In the early 1980s, pathologists in Western Nebraska recommended the use of infant car seats to decrease the occurence of Sudden Infant Death Syndrome (S.I.D.S.) Sudden Infant Death Syndrome is defined as "the sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and a review of the clinical history". In the late 1980s, clinicians in Britain, New Zealand and other countries suggested that placing infants in a supine position or on their sides decreased the occurence of S.I.D.S. In the early 1990s, the American Academy of Pediatrics and the U.S. Public Health Service launched the "Back to Sleep" program which revealed a 30% decline in infant deaths due to S.I.D.S. between October, 1993 and October, 1995. In subsequent years, the American Academy of Pediatrics removed recommendations for having infants sleep on their sides because some infants rolled onto their stomachs (prone position) and were at increased risk for S.I.D.S.
There appears to be several potential problems associated with simply placing infants in a supine position for sleep. For example, as infants attain six months of age, infants may easily roll to the prone position. Therefore, despite the apparent early success of the "Back to Sleep" program, some believe the placing of otherwise healthy infants in a high quality infant car seat still has significant advantages because (1) experience has shown that infants who sleep from a young age in infant car seats do not roll to the prone position during sleep even at six months of age or older (2) infant car seats position infants not only on their backs but in a reverse Trendelenburg position which better opens their airways (approximating the "sniff position") and decreases the likelihood of gastroesophageal reflux or aspiration, (3) parents who use infant car seats for infant sleeping are more likely to use infant car seats for infant sleeping in non-home settings and in automobiles while traveling which decreases morbidity and mortality of infants due to motor vehicle accidents, and (4) infant car seats may decrease the potential occurence of the plagiocephaly which occurs occasionally in infants who always sleep in the supine position. In plagiocephaly, the skull flattens by one year of age and the infant's posterior head is flat from the nape of the neck to the top of the skull. Infants with plagiocephaly may need to wear a "Dynamic Orthotic Cranioplasty" head band. Plagiocephaly must not be confused with craniosynostosis. The use of completely noncluttered, large SAFE firm bedding playpens (no crib in the home at all) as the primary sleeping areas for infants in well designed, safe infant car seats may be desirable in the unlikely event infants "buck out" of the infant car seats while crying or irritable and becoming wedged between the side of the crib and the infant car seat.
It is extremely important to emphasize that, in all locations, otherwise healthy infants should be placed in either the supine position or within an infant car seat for naps and sleep to decrease the likelihood of Sudden Infant Death Syndrome. Recent amended precautions by the American Academy of Pediatrics about "tummy time" when infants are awake is potentially problematic because some infants, not under close observation, may quickly fall asleep in the "tummy time" position and be at increased risk for SIDS. Precautions, by parents, are often taken at home, then, at another location, such as a day care center, relatives' homes, etc., infants are placed in the higher risk prone position. Tragically, sudden infant death syndrome has occured in these situations. Educating day care center personnel, relatives, and others is needed to decrease the likelihood of S.I.D.S. in the non-home location.
Comprehensive and optimal prenatal care, natural childbirth, breast feeding; warm, low humidity safe homes, 100% natural firm bedding; one blanket; lightly dressed, nonrestrictive clothing; no substance abuse,tobacco or smoke exposure; knowledgeable, married income earning biological adult parents as primary caregivers; nonuse of pillows, waterbeds, beanbags, etc. appear to be associated with decreased likelihood of S.I.D.S. These plausible recommendations to decrease S.I.D.S. are continuously updated and demonstrate that human morbidity and mortality can be greatly improved by nonpharmacologic means.
© Copyright 1982-2007 Byron L. Barksdale, M.D. All rights reserved.