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SIDS

Shorties | Are Mesh Crib Mattresses and Hammocks Safer for Infant Sleep?

By January 18, 2017 No Comments
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Is there any data on [mesh hammocks and mattresses for cribs]? I’ve seen them around Facebook. I generally assume that [their safety claims] are made up, but you never know.

– Ally via Facebook

I’ve seen these too! The hammock looks like something I might want to sleep on, but I’m not sure how safe they are for infants, so I dug into it.

My first stop was a scan of the peer-review literature for information about these and found only one study.  That study references the hammock, but the study only included 23 infants and looked at oxygen levels during sleep.  As we know 23 is way to small of a sample size to be able to say anything definitive, so we can’t really consider the results conclusive or generalizable.  The authors of the study did raise an important point about the hammock’s safety: you can’t predict when a baby will start to roll over, and an infant trying to roll in a device like this is dangerous.  For this reason the authors don’t recommend it for unsupervised sleep, and that seems like pretty sound advice.

I asked a variety of experts about the safety of these products and each said they were untested in the peer-review literature in moderate or large cohort studies. They cautioned that these devices may lull parents into a false sense of security, and lead them take some risks that the American Academy of Pediatrics’ (AAP) Safe Sleep guidelines does not recommend.

Each of the products you mentioned market themselves as breathable, as the mesh allows air to flow freely through the mattress, but Rachel Y. Moon, M.D. a SIDS researcher with the University of Virginia School of Medicine, and mother of two, says that may not be true, “theoretically these are supposed to reduce rebreathing of carbon dioxide, but there’s no evidence that they reduce the risk of SIDS in that manner.” Dr. Moon notes that it’s currently unclear what role rebreathing CO2 has in SIDS when an infant is placed in an otherwise safe sleep environment, so there may not actually be any benefit to be had by using a mesh crib mattress.

Dr. Moon also notes that suffocation is not the same as SIDS, and if a infant is placed face down on a mesh mattress and their airway is partially blocked by their own body weight, suffocation is still a concern.

Dr. Scott Krugman, chair of the Baltimore County Child Fatality Review Team, and father of two, echos Dr. Moon’s reservations. “These are untested products and there’s no evidence that they are safe or safer than a firm traditional mattress.” He also adds, “the AAP does not recommend the use of any products or devices that are marketed to prevent SIDS.”

Pediatrician and mother of two, Dr. Jaime Friedman, says her advice to parents remains the same, “the AAP says the safest sleep environment for babies is to sleep alone, on their backs, on a firm mattress on a bare crib.” She also adds that unless recommended by a physician parents shouldn’t use any other devices in the crib, “like wedges, positioners or electronic equipment that claim that they can prevent SIDS.”

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Categories: Accidents, Injuries, + Abuse

Recent Reports of Skin-to-Skin Benefits Fail to Mention Key Infant Safety Risks

By January 5, 2016 1 Comment
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Last week, news of a recent study trickled  across my newsfeed, touting the benefits of skin-to-skin contact with infants. That study, published online by the American Association of Pediatrics,  presented evidence in support of Kangaroo Mother Care (KMC), which is a method that involves infants being carried and held with prolonged skin-to-skin contact (S2S).

As is often the case, though, the mainstream media picked up the story and ran with it, touting the potential benefits of the practices, while making no mention of any risk. But there are risks – and I believe a parent needs to be aware before putting the practices into place.

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Categories: Accidents, Injuries, + Abuse, Ages + Stages, Newborns + Infants, Science 101 + Mythbusting

I Shared A Bed With My Infant and Lost My Son to Sudden Unexpected Infant Death Syndrome (SUID)

By July 12, 2015 36 Comments
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It’s the type of nightmare that you hear about and it brings you to tears

as you cling to your children, feeling so grateful that it’s not your family. This is the type of nightmare that only happens to other people. Until one morning you wake up, and the nightmdare becomes your life. It happened. It really happened to me.

Of course when things like this do happen, other people always want to jump to conclusions and make their own assumptions about what must have gone wrong. Bed sharing accidents only happen to people who have been drinking, on drugs, or obese, right? Surely, this parent or caregiver was not practicing the safe sleep guidelines written by the almighty attachment parenting doctors. The rest of the world always wants to find a fault; any reason they can cling to to believe this would never happen to them. Healthy babies don’t just die, right? Sadly they do. Mine did.

So this is the story of my son, Benjamin David.

As a second-time mom, I didn’t feel the anxiety I felt bringing my first son Trae home in 2011. After a beautiful and peaceful water birth, and Ben latching on and taking to breastfeeding right away, I felt like I could take on anything. I knew that it would be tough and exhausting to take care of my two boys alone, but I was up for the challenge. My heart had never been so full.

Benjamin 2

Amanda, Trae and Benjamin cuddle together shortly after coming home from the hospital.

The night Ben passed away was no different than any other night. I laid him in his cosleeper that was attached to my bed, and I drifted off to sleep knowing that it wouldn’t be long until he woke up again. Ben never slept for long unless he was in my arms. It was only a short while later I awoke to Ben fussing. I took him out of his swaddle blanket, changed his diaper, then I latched him on so he could eat. Not long after he started eating, I fell asleep.

8 A.M. My alarm on my phone goes off. I reached over to turn it off, and I thought to myself it was odd that Trae hadn’t already woken up and dragged me out of bed to turn on Curious George or Thomas & Friends. Then I looked at my sweet Ben, all cuddled up to me as he loved to do. But something wasn’t right. His face was pale and his nostril was stuck halfway down. I sat up and I realized there was a pool of blood next to Ben. I thought to myself, “No. No. This isn’t happening!” I picked up my little 30-day-old son, laid him on his back, and started to gently shake him saying, “Ben! Ben! Wake up! Wake up, Ben!” It was then that I realized he was not going to wake up. He was already gone.

In my shock, I called my family; first my sister, but there was no answer as her phone battery was dead; then my grandma, who begged me to call 9-1-1. I carried Ben downstairs, pacing my living room as I talked to the operator. She asked me a few times if I would like to start CPR. Each time, I told her there was no point. Ben was gone. His little hard body was stiff in my arms, and he didn’t look like my Ben anymore. I knew there was no hope.

Amanda, her eldest son Tre and Benjamin in the hospital shortly after Benjamin's birth.

Amanda, her eldest son Trae and Benjamin in the hospital shortly after Benjamin’s birth.

The ambulance finally arrived, and the paramedics walked into my living room. The male paramedic touched Ben and made the call to try and revive him, took Ben from my arms and ran out my door with him.  As he’s running out, my aunt was running in (my grandma had called her). She had no idea that Ben was dead, she just thought he had stopped breathing but was still alive. I’ll never forget the moment she realized the truth, seeing his body in the EMT’s arms as he rushed by. Her face changed from panic to horror.

I fell to my knees as I begged God, anyone, to bring my son back. It was only a matter of minutes before I felt the hand of the paramedic gently touch my back as he said, “I’m so sorry Mom, but..” I don’t recall what the other words he spoke were. The “but” told me everything I needed to know. They couldn’t get Ben back. He had been gone for hours.

Before long, my house looked like something out of the crime shows you see on TV. Police, detectives, investigators and eventually the coroner arrived to analyze the death scene. My bedroom, my bed where I laid Ben with me had become a death scene. I only had one question for the coroner: “Did Ben suffer?” The answer I got is something forever burned into my mind. I can still remember the look on his face when he answered me, the smell in the room, and even the temperature in my house.

“Babies this small generally don’t suffer when they’re smothered,” he said.

Benjamin nursing in the hospital a few minutes after being born.

Benjamin nursing in the hospital a few minutes after being born.

And that is the moment my whole life, my whole being, was consumed with guilt. I killed Ben? But I knew I didn’t lay or roll onto him. The coroner told us that by smother, he meant suffocation. Somehow after I fell asleep, Ben suffocated. I explained to him that there was nothing blocking Ben’s airway. How did this happen if his nose and mouth were not covered? I did not understand.

As my family and friends started pouring into my house, the questioning began. The detective kept apologizing about the questions he had to ask. “Did you have any alcohol in the last 24 hours? Did you take any medication in the last 24 hours? What position did you find Ben in? What position were you in? Are you sure you have not consumed any alcohol recently?” While the detective was so kind about it, I felt like they were trying to find where I screwed up, as if I must have done something to put myself into an abnormally deep sleep. But there was nothing. I never felt as if I slept too deeply while Ben was in bed with me. Whenever I did roll over in the middle of the night, I would consciously pick Ben up and move him with me. Not once did I wake up facing away from him. That morning was no different than any other.

I call this my hell day. It is the worst story to tell. And it never seems to get easier.

Weeks went by before I got Ben’s final cause of death. It was ruled a SUID (sudden unexpected infant death)- positional asphyxiation due to unsafe sleep conditions. While there was never anything found in his autopsy to prove that he suffocated, nor was his airway blocked when I found him, his death was ruled an accidental asphyxiation.  I was one of the unlucky mothers who got a coroner that refused to rule a death as SIDS (sudden infant death syndrome) because of his sleeping conditions. Naturally, I was angry and consumed with guilt.

Baby Ben

Baby Ben

Grieving your child is up and down at the same time. It’s mad and sad. Grief is every contradicting emotion all at once. I would give anything to prevent others from living this nightmare. Not only do you lose your child, you lose yourself. Life will always be grouped as before your child died, and after your child died. You are never the same.

Since Ben’s death, I feel it is my duty to promote safe sleep knowledge to parents. The knowledge is not always well received. Often I hear the line, “I bed shared with all of my children and they are fine.” I too shared a bed with both of my children. If either of my kids were at a higher risk for this, it would’ve been Trae. Trae was mostly formula fed, I was overweight from gaining 60 lbs during my pregnancy with him, and his dad sleeping in bed with us added a much higher risk of accidental suffocation or parental overlay. Yet, it was Ben who died. My breastfed baby that I gained the recommended 30 pounds with, that I slept alone with, only bringing him into the bed with me for midnight feedings.

I see a lot of information out there on how to safely bed share. After losing Ben, I cannot agree with it. Science has proven time and time again that bed sharing absolutely does increase a baby’s risk of SIDS or SUID. Many people tell me that if their babies were to die for no reason in their sleep, they would want their child next to them, instead of alone. I would also have to disagree there. Never knowing if my baby would still be alive had he been sleeping alone is something I will take to the grave with me. If Ben had died while I was practicing the ABC’s of safe sleep, I feel my life wouldn’t constantly be filled with doubt and guilt. Could his death have been prevented? I may never know. But I would not wish this feeling of guilt and never knowing the answer on anyone.

In memory of: Benjamin David “Benny Bear”
10/20/14-11/19/14

 

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Categories: Accidents, Injuries, + Abuse, Ages + Stages, Mental, Emotional, + Behavioral Health, Newborns + Infants, Science 101 + Mythbusting

Crib Notes: Is Cosleeping Really Unsafe?

By June 23, 2015 10 Comments
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This post was written in response to a question by TheScientificParent.org reader Kate.

It has been every parent’s worst nightmare for generations – finding their infant dead suddenly and unexpectedly. As a father of two, I remember the sleepless nights alternating between crying infants and complete silence, wondering if my boys were actually breathing. The fear is palpable. As a pediatrician who has had to pronounce infants dead and as a member of the team in my county that reviews infant deaths, I have far too often seen the grief and confusion when that fear becomes a reality.

For centuries we’ve struggled to understand the cause of, and even define what Sudden Infant Death Syndrome (SIDS) is. Over the years, the fear SIDS (sometimes known as cot death or crib death) has spawned multiple attempts by researchers and device makers to develop products to prevent SIDS – including apnea monitors, sleep positioners, or wedges. None of these interventions have been demonstrated to reduce the risk of SIDS. But what has been shown to reduce an infant’s risk of SIDS is very simple and many parents aren’t aware of it.

Since a consensus conference in 1991, Sudden Infant Death Syndrome (SIDS) has been defined as a death of an infant under one year of age that cannot be explained after a thorough investigation which includes an autopsy, a scene investigation, and a review of the medical and social histories. SIDS is one type of Sudden and Unexpected Infant Deaths (SUID). The reasons why the authorities need to investigate when an infant dies unexpectedly include ensuring no foul play was involved or whether or not a preventable genetic condition (like certain heart arrhythmias) occurred that impact future deaths in a family.

Scientific Parent SIDS InfographicThe majority of infants who die from SIDS have underlying risk factors that can be addressed to reduce the risk of death. Some children are likely born with intrinsic and undetected brain stem abnormalities that make them more susceptible to sudden death and despite risk factor modification, these infants still may die. Some researchers are looking into the role the inner ear plays in SIDS, but the research so far is in its preliminary stages. Unfortunately for many families, approximately 5% of SIDS cases involve otherwise healthy infants with no underlying risk factors. I’m going to focus on the 95% in this post, because the majority of these deaths can be prevented.

Improved death scene investigations over the past 2 decades have shown us that most SUIDs are a result of infants being placed in unsafe sleep positions. Improved examinations by death investigators and Child Fatality Review Teams have shown that for most infants who die of SIDS and a vast majority of infants who die of asphyxiation (also known as suffocation) or undetermined causes are found in an unsafe sleep position. The Back to Sleep campaign started in the 1990s after studies showed that infants placed on their back to sleep had a reduced risk of dying from SIDS. Between 1992 and 2001 the Back to Sleep campaign reduced the risk of SIDS by over 50%.

Unfortunately one of the worst sleep environments for a child is to co-sleep in an adult bed, or more specifically co-bed. We’ve designed adult beds to be comfy and welcoming for us at the end of a hard day, with pillows, blankets and soft mattresses, but these are all major asphyxiation risks for an infant not old enough to roll over or lift their head. Asphyxia while co-bedding can occur from 3 primary mechanisms – the parent rolling over on the child and restricting breathing, the child rolling or being rolled between the bed and a wall, or a child suffocating on soft bedding like blankets or pillows.

But these methods are not how most high-risk infants who asphyxiate while co-bedding die: Most die from carbon dioxide poisoning, by regularly re-breathing in their own or their parents exhaled breath. Any object near the mouth and nose of an infant can create an air pocket in which the exhaled air gets trapped. The infant then re-breathes air with a higher concentration of carbon dioxide. As the carbon dioxide level increases in the bloodstream and oxygen levels decrease, the infant is more likely to stop breathing and die.

These mechanisms for death can also occur in an adult bed without an adult and on other surfaces with an adult – like a couch. It is very easy for an infant to roll off the chest of a sleeping adult and get wedged between the parent and the side of the couch.

Due to an increase in the number of cases of Accidental Strangulation and Suffocation in Bed (ASSB), which have quadrupled from 1984-2004, the number of total infant deaths has stopped decreasing since 1998 despite the drop in SIDS cases. The number of deaths in unsafe environments, like co-bedding in adult beds, is staggering. A report out of Michigan in 2011 demonstrated that 83% of their infant deaths were a result of sleep related asphyxiation. Even looking only at SIDS cases, well designed epidemiological studies have demonstrated there is an increased risk of SIDS from co-bedding by itself after controlling for other risk factors, such as family history and smoking.

Despite the overwhelming body of research showing the deadly risks of co-bedding, many lactation consultants and some prominent anthropologists strongly believe co-bedding reduces the risk of death and increases the length of breastfeeding. While co-bedding may increase the length of breastfeeding and breastfeeding has been shown to independently reduce an infant’s risk of SIDS, the risks of sleeping in an adult bed outweigh the benefits gained by breastfeeding. Many co-bedding proponents claim that so long as the parent removes soft objects or strangulation risks from the bed (such as excessive throw pillows, heavy blankets or pillows and blankets with tassels) that co-bedding is safe. Unfortunately these individuals have failed to understand the bigger picture and the lessons learned from Child Fatality Review.

The American Academy of Pediatrics has several recommendations for parents who want to reduce their infant’s risk of SIDS and SUIDs, in addition to placing your infant on their back to sleep in a crib or bassinet of their own:

  • Sleeping on a firm surface and avoiding soft objects in the crib
  • Avoiding exposure to tobacco smoke
  • Breastfeeding
  • Room sharing without bed sharing (place the bassinette next to the adult bed)

The research is clear: Very few infants die alone, on their back, and in a safe crib, and the majority of these deaths are preventable. I understand why some parents may want to co-bed or find themselves unintentionally co-bedding. Co-bedding can make parents feel closer to their infant, it also may make it easier for some parents to extend breastfeeding during the night and to get a little extra sleep. As a parent I understand the exhaustion parents feel in the first weeks and months of life, and I’m not trivializing that, but the research is clear: Very few infants die alone, on their back, and in a safe crib, and the majority of these deaths are preventable.

For more information on safe sleep go to:

 


 

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Categories: Accidents, Injuries, + Abuse, Ages + Stages, Newborns + Infants, Science 101 + Mythbusting

Has A Seattle Doctor Found the Cause of SIDS?

By April 29, 2015 3 Comments
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Sudden Infant Death Syndrome (SIDS) looms over many new parents like a poltergeist, an unpredictable thief of life and joy. It is the third most common cause of infant mortality in the US (0.6 deaths per 1,000 live births), yet it is still little understood. SIDS is such a visceral fear for parents that an entire industry has popped up claiming to provide parents with early notice should their baby stop breathing in the night, for the low-low price of $199.99 per device. Unfortunately for many concerned parents these devices are unlikely to have any positive effect on SIDS deaths.

That’s why we weren’t surprised when a number of readers forwarded us this article from the Seattle Times that claims, One Seattle Children’s Doctor Thinks He’s Close to Stopping SIDS. Each reader said the article gave them a sense of safety and relief to know that since their infants had passed their hospital hearing tests, they were considered safe from SIDS. When we read the article Julia and I came away with a different understanding, which is why we haven’t shared the article.

So, is the article bunk or what? Has this doctor really found the cause of SIDS?

The answer to this lies somewhere in the middle, it is neither bunk, nor is it science … yet. The physician named in the article, Dr. Daniel D. Rubens, is indeed a practicing, board certified anesthesiologist with Seattle Children’s Hospital, with a special interest in SIDS. He’s formed the SIDS Research Guild at Seattle Children’s and is currently seeking funding to further his research into the causes of SIDS.

Scientific Parent SIDS InfographicWhile Julia and I read the article and saw a plea for research funding, not a definitive answer on SIDS, as many readers did. This is because Julia and I have either been in that position or have been on the receiving end of these pitches. But the way the article is worded, it could easily be interpreted as an announcement of new findings.

Dr. Rubens hypothesis that the inner ear dysfunction plays a role in SIDS is supported by initial research, much of which has been conducted by Dr. Rubens himself. This doesn’t invalidate his existing research, but we hold off saying that something is a scientific fact until others can replicate findings independently.

To get an independent take on the article, we reached out to Dr. Rachel Moon, Associate Chief, Division of General Pediatrics and Community Health, and a SIDS researcher at Children’s National Medical Center in Washington, DC. Dr. Moon feels that Dr. Rubens findings are compelling, but should be considered preliminary at this point, and parents shouldn’t change their behaviors based on the article or panic if their infant fails a newborn hearing test.

For right now, Dr. Moon says parents should follow these guidelines to reduce their baby’s chance of SIDS:

  • Put your infant to sleep on their back back
  • Infants should sleep in a crib with a firm surface, with nothing else in the crib except for the baby
  • Sleep in a crib next to the parents’ bed for the first months of life
  • Do not sleep on the same surface with another person
  • Never sleep on a couch, sofa, or armchair
  • Avoid smoke exposure, both during pregnancy and after birth
  • Breastfeed for as long and as much as possible
  • Avoid exposure to alcohol and illicit drugs during pregnancy and after birth
  • Offer a pacifier at sleep time
  • Immunize your baby

 

Resources:

Hoyert, D. and Xu, J. National Vital Statistics Report: Deaths: Preliminary Data for 2011. Centers for Disease Control and Prevention. 61:6. October 10, 2012

Alexandra Sifferlin. Don’t count on Smart Baby Monitors to Prevent SIDS. Time Magazine. November 19, 2014.

King, D. Marketing Wearable Home Baby Monitors: Real Peace of Mind? The British Medical Journal. doi: 10.1136/bmj.g6639

Nicole Brodeur. One Seattle Children’s doctor is close to stopping SIDS. The Seattle Times. April 3, 2015.

Seattle Children’s Hospital. Find a doctor: Daniel D. Rubens. Retrieved April 28, 2015.

Seattle Children’s Hospital. SIDS Research Guild. Retrieved April 28, 2015.

National Institutes of Health. Pub Med Search: SIDS + “inner ear.” National Center for Biotechnology Information. U.S. National Library of Medicine. Retrieved April 28, 2015.

Children’s National Health System. Find a doctor: Rachel Moon, MD. Retrieved April 28, 2015.

Eunice Kennedy Shriver National Institute of Child Health and Human Development. Reduce the risk of Sudden Infant Death Syndrome (SIDS) and other sleep-related causes of infant death. September 2012. Retrieved April 28, 2015.

Centers for Disease Control and Prevention. SIDS and SUID > Parents and Caregivers. Last Updated December 1, 2014. Retrieved April 28, 2015.

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Categories: Accidents, Injuries, + Abuse, Ages + Stages, Newborns + Infants