The "back to sleep" message for babies is getting an upgrade.
Although it's estimated that more than 70 percent of American infants now sleep on their backs, experts attending a national conference on promoting safe sleep environments for babies here last month know a broader prevention message is needed to save tiny lives.
Sleeping prone has prevented an estimated 26,000 deaths from Sudden Infant Death Syndrome since 1994, but some 4,500 babies younger than 1 year old still die suddenly and unexpectedly in their sleep annually.
This toll has been largely unchanged for more than a decade, although fewer of the deaths are labeled SIDS. SIDS is supposed to be diagnosed only after an autopsy and death scene investigation rule out any other cause.
Scripps Howard News Service showed in a 2007 report that the investigation and classification of infant deaths has been erratic for decades, with some jurisdictions labeling virtually all mysterious baby deaths as SIDS, while others never using the term. The resulting vital statistics give little insight into why babies die.
Since then, researchers have come to realize that many deaths once identified as SIDS are now attributed to suffocation or simply called "unexplained" or "undetermined" or Sudden Unexplained Infant Death. Through better, more detailed investigations and child death reviews, health officials know much more about the circumstances in which babies are dying in their sleep. Roughly 90 percent of the deaths occur in unsafe sleep environments -- couches, chairs, adult beds, with or without another person -- or in cribs overstuffed with toys, pillows and soft bedding.
And that's bringing the same federal agency that ran "back to sleep" to launch a new campaign: "Safe To Sleep," with a broader message aimed at having parents and caregivers put babies to bed with the best odds to keep breathing.
Cases of Sudden Unexplained Infant Death "are going up, and no matter what you call them in your state, we can make them go down," Shavon Artis, Safe to Sleep program coordinator with the National Institute of Child Health and Human Development, told conference-goers. The conference was hosted by Cribs for Kids, a nonprofit group that supports safe-sleep education and distributes cribs to needy families.
Expanded safe sleep guidelines were issued by the American Academy of Pediatrics in late 2012, with an explicit warning against bed-sharing with infants and urging that babies sleep on their backs in uncluttered cribs. Sleeping on the back is the best way to ensure a baby's airway stays open. Soft mattresses and bedding, pillows and stuffed animals raise the risk of smothering, along with other factors, like parents who smoke.
Dr. Rachel Moon, a member of the AAP committee that wrote the guidelines and a researcher at Children's National Medical Center in Washington, said it has become clear that some babies are born with conditions that make them more likely to stop breathing and that some sleep conditions -- like being rolled on by an adult or trapped between a mattress and wall -- will likely cause death in all babies. "It doesn't take much to block a baby's airway. The key for us is that having them in a safe sleep environment is a win-win,'' she said.
Still, getting out the message on safe sleep to a constantly changing group of new parents, grandparents and other care givers demands diverse national and local efforts. Cribs for Kids partners with more than 400 state and local organizations to promote safe sleep; the NICHD has trained hundreds of community advocates in Detroit and Atlanta.
The conference noted some state-level victories: a ban on sales of crib bumper pads in Maryland; a new state law in Florida mandating safe sleep education at all birthing centers.
In Fort Lauderdale, Fla., firefighters and paramedics do a safe-sleep check whenever they enter a house or apartment with an infant, showing parents how to clear cribs of clutter and giving them a packet of materials, or even a portable crib. There were three infant sleep deaths in the community last year, but none since last August.
In Tennessee, since the launch of a statewide safe sleep effort with special focus on several high-risk counties, the number of infant deaths related to sleep environments declined in 2011 to 109, down from 131 the year before.
"When you think about 131 deaths, that's the equivalent of six kindergarten classes -- infants dying in circumstances that can be changed if we can get the message out,'' said Dr. Michael Warren, director of the division of Family Health and Wellness for the Tennessee Department of Health.
(Contact Scripps health and science writer Lee Bowman at BowmanL@shns.com. Distributed by Scripps Howard News Service, www.shns.com.)