prone (stomach) sleeping infants in this study slept an average of 225.2 hours (8.3%) more in their first 6 months of life than the supine (back) sleeping infants (source).
Back-sleeping significantly reduces the amount of slow wave sleep that infants engage in and it is theorized that infants that have the brain-stem defect are at increased risk of being unable to arouse from SWS (also called deep sleep) and therefore have an increased risk of SIDS due to their decreased ability to arouse from SWS (Kattwinkel J, Hauck F.R., Moon R.Y., Malloy M and Willinger M Infant Death Syndrome: In Reply, Bed Sharing With Unimpaired Parents Is Not an Important Risk for Sudden\Pediatrics 2006;117;994-996). (Basically they're saying that if the infant has this defect, then they are at risk. Healthy infants are not apparently at risk for not arousing from SWS, and prenatal factors are what affect the development of the brainstem). SWS is vitally important to development and growth, and studies indicate that supine-positioned infants are being deprived of it, thereby aiding in cognitive and psychomotor delay.
Many of the studies and articles cited are available to be read online and I strongly suggest that if you are concerned that you read them. To me, there is no question: the risks of SIDS is hugely outweighed by the crushing evidence that back sleeping is unhealthy for children and causes several kinds of developmental delays. My purpose for this post is to help to inform, as the BTSC is so powerful and pervasive. Children are at risk for SIDS no matter what their sleep position; it is not prone sleeping that causes this condition. Hopefully in the future the true causes for SIDS will be discovered, SIDS investigations will be well-regulated, and no parent will have to suffer. It is unnacceptable to me that the basic message of the BTSC is "if you put your baby to sleep on his back, he will not die of SIDS". It's ridiculous, and I think the whistle needs to be blown.
Fed up with the AAPs' and Back to Sleep Campaign's current SIDS scaremongering, I've decided to write an informed post about the issue of SIDS, particularly where it fits in with prone vs. supine sleeping. I, too, was bamboozled and hoodwinked by the current global "Back to Sleep" propaganda. A small amount of research, however, and I found that most of this is horse feathers. Let me begin with busting some myths:
Myth I, "Supine sleeping has greatly reduced the incidence of SIDS since 1992.": FALSE. The absolute incidence of SIDS prior to the Back to Sleep Campaign was already dropping in the US, from 1.511 per 1000 in 1979 to 1.301 per 1000 in 1991 (cdc.gov).
SIDS deaths in the U.S. decreased from 4,895 in 1992 to 2,247 in 2004 (source). But, during a similar time period, 1989 to 2004, SIDS being listed as the cause of death for sudden infant death (SID) decreased from 80% to 55% (source). According to Dr. John Kattwinkel, chairman of the Center for Disease Control (CDC) Special Task Force on SIDS "A lot of us are concerned that the rate (of SIDS) isn't decreasing significantly, but that a lot of it is just code shiftingâ (source).
Myth 2, "There is a regulated, standard, routine procedure for determining an infant death as SIDS. I can be confident that the statistics match actual SIDS deaths.": FALSE. Deaths that are determined to be SIDS deaths are as variable as the doctor or coroner determining the cause of death. There is currently no legislation (law) regulating the national standards for investigation (source). The Scripps review of 40,000 infant deaths going back to 1992 revealed that the quality of infant death investigations, the level of training for coroners, and the amount of oversight and review vary enormously across the country. In many cases, professional bias â both for and against a diagnosis of SIDS â trumps medical evidence (source). President Obama and the CDC are only just (as of this year, 2009) beginning to make legislation to standardize these investigations.
Myth 3, "Supine sleeping, prevents SIDS.": FALSE. No one thing prevents SIDS. It is a mysterious occurrence that the medical world only has theories about. It seems to be an environmental incident, closely related to the infant's home environment, environmental exposures, pre and antenatal care, among other factors. This is Wikipedia's list of possible SIDS causes.
Myth 4, "Because I know that supine sleeping prevents SIDS, it must be safe to place my baby to sleep this way." Not entirely false, not entirely true. There are several current completed and working studies that indicate that supine sleeping may be dangerous.
Dr. Rafael Pelayo from Stanford University and a number of other pediatric sleep researchers in the U.S. have stated that they believe that the American Academy of Pediatrics' recommendations regarding cosleeping and pacifier use may have unintended consequences. They have stated that the SIDS prevention strategy of the American Academy of Pediatrics which keeps infants at a low arousal threshold and reduces the time in quiet sleep may be unhealthy for children. They state that slow wave sleep is the most restorative form of sleep and limiting this sleep in the first 12 months of life may have unintended consequences to both the sleep and the infant (source).
According to a 1998 study by British researchers that compared back sleeping infants to stomach sleeping infants there were developmental differences at 6 months of age between the two groups. At 6 months of age the stomach sleeping infants had higher gross motor scores, social skills scores, and total development skills scores than the back sleeping infants. The differences were apparent at the 5% statistical significant level. But, at 18 months the differences were no longer apparent. The researchers deemed the lower development scores of back sleeping infants at 6 months of age to be transient and stated that they do not believe the back sleeping recommendations should be changed (source). Other scientists have stated that the conclusion that the negative effects of back sleep at 18 months of age is transient is based upon very little evidence and that no long-term randomized trials have been completed (source; This source, by the Scientific World publication offers a challenge to the Back to Sleep Campaign (BTSC) from two perspectives: (1) the questionable validity of SIDS mortality and risk statistics, and (2) the BTSC as human experimentation rather than as confirmed preventive therapy).
Other side effects of the back sleeping position include increased rates of shoulder retraction, positional plagiocephaly (flattened back of the head) and positional torticollis (source). A research study on children with plagiocephaly found that 26% had mild to severe psychomotor delay. This study also showed that 10% of infants with plagiocephaly had mild to severe mental development delay (source). Because of the delays caused by back sleep some medical professionals have suggested that the "normal" ages at which children had previously attained developmental milestones should be pushed back. This would enable medical professionals to consider children who previously were considered developmentally delayed as "normal" (Stevens P, "The Flip Side of Back to Sleep", The O&P Edge.)
Additional studies have reported that the following negative conditions are associated with the back sleep position: increase in sleep apnea, decrease in sleep duration, strabismus, social skills delays, deformational plagiocephaly, and temporomandibular jaw difficulties (source). Other studies have reported that the prone position prevents subluxation of the hips, increases psychomotor development, prevents scoliosis, lessens the risk of gastroesophageal reflux, decreases infant screaming periods, causes less fatigue in infants, and increases the relief of infant colic (source). In addition, prior to the âBack to Sleepâ campaign many babies self-treated their own torticollis by turning their heads from one side to the other while sleeping in the prone position (Graham J, Gomez M, Halberg A, Earl D, Kreuzman J, Cui J, Guo X. Management of Deformational Plagiocephaly: Repositioning Versus Orthotic Therapy. The Journal of Pediatrics. 2005;10.016:258-22).
Since 1998 there have been several studies published which report that infants placed to sleep in the supine position lag in motor skills, social skills, and cognitive ability development when compared to infants who sleep in the prone position (source, source). In a 1998 article entitled âEffects of Sleep Position on Infant Motor Development.â by Davis, Moon, Sachs, and Ottolini, the authors state âWe found that sleep position significantly impacts early motor development.â The prone (stomach) sleeping infants in this study slept an average of 225.2 hours (8.3%) more in their first 6 months of life than the supine (back) sleeping infants (source).
Back-sleeping significantly reduces the amount of slow wave sleep that infants engage in and it is theorized that infants that have the brain-stem defect are at increased risk of being unable to arouse from SWS (also called deep sleep) and therefore have an increased risk of SIDS due to their decreased ability to arouse from SWS (Kattwinkel J, Hauck F.R., Moon R.Y., Malloy M and Willinger M Infant Death Syndrome: In Reply, Bed Sharing With Unimpaired Parents Is Not an Important Risk for Sudden\Pediatrics 2006;117;994-996). (Basically they're saying that if the infant has this defect, then they are at risk. Healthy infants are not apparently at risk for not arousing from SWS, and prenatal factors are what affect the development of the brainstem). SWS is vitally important to development and growth, and studies indicate that supine-positioned infants are being deprived of it, thereby aiding in cognitive and psychomotor delay.
Many of the studies and articles cited are available to be read online and I strongly suggest that if you are concerned that you read them. To me, there is no question: the risks of SIDS is hugely outweighed by the crushing evidence that back sleeping is unhealthy for children and causes several kinds of developmental delays. My purpose for this post is to help to inform, as the BTSC is so powerful and pervasive. Children are at risk for SIDS no matter what their sleep position; it is not prone sleeping that causes this condition. Hopefully in the future the true causes for SIDS will be discovered, SIDS investigations will be well-regulated, and no parent will have to suffer. It is unnacceptable to me that the basic message of the BTSC is "if you put your baby to sleep on his back, he will not die of SIDS". It's ridiculous, and I think the whistle needs to be blown.
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