CHICAGO - Babies should be offered pacifiers at bedtime, and they should sleep in their parents' room - but not in their beds - in order to lessen the risk of sudden infant death syndrome, the nation's largest group of pediatricians says.
Both measures may help keep babies from slumbering too deeply - a problem for infants prone to SIDS, said Dr. Rachel Moon, who helped draft the new recommendations on SIDS prevention. They were prepared for release Monday at the annual meeting of the American Academy of Pediatrics.
The death rate from SIDS has fallen sharply in recent years, now that parents are warned not to let their babies sleep on their stomachs or amid fluffy bedding or stuffed toys. But it remains the leading case of death in U.S. infants between ages 1 month and 1 year, killing more than 2,000 U.S. babies each year, and new tactics are needed to fight it, the academy said.
SIDS is defined as a sudden death of an infant, often while sleeping, that remains unexplained even after an autopsy and death scene examination.
Some breast-feeding proponents have advocated letting infants share their parents' bed to facilitate nighttime nursing and have opposed pacifier use because of concern that the devices might interfere with nursing.
But the academy is a longtime supporter of breast-feeding, and the new policy was crafted with that in mind. It recommends delaying pacifier use for breast-fed infants during the first month of life - when SIDS risks are low - "to ensure that breast-feeding is firmly established." And it says placing cribs near the parents' bed makes breast-feeding more convenient. Infants may be brought into the bed to nurse, but should be returned to their cribs afterward, the policy says.
Pacifiers offered at bedtime should not be reinserted if they fall out during sleep, should not be coated in sweet substances, and should not be forced upon infants who refuse them, the policy says.
The new policy, which updates the academy's 2000 SIDS guidelines, also says that the only recommended sleep position for infants is on their backs. Letting babies sleep on their sides, considered a less favorable option in the old policy, is now considered too risky to even be considered an option, because infants could roll over to their stomachs.
In 1992, 4,660 U.S. infant deaths were attributed to SIDS. That annual number fell to about 2,800 in 1998, thanks at least partly to the government-sponsored "Back to Sleep" campaign launched nationwide in 1994. By 2002, the reported number had dropped to 2,295.
"Over 2,000 babies a year are still dying. We should be able to do something about that," said Dr. John Kattwinkel of the University of Virginia, chairman of the academy's SIDS task force.
Doctors think actual numbers are higher because some true SIDS deaths are being blamed on other causes, said Moon, a SIDS researcher at Children's National Medical Center in Washington, D.C. Data suggest, for example, that accidental suffocation, which is hard to distinguish from SIDS, has increased in recent years, Moon said.
Doctors aren't sure about SIDS causes but a prevailing theory suggests that brain stem abnormalities affecting arousal reflexes leave some babies vulnerable when faced with challenges during deep sleep, including overheating and breathing hampered by pillows, stuffed animals or other soft objects. Babies sleeping on their stomachs are at risk because they sleep more deeply and their airway risks being partly obstructed.
Laura Reno, spokeswoman for First Candle/SIDS Alliance, a national advocacy group, said her organization strongly supports the new recommendations.
"We just want to reduce as much risk as possible," said Reno, who lost a baby son to SIDS 21 years ago, long before stomach-sleeping and soft bedding were known risk factors.
"He was sleeping on his tummy on top of a sheepskin. If I had just known then what we know now," she said. "It's a devastating thing for parents and guilt is strongly associated with these deaths."
The academy's new recommendations are based on new research, including studies that have suggested that sucking pacifiers might help keep vulnerable infants from slumbering too deeply to rouse themselves.
Dr. Stephen Sheldon, director of the sleep medicine center at Chicago's Children's Memorial Hospital, said pacifiers also enhance babies' swallowing and are an age-appropriate habit.
While pacifier use can increase the risk of ear infections, these infections are less common during the first year of life - when the SIDS risk is highest - than later on, the academy said.
The policy recommends pacifier use throughout the first year but not beyond.
Pacifier use in older children may increase risks for teeth misalignment, but using them in infancy is not a problem, said Dr. Paul Reggiardo, a Huntington Beach, Calif., dentist and past president of the American Academy of Pediatric Dentistry.
"These are from our point of view appropriate recommendations," Reggiardo said.