SIDS
Risk Increases With Bed-Sharing And Soft Bedding
Experts Underscore Prevention
Infants
who share a bed with other children are at a higher risk of sudden infant
death syndrome (SIDS) than are other infants, according to a new analysis
of a study of mostly African-American SIDS deaths in Chicago.
The
report appears in the medical journal Pediatrics.
The analysis also found that two known
risk factors for SIDS - sleeping on soft bedding and sleeping on the
stomach - pose a far greater risk of SIDS when they occur together than
the sum of both risk factors added together.
Developing
Greater Understanding
The report confirms several studies reporting
that SIDS risk was lower among infants put to bed with a pacifier and
reinforced earlier findings that sleeping on a sofa also increases infants'
risk of SIDS.
The
study was supported by the National Institute of Child Health
and Human Development (NICHD) and the National Institute
on Deafness and other Communication Disorders (NIDCD), both
at the National Institutes of Health (NIH), as well
as the Centers for Disease Control and Prevention (CDC).
The researchers studied all infants from
the ages of birth to one year who had died of SIDS in Chicago between
November 1993 and April 1996. There were 260 SIDS deaths during that
time.
"This study
provides important new information regarding SIDS risk factors,"
said Dr. Duane Alexander, Director of the NICHD. "The
next step is to get this information to the parents and families who
can use it to reduce the risk of SIDS among their own infants."
According to CDC
Director Dr. Julie Gerberding, "The SIDS rate for African-American
babies is more than twice that for white infants. Families need counseling
on ways to reduce the risk of SIDS. For example, they need to know they
should avoid putting an infant to sleep with other children."
The research is part of the Chicago Infant Mortality
Study, designed to identify risk factors for SIDS that place African-American
infants at roughly double the SIDS risk of Caucasians.
"Our study
found a dramatic increase in SIDS risk for prone sleeping on soft surfaces,
highlighting the need to eliminate these unsafe sleep practices,"
said Dr. Fern R. Hauck, lead investigator of the study. "Additionally,
infants should never be placed to sleep on a couch with anyone or in
a bed with other children."
Getting
the Word Out
The study authors conclude that physicians
should counsel new parents not only about the benefits of placing infants
to sleep on their backs, but also about the risk their study had uncovered.
"Parents are influenced strongly by their physicians
in choosing the sleep position for their infants," they wrote.
"Other infant care practices, such as bed sharing and use of soft
bedding, may also be influenced by medical providers, particularly if
reinforced by the media."
To reduce the racial disparity in SIDS rates, the authors
advised taking families' economic circumstances into consideration.
For example, some parents may not be able to afford firmer mattresses
or to have enough beds for all their family members. The authors called
for research on how best to meet these needs.
"On the basis of the findings of this study, they
[parents] should receive instruction that emphasizes supine (on the
back) sleeping, firm bedding, not using pillows, and not sharing a bed
with other children or sleeping with another person on a sofa, while
being sensitive to parental concerns and cultural traditions."
The researchers noted that sleeping on the stomach,
and sleeping on soft bedding - both known to increase the risk of SIDS
independently - posed a much greater risk for SIDS when occurring together
than might be expected.
For example, soft bedding appeared to pose 5 times the
risk of SIDS as firm bedding; sleeping on the stomach increased the
risk of SIDS 2.4 times. Yet infants who slept stomach down on soft bedding
had 21 times the risk of SIDS as infants who slept on the back on firm
bedding.
Always consult your child's physician for more information.
Children's
Juice Intake Adds Extra Calories
"Parents think that because fruit
juices are natural that they are a healthy drink, so they don't put
a limit on how much their children consume," says study author
Dr. Sarita Dhuper, director of pediatric cardiology and the pediatric
obesity clinic at the Brookdale University Hospital and Medical Center.
In truth, however, Dhuper says fruit drinks are a major
source of calories on their own. Moreover, she says, their high sugar
content may increase a child's appetite for even greater amounts of
food, thus further contributing to weight gain.
"Our study
found that juice consumption is almost shocking. For some kids, there
seems to be no limit to what they can drink in a given day," says
Dhuper, who presented her findings at the annual meeting of the Pediatric
Academic Societies.
Pediatric nutritionist Pam Birkenfeld agrees with the
finding.
"Parents tend to think that because fruit juice
is fat-free and comes from nature, it's OK," she says. "But
what they often don't realize is that it is a very concentrated source
of calories that generally does not fill you up, just out," says
Birkenfeld, a dietician at Nassau University Medical Center in East
Meadow, N.Y.
"In some obese children, juice consumption went
as high as 50 ounces per day," Dhuper says. "There were just
no limits."
The study calls for parents to dramatically limit their
children's juice consumption, and for pediatricians to incorporate information
on the links between fruit juices and obesity in all well-child visits.
Always consult your child's physician for more information.
Online
Resources
American Academy of Child & Adolescent Psychiatry
American
Academy of Pediatrics
American Psychiatric Association
American
Psychological Association
Centers
for Disease Control and Prevention (CDC)
National
Institute of Child Health and Human Development (NICHD)
National
Institute of Mental Health (NIMH)
National
Institutes of Health (NIH)
National
Institute on Deafness and other Communication Disorders (NIDCD)
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June 2003
In
This Issue:
SIDS
Risk Increases With Bed-Sharing And Soft Bedding
Developing
Greater Understanding
Getting
the Word Out
Children's
Juice Intake Adds Extra Calories
Mood
Disorders Can Affect Babies and Toddlers
Watching
for Signs
Building
Trust
Online
Resources
Other
Resources:
Find
a St. John's Mercy Physician
Children's
Services at St. John's Mercy
Children's
Health Information
St.
John's Mercy Classes and Programs
Mood
Disorders Can Affect Babies and Toddlers
Experts
say children under age 3 can suffer from symptoms of depression,
including disruptions in eating and sleep.
What
causes mood disorders in children is not well known. There are chemicals
in the brain that are responsible for positive moods.
Other
chemicals in the brain, called neurotransmitters, regulate the brain
chemicals that affect mood. Most likely, depression (and other mood
disorders) is caused by a chemical imbalance in the brain.
Life
events (such as unwanted changes in life) may also help cause this
chemical imbalance.
In
recent years, researchers have discovered the youngest humans can
even suffer from post-traumatic stress disorder, once thought to
be only an illness of adults.
"The
picture has totally changed," says Alicia Lieberman, director
of the Child Trauma Research Project at San Francisco General Hospital.
Watching
for Signs
Researchers have found that parents
who continually fail to create a bond of trust with their babies
may set them up for insecurity later in life, says Alice Sterling
Honig, a child development expert at Syracuse University.
"You're not going to have this
feeling of trusting that someone is really for you," she says.
Psychologists, of course, cannot ask
infants how they feel.
"We don't put babies on couches,"
Lieberman says. Instead, they rely on instinct and a guide to symptoms
of mental health problems among children up to age 3. The guide,
by the infant advocacy group Zero to Three, is similar to the popular
DSM-IV, a handbook of psychological disorders among older children
and adults.
Even without a guide, many psychologists
can detect problems in a baby by just looking at him or her, Lieberman
says. Stressed-out babies look "sad, withdrawn, frightened,
and disorganized," she says.
Some babies as young as 4 months will
not smile or laugh, she says, and they may show signs of stress
seen in much older people - digestive problems and weight loss.
As they get older, toddlers who have
been exposed to severe stress reveal the after-effects through "post-traumatic
play," Lieberman explains. "Their play is rigid and repetitious."
Mood disorders in children also put
them at risk for other conditions (most often anxiety disorder,
disruptive behavior, and substance abuse disorders) that may persist
long after the initial episodes of depression are resolved.
Building
Trust
Without the benefit of drugs or psychotherapy,
counselors can only change the lives of infants by convincing their
caregivers to do things differently.
Dr. Stanley Greenspan, a child psychiatrist
at George Washington University, says experts are teaching parents
and other caregivers to adjust how they interact with an infant
depending on how he or she reacts to sensations.
A hypersensitive baby who is sensitive
to noise and sound might need extra soothing and comforting, for
example.
Therapists must often teach parents
to compliment their infants instead of criticize them and make sure
the these children feel safe in times of stress, Honig says.
Whatever the treatment, experts agree
that helping infants handle the challenges of life will pay off
down the line.
"The biggest myth is that it doesn't
make a difference what you do in the early years, that people's
traits are genetic and you can't have a favorable influence,"
Greenspan says. "That's not true."
Always consult your child's physician
for more information.
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