New recommendations based on research identifying risks for all infants
Tuesday, October 18, 2011
Representatives of the agencies in the U.S. Department of Health and Human Services with a focus on infant health and safety today expressed their support for the new infant safe sleep recommendations issued by the American Academy of Pediatrics (AAP).
The AAP announced the expansion of its recommendations for reducing the risk of sudden infant death syndrome (SIDS) to include recommendations for a safe sleep environment for all infants. Many of the sleep environment risk factors for SIDS—bed sharing and soft bedding materials, for example—have accounted for the accidental suffocation observed in many cases of sudden unexpected infant death (SUID), which describes any sudden and unexpected death of a child under 1 year of age, whether explained or unexplained. The new recommendations were developed to reduce the risk of infant death from SIDS as well as death from known sleep-related causes, such as suffocation from soft bedding materials and entrapment from inappropriate sleep situations, such as becoming lodged between a mattress and headboard. Providing a safe sleep environment has the potential to reduce SIDS risk as well as reduce the risk for SUID.
The AAP’s recommendations are available at http://pediatrics.aappublications.org/content/early/2011/10/12/peds.2011-2284.
In 1992, after several international studies showed that SIDS rates were lower in societies in which infants were place for sleep on their backs, the AAP recommended that all healthy U.S. infants be placed to sleep on their backs.
Support for the new recommendations was expressed by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) at the National Institutes of Health, the Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration, the U.S. Centers for Disease Control and Prevention, and the U.S Food and Drug Administration.
The Sudden Infant Death Syndrome Act of 1974 assigned the responsibility for SIDS research to the NICHD. In response to the 1992 recommendation, the NICHD established the Back to Sleep Campaign, to urge parents and caregivers to place infants on their backs for sleep. Through the years, the institute updated the campaign materials and messages to reflect the revisions of the AAP guidelines as well as the research supported by the NIH and other organizations. The act also designated the establishment of infant death counseling programs through the Office of Maternal and Child Health, now the Maternal and Child Health Bureau (MCHB) of HRSA. In 1979, the MCHB established a national clearinghouse for the dissemination of information on SIDS to health professionals, community service personnel, SIDS parents, and the general public.
Healthy People 2020 will include a measure that tracks the proportion of infants who are put to sleep on their backs. Healthy People 2020 is a set of goals, measures, and targets for the Nation’s Health. It is coordinated by the Office of Disease Prevention and Health Promotion within the Department of Health and Human Services.
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health
The NICHD has begun revising its Back to Sleep materials to include the new recommendations. In addition, recent research suggests that certain infants may be highly susceptible to SIDS, due to an abnormality in a specific network of nerve cells in the brain, explained Alan Guttmacher, M.D., director of the NICHD. He added that NICHD research will continue its investigation of factors that place all infants at risk as well as understanding the biological factors which appear to make some infants particularly vulnerable for SIDS. “We have the opportunity to reduce SIDS deaths and other accidental deaths by removing hazards from the sleep environment,” Dr. Guttmacher said.
Maternal and Child Health Bureau of the Health Resource Services Administration (HRSA)
A major focus of MCHB is to decrease infant mortality by working with states and local agencies that serve families through Title V, Healthy Start, Home Visiting and the Sudden Unexpected Infant Death/Sudden Infant Death (SUID/SIDS) Consortium. The MCHB will be updating its materials to reflect the revised AAP recommendations to promote safe sleep.
“For over 30 years, the Maternal and Child Health Bureau has invested in resources to support families, health care providers and health promotion specialists in risk reduction efforts, and the provision of bereavement support for families experiencing a loss,” said Christopher DeGraw, M.D., M.P.H., senior medical advisor for the MCHB. “Through the decades, we have attained increasing clarity on risk and protective factors for protecting infants across the nation from sudden infant death. The American Academy of Pediatrics continues to provide leadership in distilling research to develop the most promising strategies for risk reduction. Creating a safe infant sleep environment has been identified as one of the key behaviors to protect infants against both SIDS and accidental suffocation.”
U.S. Food and Drug Administration
The FDA also expressed support for the new recommendations. Prevention of SIDS or reduction of the risk of SIDS is a common medical claim made by manufacturers of products for infants, said Susan Cummins, M.D., M.P.H., chief pediatric medical officer at FDA’s Center for Devices and Radiological Health. Baby products are considered medical devices when claims to cure, treat, prevent, or reduce the chances of SIDS are made in the product's labeling, packaging, or advertising, she explained. Medical devices are subject to FDA regulations.
She added that, in seeking to provide a safe sleep environment, parents should be aware that the FDA has never cleared or approved a product for babies to prevent or reduce the incidence of SIDS.
“Parents and caregivers should beware of products that make SIDS prevention claims because the FDA has never cleared or approved a device to prevent SIDS or reduce the risk of SIDS, ” Dr. Cummins said. “Parents should also beware that some common baby products like infant positioners, may introduce the chance of entrapment and strangulation.”
Centers for Disease Control and Prevention
The mission of the CDC's Division of Reproductive Health is to promote optimal reproductive, maternal, and infant health and quality of life through scientific and programmatic expertise, leadership, and support.
In addition to new recommendations about infant safe sleep environments, the AAP policy statement outlines a need for improved surveillance of SIDS and other SUID as well as the implementation of standardized protocols for infant death-scene investigations. In keeping with the new recommendations, the CDC has developed guidelines, a reporting form and training curriculum for the investigation of SUID. Since 2004, CDC and its partners have trained more than 23,000 medical examiners, coroners, law enforcement, first responders, and child advocates in conducting comprehensive infant death investigations. Also, CDC has implemented the SUID Case Registry, a state-based SUID surveillance system, by joining forces with state Child Death Review programs in Colorado, Georgia, Michigan, New Jersey and New Mexico, Minnesota and New Hampshire. These methods provide standardized protocols for the investigation of SUID and promote consistent classification.
“By improving investigation standards and reporting of SUID, we will have more accurate data to monitor SUID trends, develop prevention strategies for populations at highest risk and ultimately reduce infant deaths,” said Senior Scientist Dr. Carrie Shapiro-Mendoza, Ph.D., M.P.H.
Additional information is available at http://www.cdc.gov/sids.