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Category:  Babies

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Reduce Sids Risk Factors By Managing Your Baby's Sleeping Microenvironment

By Debra Dobbins

As King Solomon gazed upon a baby and asked for his sword, little did he know he was adjudicating the first SIDS case in recorded history. (SIDS stands for Sudden Infant Death Syndrome.)

The child was one of two infants born to two mothers. After one infant died while sleeping with his mother, the distraught mother switched her child with the live child who was also sleeping with his mother. This, of course, cause great turmoil for the second mother, who found herself arguing over which child belonged to whom. Solomon was asked to intercede.

The story ended happily, as many people know, when the king used reverse psychology; he announced he would slice the baby and half and award each woman her share. When the rightful mother cried that the infant be given to the deceitful mother so that he might live, Solomon presented the baby to his natural caregiver. One tragedy, then, did not bring about another, and Solomon gained renown for his wisdom.

Though modern parents obviously do not resort to such drastic measures as Solomon’s, they do seek wise advice as they make hundreds of decisions on how to nurture and protect their infants, especially in the critical first few months of life. This advice includes ways to reduce risk factors for SIDS, a tragedy which still claims about 2,500 lives each year in the United States and thousands worldwide.

SIDS, also known as crib or cot death, is a rather broad label to describe the sudden death of an apparently healthy and thriving infant up to 12 months of age while in his sleep. Scientists worldwide have studied a wide array of possible risk factors—everything from drug use during pregnancy to suffocation while co-sleeping with an adult, as was the case for the hapless infant in Biblical times.

While SIDS remains insidious and not fully understood, the heartening news is that for the past two decades the number of SIDS cases in the United States has steadily dropped. Many people attribute this decline to better public awareness brought about by the American Academy of Pediatrics’ Back to Sleep campaign that has educated parents on managing their babies’ sleeping microclimates.

First and foremost, childcare experts urge parents to place their infants on their backs—both for nighttime rest and for naps. (Parents, therefore, should pass the word on to daycare providers.) Stomach sleeping, research indicates, seems to increase the chances for respiratory distress. “Belly sleep has up to 12.9 times the risk of death as back sleep,” says Betty McEntire, Ph.D., executive director of the American SIDS Institute in Marietta, GA.

Stomach sleeping may put too much pressure on the child’s face, compressing natural air passages. Or, the child may end up “re-breathing”—taking in his or her own exhaled air. If the child has a deficiency in the arcuate nucleus, a part of the brain that signals the child to wake up and cry and in the process regain some oxygen, stomach sleeping may exacerbate SIDS risk factors.

Still another theory suggests that stomach sleeping allows the child to go into deeper stages of sleep and thus not react to distress signals from the brain as quickly as needed if oxygen is in short supply. In essence, the child needs to sleep a little bit lighter so that concerned parents can sleep tighter….

A possible exception to habitually placing an infant on his or her back would be if the child has GERD—gastreoesophegeal reflux disease, which may cause excessive spitting up. Parents should follow their doctor’s guidance on risks versus benefits of sleeping positions for this condition.

Besides placing babies on their backs (and checking periodically to ensure they’ve stayed there), parents are advised by professionals to make sure that crib mattress sheets fit snugly and they are used on firm baby mattresses. Parents should forego sheepskins, pillows and even waterbeds. It may, however, not suffice simply to select a firm mattress. A recent study in Germany found that some mattresses trap too much carbon dioxide (CO2) and may contribute to excessive heat build-up in an infant—both of which have been theorized as SIDS risk factors.

The study was conducted by Graduate Engineer Petra Dietze at the Children’s Sleep Laboratory of the Technical University of Dresden, Germany, under the supervision of Dr. Ekkehart Paditz, a medical professor and the president of Babyhilfe Deutschland (Babyhelp Germany). Dietze tested three mattresses.

The first mattress is considered environmentally friendly, because it is composed of a vulcanized latex core with coconut fibers, cotton encasement and a rough cotton covering. The second is a foam rubber mattress, commonly available. The third mattress is made out of advanced thermoplastic material (the same material found in wound dressings) and has a ventilated honeycomb structure.

Dietze’s hypothesis was that an infant who ends up sleeping on his/her stomach may encounter the danger of re-breathing. Using a baby doll placed face down under tightly controlled testing conditions, Dietze found that only 20% of the CO2 breathed onto the coconut/cotton mattress could be detected under it, leading her to wonder if the “environmentally friendly” mattress was actually the exact opposite when placed into a baby’s sleeping microenvironment created by a bassinet or crib.

The commercial foam mattress a bit better; 46% of the exhaled CO2 could be found under this mattress; that, however, meant that 54% could possibly be part of a baby’s re-breathing. The honeycomb mattress, which has thousands of tiny horizontal and vertical perforation throughout its cells, tested the best. Nearly all (92%) of the baby doll’s exhaled CO2 passed through the mattress, leaving only 8% unaccounted for.

The German independent test results verified a basic premise of the honeycomb mattress’ manufacturer, Supracor of San Jose, CA ( “Babies can suffocate from inhaling their own carbon dioxide,” says Susan Wilson, director of research, design and development. “Because our Stimulite Baby Mattress circulates air both vertically and horizontally, we know it can help save babies’ lives.” Wilson adds that the washable mattress is naturally antibacterial, antifungal and allergen-free.

Dietze urges parents to shop carefully for their baby mattresses. “Baby mattresses and bed underlayment should allow air to pass sufficiently and not contribute to the heat and CO2 buildup,” she advises. “Read the fine print and ask specific questions.”

Along with stomach sleeping, researchers say that excessive heat may put an infant into too deep a sleep, again restricting his or her ability to respond to distress signals from the brain when there is too little oxygen.

Heat build-up in a baby’s sleeping microclimate can also be alleviated if parents banish head pillows and stuffed animals in the baby’s bassinet or crib. Both, along with blankets, also present the danger of suffocation. A sleep sack for the baby should be used, instead.

The baby should slumber in a smoke-free, cool, well-ventilated room, preferably at 61-64 degrees Fahrenheit, or 16-18 degrees Celsius. And, yes, that cool room should be the parents’ room, too, for the first year of life. Better that way to breastfeed and/or to listen for sounds of respiratory discomfort. Most child-care experts say it’s just fine to take a babe into bed to nurse, just as long as the little one is returned to his own safe haven once his tummy is full.

Managing an infant’s microclimate is actually just one of many strategies for parents to reduce SIDS risk factors. Parents looking for more wise words may wish to check out the American SIDS Institute’s Web site, which offers well-vetted research into the complexity of SIDS.

What would King Solomon say if he were with us today? Perhaps, looking at the wealth of information on this ailment, Solomon would agree that the pen is indeed mightier than the sword, because getting the word out on basic precautions is more than half the battle against SIDS. As concerned people band together and share information, surely the world can hope that SIDS will soon be banished from the globe. “The death of even one more infant is intolerable!” says Marc Peterzell, chairman of the American SIDS Institute. “Together we can end the tragedy of SIDS.”

About the Author: Debra Dobbins, a retired public school teacher, enjoys traveling and communicating with friends in various outposts of the world. She has visited about 70 countries, experiencing travel destinations ranging from the Berlin Wall to the Taj Mahal. (


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