Tuesday, February 28, 2012

Prone Sleep Position

We hear a lot about the importance of placing a baby on its back (the surpine position) to help reduce the risk of SIDS. What does this mean, though, and is it helpful?

There are a couple of reasons why it is recommended to place a baby on its back in regards to SIDS. For starters, there is the CO2 theory. This is the theory in which the baby dies because it lacks the trigger to turn its head when it is rebreathing its own CO2, effectively poisoning itself. This is one of the most popular theories, but like the other ones, it has flaws. It wouldn't, for instance, explain the deaths that happen when babies are on their backs, in swings, or in carseats. Or when they have no obstruction.

There is also a theory that seems to think that babies sleep better on their tummies (they do!) and that the ones who are predisposed to whatever causes SIDS fall into a deep sleep and can't be roused when they are on their tummies. Obviously, that theory is more complicated than what I just said but that's the gist of it.

When babies are face down in their bedding and obstructed from moving for whatever reason, that is not SIDS. That is accidental suffocation. So we won't go there.

Many parents wonder about the safety of placing their babies on their backs to sleep. I know I do. Could there be risks to that? Maybe.

With my oldest son who suffered from severe acid reflux and large tonsils, obstructive sleep apnea was a very real danger. Although we placed him flat on his back to sleep because we were afraid of SIDS I have since learned that was just as risky. Some of the risks were developmental. I'm not exaggerating when I say that Sam was more than a year old before he slept through the night. Before then, he gagged, choked, cried, grunted, and moaned starting at about 5 minutes after he fell asleep until he finally woke himself up less than an hour later.

We eventually found an ENT who talked to us about that and he said that the fears here were developmental delays since Sam was not getting good quality of sleep. When you sleep, your body grows and repairs itself. When you don't, you're opening yourself up to infections, a poor immune system, and a stunting of several systems.

We finally got a swing when he was around 6 months old and the inclined position helped him sleep for at least two hours at a time. This helped. The sleeping habits he developed as an infant, though, have not served him well as a toddler. Friends know the troubles we have regarding Sam's sleep habits. He generally falls asleep around 4:00 am, proceeds to wake up several times during the "night", and then finally gets up at bout 3:00 pm. Waking him up at 7:00 am and forcing him through activities in hopes of getting him to sleep at an early time does not work. In those rare cases that he does drift off at 10:00 pm or even 11:00 pm he is wide awake and bushy tailed at 2 o'clock in the morning. That's not an improvement.

Toby also had these problems. The gagging, straining, crying, and moaning in his sleep from the reflux sounded like something from a horror movie. In public settings, people would actually come running to make sure he was okay. I should add, Toby was on his back when he died. He was not a tummy sleeper. The few times I did place him on his tummy were when I was sitting there with him. During those moment, there was no throwing up in his sleep, no gagging, and no choking.

I found some information regarding the prone position and its link to SIDS and thought I would share:

"In another study of infants aged 3-37 weeks who never slept on their stomach, it was found that they do not learn the behaviors that may reduce their risk of SIDS if they are prone. In this study, researchers placed a comforter over a foam rubber mattress directly under the babies' faces. All babies awoke after approximately 5 minutes and sought fresher air. The babies with prone sleeping experience lifted and turned their heads to the side; however, the babies inexperienced in sleeping prone only nuzzled the bedding or briefly lifted their heads and then resumed sleeping facedown." http://emedicine.medscape.com/article/804412-overview#a0104

So what does that mean? If we place them on their backs when they sleep that when they do finally turn over on their tummies they are unable to turn their heads for fresh air because they haven't learned that behavior? There are a lot of parents that believe this. Many parents lost their babies to SIDS on the first night their babies learned to turn over in their sleep. They say that they always placed their babies on their backs but when they found them the morning of their death they were on their tummies. 

If that is the case, then putting them on their backs to sleep is not a good thing. At least not all the time. 

I've written about this before and talked about the over-inflated statistics regarding the Back to Sleep Campaign. The fact is, we can't be sure if putting infants on their backs to sleep is related to the lower incidence of SIDS or not. The deaths were already dropping significantly before the campaign and the campaign itself uses those numbers in their tallies. A lot of people think that less exposure to secondhand smoke and better prenatal care (both of which were on the uprise before the campaign) are the real reasons for the SIDS death declines. 

There's also the fact that reporting has changed since the Back to Sleep campaign. Before the campaign started, SIDS covered a larger pool of deaths. Now, deaths can be reported as SUID and under other acronyms that mean the same thing as SIDS but are counted under different stats. So while it might look like SIDS is significantly decreasing, it might not really be. 

I actually wish I'd had the nerve to put Sam to sleep on his tummy. What a different baby he would have been. As much as I might talk, though, and agree that the prone sleep position is probably better I, like most people, am afraid to do it. There might be little understanding of SIDS but the back to sleep thing is one of the first mandates of the syndrome. 

I hope that in the future we can figure out what causes SIDS for a number of reasons. When we do, though, I hope the first thing they decide is that tummy sleeping is NOT a trigger. Then, the parents who found their babies on their tummies won't feel so guilty and the ones who have reflux babies like Sam and Toby can put them on their tummies and feel less guarded about it. 


Katie (LukeGrantsMom) said...

Love this post - I feel this way as well. Luke was not in the "prone position" or any of the other at risk behaviors that are listed. I was told only 10% of babies are found not in a "at risk" sleep environment. Putting your baby on their tummy does not kill them, there is a real reason - it is just currently not known. There might be triggers that make it happen at one point rather than another, but nobody can say it would not have happened anyway.

Rebecca said...

I have this feeling that one day we're going to learn the real SIDS trigger and it's going to be something like the type of music we listen to when they are still in the womb (or something similarly crazy).

I remember telling a former teacher about Toby. The first thing she said was, "Oh. I'm sorry. Did you have him on his tummy, then?" No, I did not, but if I had then that would have made me feel terrible.

I tell most of the new parents I meet that until they actually find a theory that sticks there's no reason to think that they did anything wrong or that it wouldn't have happened anyway. I'm starting to feel like I didn't do anything different or better with Sam-that I was just lucky he survived infancy.

Katie (LukeGrantsMom) said...

So far the theory that some babies were just not "meant" to grow up, seems as logical as anything else. Maybe our babies had purposes we don’t get to know until we leave this life. The feeling we should be able to protect our babies and if anything happens to them we did something wrong is very strong. But sadly we don't have that control, too bad we don't! It is horrible someone said that to you about putting the baby on their tummy. My neighbor (who is over 80 and very sweet) indicated to me that if I have another one, I should not send it to daycare. People don't really understand how their words insinuate things, specifically as parents when we look for how it could be our fault or how we could of changed the outcome (regardless of logic).