SUDDEN INFANT DEATH SYNDROME (SIDS)

SIDS prevention Guidelines from American Academy of Pediatrics AAP Policy Statement "The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk," Oct. 10, 2005 (from AAP website):

• Sleep on back only, not side or prone
• Use a firm sleep surface
• No pillows, stuffed animals, quilts, comforters, sheepskins, etc. in crib
• If using a blanket, tuck it in under mattress
• Do not bed share, or if bed sharing, minimize duration (e.g. only until infant is asleep)
• Avoid smoking during pregnancy or smoke exposure postnatally
• Room sharing w/o bed sharing may reduce risk
• Pacifier use reduces risk (by about 50% in observational studies; see meta-analysis in Peds 116:716e, 2005; also case-control study reported in BMJ 332:18, 2006) but do not use in breastfed infants until 1mo of age, to allow breastfeeding to take hold
• Avoid overheating infant
• During waking time emphasize positions which do not involve pressure on occiput to reduce risk of positional plagiocephaly, i.e. lots of "tummy time" and not a lot of time in infant car seats.

In a case-control study in 185 infants who died of SIDS and 312 randomly selected controls, pacifier use during the last sleep was associated with sig. reduction in risk for SIDS (OR 0.08); the effect was seen in all of the various subgroups tested. (BMJ 332:18, 2006--JW)

In a multivariate meta-analysis of data from four case-control studies, usual use of pacifiers was associated with sig. lower risk of SIDS (OR 0.71) (Peds. 116:e716, 2005--JW)