SIDS in the The News

Babies' 'flat heads' can be prevented: health coalition
Growing public awareness of SIDS prompts concern about positional plagiocephaly

OTTAWA (Monday, October 15, 2001) - The partners in a national campaign aimed at reducing the risk of Sudden Infant Death Syndrome (SIDS) want to allay concerns over a possible consequence of babies who sleep on their back: positional plagiocephaly, more commonly known as "flat head."

The key recommendation of the Back to Sleep campaign-launched in 1999 by the Canadian Foundation for the Study of Infant Deaths, the Canadian Institute of Child Health, the Canadian Paediatric Society, and Health Canada-is that babies should be placed to sleep on their back. Sleeping in the prone position (on the stomach) or on the side are known risk factors for SIDS. The campaign followed up on a 1993 statement by the partners warning against the risks of tummy sleeping.

Since the launch of the campaign, which included a joint statement for health care professionals and public education initiatives, awareness of SIDS and proper sleep positioning has continued to grow. In a recent survey conducted for Health Canada by Environics, 71% of parents and caregivers reported putting their babies to sleep on their back, up significantly from 40% before the campaign. As awareness of the importance of the back sleeping position has increased, the number of SIDS deaths in Canada has fallen steadily-from 385 in 1989 to 269 in 1994 to 138 in 1999.

At the same time, health care professionals are hearing concerns from parents over babies with "flat head," which can occur when a baby sleeps with its head in the same position. Because a baby's neck muscles are weak, they tend to turn their head to the same side when placed on their back. A baby's skull is very soft, and the bones can be affected by pressure. If they always turn their head to the same side, the skull may become flat.

Although most flattening resolves on its own, and while this condition does not affect brain function and development, it is still preventable.

Since babies like to have something to look at, they tend to turn their head out toward the room rather than toward the wall. By placing the baby at alternate ends of the crib (at the head of the crib one day, the foot of the crib the next), the baby can still look out into the room, but will not be resting its head on the same side every day.

This is called "counter positioning." Parents can also place a mobile on the side of the crib facing out into the room to encourage the baby to look that way.

To reduce the risk of SIDS and to prevent positional plagiocephaly or "flat head," the partners in the Back to Sleep coalition recommend that:

• Babies be placed on their back to sleep, and that their head be placed in a different position on alternate days.
  
  
• Babies have enough supervised "tummy time" while they are awake for developmental reasons.

The partners are currently preparing an update to the joint statement on reducing the risk of SIDS. It will be published in an upcoming issue of Paediatrics & Child Health, the peer review journal of the Canadian Paediatric Society, posted on the partners' website, and disseminated to health care professionals. A fact sheet for parents will also be developed.

The joint statement on Reducing the Risk of Sudden Infant Death Syndrome is available on the Internet at: http://www.hc-sc.gc.ca/hppb/childhood-youth/cyfh/sids/

Backgrounder: Sudden Infant Death Syndrome

What is SIDS?

• Sudden Infant Death Syndrome (SIDS) is the unexpected death of an apparently healthy infant that remains unexplained after a complete post-mortem investigation, which includes and autopsy, death scene investigation and review of the medical history.
  
  
• The rate of SIDS is highest between 2-4 months old.
  
  
• 90-95% of SIDS cases occur before the age of 6 months.
  
  
• There appears to be no suffering.
  
  
• SIDS is the leading cause of death in Canada for infants between the age of one month and one year, claiming the lives of 3 babies every week.
  
  
• SIDS strikes one in every 2,000 liveborn babies in Canada.

 
Risk Factors (Risk factors are not causes of SIDS)

• Babies who sleep on their tummies (6.6x)
• Babies who sleep on their sides (2x)
• Smoking during pregnancy (3x)
• Exposure to second-hand smoke (2x)
• Overheating
• Cluttered sleeping area
• Soft sleeping surface (increases with tummy sleeping)
• Boys slightly more than girls
• Aboriginal (3x)
• Substance abuse during pregnancy
• Teen mothers (less than 20 yrs of age)
• Mothers with late or no prenatal care
• Preterm infants (before 37 weeks gestation)
• Low birthweight infants (under 2500 g)
• Multiples (twins, triplets, etc.)
• Mild respiratory infections
• Unaccustomed tummy sleepers (18-20x)

Source: Canadian Foundation for the Study of Infant Deaths