Research that links putting infants to sleep on soft bedding with increased risk of infant death due to suffocation will be presented today by the Consumer Product Safety Commission (CPSC) at the annual Society for Pediatric Research meeting in Washington, D.C. The research was conducted by CPSC in collaboration with the Washington University School of Medicine in St. Louis and the University of Maryland. It is the first epidemiologic evidence that directly links the rebreathing of carbon dioxide trapped in bedding to infants found dead in the prone sleep position.
The research project, completed in 1994, found that about 30 percent of the 206 infants in the study who died of Sudden Infant Death Syndrome (SIDS) were found with their noses and mouths covered by soft bedding. Most of those infants had been placed on their stomachs to sleep and were found lying on top of soft bedding such as pillows, comforters and sheepskins. Eighty percent of the SIDS deaths in the study occurred in babies under four months of age.
"We have not found a cause for SIDS," says N.J. Scheers, Ph.D., CPSC's project director and epidemiologist, "but our results show that specific items of bedding used in the U.S., such as comforters and pillows, were associated with an increased risk for death to prone-sleeping infants whose faces became covered, compared to infants on their sides or backs without soft bedding underneath them."
The study followed preliminary evidence suggesting that soft bedding may play a role in the occurrence of SIDS, which kills some 6,000 babies each year in the United States. The purpose of the study was to answer two broad questions: (1) are there bedding items that increase the risk for infants being found dead with their airways covered, and (2) are there economic and sociological SIDS risk factors that explain the risk for infants found dead with their airways covered?
The study used a multicenter, case-comparison design with death scene investigations of SIDS infants, and included using a mannequin to re-create the position of the infant when found unresponsive.
The study concludes that economic and sociological factors had little effect on the risk for death with airways covered. Bedding items with enough softness and malleability to allow pocket formation beneath an infant's head, particularly pillows and comforters, increased the risk of death with airways covered. "These items should not be placed near infants sleeping prone," says James Kemp, M.D., Assistant Professor of Pediatrics at Washington University School of Medicine, "and probably should be avoided regardless of sleep position." CPSC and the collaborating researchers recommend the following safety guidelines for infants less than eight months old:
-- Place infants to sleep in a crib on a firm, flat mattress.
-- Do not place soft, fluffy products, such as pillows, comforters, or sheepskins under infants while they sleep or nap.
-- Place healthy infants on their backs or sides to sleep, as recommended by the American Academy of Pediatrics.