Sympathy Pain

I’m a nerd. I have a tendency to read reports that are extremely dry to get the “pros” view on things. Sarah hates it sometimes. I “prove” that I am right by e-mailing her clips from different reports.
I was curious about Sudden Infant Death Syndrome, so I went to the top of the class, the American Academy of Pediatrics report. Yep it’s dry, and has alot of…words. But I found their list of recommendations. If you want to read the entire report…which is pretty interesting, you can do so here.

If not, here’s their shortened list:

1. Back to sleep: Infants should be placed for sleep
in a supine position (wholly on the back) for
every sleep. Side sleeping is not as safe as supine sleeping and is not advised.

2. Use a firm sleep surface: Soft materials or objects
such as pillows, quilts, comforters, or sheepskins
should not be placed under a sleeping infant. A
firm crib mattress, covered by a sheet, is the
recommended sleeping surface.

3. Keep soft objects and loose bedding out of the
crib: Soft objects such as pillows, quilts, comforters,
sheepskins, stuffed toys, and other soft objects
should be kept out of an infant’s sleeping
environment. If bumper pads are used in cribs,
they should be thin, firm, well secured, and not
“pillow-like.” In addition, loose bedding such as
blankets and sheets may be hazardous. If blan-kets are to be used, they should be tucked in
around the crib mattress so that the infant’s face
is less likely to become covered by bedding. One
strategy is to make up the bedding so that the
infant’s feet are able to reach the foot of the crib
(feet to foot), with the blankets tucked in around
the crib mattress and reaching only to the level of
the infant’s chest. Another strategy is to use sleep
clothing with no other covering over the infant or
infant sleep sacks that are designed to keep the
infant warm without the possible hazard of head
covering.

4. Do not smoke during pregnancy: Maternal
smoking during pregnancy has emerged as a
major risk factor in almost every epidemiologic
study of SIDS. Smoke in the infant’s environment
after birth has emerged as a separate risk factor
in a few studies, although separating this variable
from maternal smoking before birth is problematic.
Avoiding an infant’s exposure to second-
hand smoke is advisable for numerous
reasons in addition to SIDS risk.

5. A separate but proximate sleeping environment
is recommended: The risk of SIDS has been
shown to be reduced when the infant sleeps in
the same room as the mother. A crib, bassinet, or
cradle that conforms to the safety standards of
the Consumer Product Safety Commission and
ASTM (formerly the American Society for Testing
and Materials) is recommended. “Cosleepers”
(infant beds that attach to the mother’s bed)
provide easy access for the mother to the infant,
especially for breastfeeding, but safety standards
for these devices have not yet been established
by the Consumer Product Safety Commission.
Although bed-sharing rates are increasing in
the United States for a number of reasons, including
facilitation of breastfeeding, the task
force concludes that the evidence is growing that
bed sharing, as practiced in the United States and
other Western countries, is more hazardous than
the infant sleeping on a separate sleep surface
and, therefore, recommends that infants not bed
share during sleep. Infants may be brought into
bed for nursing or comforting but should be
returned to their own crib or bassinet when the
parent is ready to return to sleep. The infant
should not be brought into bed when the parent
is excessively tired or using medications or substances
that could impair his or her alertness.
The task force recommends that the infant’s crib
or bassinet be placed in the parents’ bedroom,
which, when placed close to their bed, will allow
for more convenient breastfeeding and contact.
Infants should not bed share with other children.
Because it is very dangerous to sleep with an
infant on a couch or armchair, no one should
sleep with an infant on these surfaces.

6. Consider offering a pacifier at nap time and bedtime:
Although the mechanism is not known, the
reduced risk of SIDS associated with pacifier use
during sleep is compelling, and the evidence that
pacifier use inhibits breastfeeding or causes later
dental complications is not. Until evidence dictates
otherwise, the task force recommends use
of a pacifier throughout the first year of life
according to the following procedures:

• The pacifier should be used when placing the
infant down for sleep and not be reinserted
once the infant falls asleep. If the infant refuses
the pacifier, he or she should not be forced to
take it.
• Pacifiers should not be coated in any sweet
solution.
• Pacifiers should be cleaned often and replaced
regularly.
• For breastfed infants, delay pacifier introduction
until 1 month of age to ensure that breastfeeding
is firmly established.

7. Avoid overheating: The infant should be lightly
clothed for sleep, and the bedroom temperature
should be kept comfortable for a lightly clothed
adult. Overbundling should be avoided, and the
infant should not feel hot to the touch.

8. Avoid commercial devices marketed to reduce
the risk of SIDS: Although various devices have
been developed to maintain sleep position or to
reduce the risk of rebreathing, none have been
tested sufficiently to show efficacy or safety.

9. Do not use home monitors as a strategy to reduce
the risk of SIDS: Electronic respiratory and cardiac
monitors are available to detect cardiorespiratory
arrest and may be of value for home monitoring
of selected infants who are deemed to
have extreme cardiorespiratory instability. However,
there is no evidence that use of such home
monitors decreases the incidence of SIDS. Furthermore,
there is no evidence that infants at
increased risk of SIDS can be identified by inhospital
respiratory or cardiac monitoring.

10. Avoid development of positional plagiocephaly (flat head) :
• Encourage “tummy time” when the infant is
awake and observed. This will also enhance
motor development.
• Avoid having the infant spend excessive time
in car-seat carriers and “bouncers,” in which
pressure is applied to the occiput. Upright
“cuddle time” should be encouraged.
• Alter the supine head position during sleep.
Techniques for accomplishing this include
placing the infant to sleep with the head to one
side for a week and then changing to the other
and periodically changing the orientation of
the infant to outside activity (eg, the door of
the room).
• Particular care should be taken to implement
the aforementioned recommendations for infants
with neurologic injury or suspected developmental
delay.
• Consideration should be given to early referral
of infants with plagiocephaly when it is evident
that conservative measures have been
ineffective. In some cases, orthotic devices
may help avoid the need for surgery.

11. Continue the Back to Sleep campaign: Public education should be intensified for secondary care-givers (child care providers, grandparents, foster
parents, and babysitters). The campaign should
continue to have a special focus on the black and
American Indian/Alaska Native populations.
Health care professionals in intensive care nurseries,
as well as those in well-infant nurseries,
should implement these recommendations well
before an anticipated discharge.