Today the American Academy of Pediatrics (AAP) issued a new update to their infant sleep positioning recommendation to prevent Sudden Infant Death
The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleep Environment, and New Variables to
Consider in Reducing Risk
"Despite major decreases in the incidence of Sudden Infant Death Syndrome (SIDS) over the past decade, SIDS is still responsible for more infant
deaths beyond the newborn period in the United States than any other cause of death during infancy. In an updated policy statement on “The Changing
Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in
Reducing Risk,” the American Academy of Pediatrics (AAP) addresses several issues that have become relevant since they last published a statement in
Changes and clarification from their 2000 directive include as a few examples:
From side sleeping being markedly safer than tummy sleeping to - "The AAP no longer recognizes side sleeping as a reasonable alternative to fully
supine (lying on back) sleeping... Every caregiver should use the back sleep position during every sleep period."
From co-sleeping being hazardous under certain conditions to - "Bed sharing is not recommended during sleep."
And a new additional endorsement that - "Research now indicates an association between pacifier use and a reduced risk of SIDS, which is why the
revised statement recommends the use of pacifiers at nap time and bedtime throughout the first year of life."
These more stringent guidelines come five months after the publishing of a study on statistics of SIDS deaths that determine no decrease in overall
infant deaths - just a shifting in assignation of cause of death.
Changes in the classification of sudden unexpected infant deaths: United States, 1992-2001
"The failure of the overall postneonatal mortality rate to decline in the face of a declining SIDS rate in 1999-2001 raises the question of whether
the falling SIDS rate is a result of changes in certifier practices such that deaths that in previous years might have been certified as SIDS are now
certified to other non-SIDS causes. The observation that the increase in the rates of non-SIDS causes of sudden unexpected infant death could account
for >90% of the drop in the SIDS rates suggests that a change in classification may be occurring."
Disturbingly, one of the study authors reveals a nuanced observation in an interview for a news article that the community of coroners, etc. may feel
bullied or either pressure themselves to not certify infant deaths to be a result of SIDS now. In addition, a new requirement of health authorities
mandates that they must conduct an investigation of every suspected SIDS deaths; this means that many times additional information comes to light that
leads them to another cause of death (i.e. suffocation.) Also, this new investigation requirement dictates that when and investigation isn't
conducted, a cause of death of "unknown" must be assigned.
U.S. Study: Recent decline in SIDS deaths illusory
""There's been this general feeling out in the community of pathologists and people who certify deaths (of) reticence to assign SIDS as the cause
of death," study author Dr. Michael Malloy of the University of Texas Medical Branch in Galveston said in a telephone interview. "
"Health authorities now require a death scene investigation prior to certifying SIDS as a cause of death. Such information can yield clues to whether
pillows, blankets or loose bedding might have led to suffocation. If no investigation is done, then the cause of death is usually listed as unknown.
Even the support group First Candle/SIDS Alliance recognizes a need to apply some standardization to determining SIDS (from news article already
""We've definitely come a long way and we don't want to see this classification issue undo the recommendations and their effectiveness," said
Laura Reno of the SIDS support group First Candle/SIDS Alliance. She said her group is working with health experts to improve consistency in applying
the SIDS classification to deaths. "
Increasingly, studies are beginning to challenge current SIDS statistics (abstracts follow):
A Reassessment of the SIDS Back to Sleep Campaign
"The principal argument that initiated the BTSC (Back to Sleep Campaign) and that continues to justify its existence is the observed parallel
declines in the number of infants placed in the prone sleeping position and the number of reported SIDS deaths. We are compelled to challenge both the
implied causal relationship between these observations and the SIDS mortality statistics themselves."
How reliable are SIDS rates?
"This report shows how varying the criteria for a diagnosis of SIDS significantly alters the SIDS rate in Ireland."
Investigation into sudden infant deaths and unascertained infant deaths in England and Wales, 1995-2003
"It concludes that changes in certification practices surrounding sudden infant deaths and unascertained deaths suggest that it is becoming more
difficult to distinguish between these two causes of death."
I have more thoughts later on the impact of alleged inaccurate SIDS statistics, but would appreciate any dialogue or comments from anyone interested