Cool news regarding SIDS prevention

Using a fan may prevent SIDS.

I can’t access the full-text article, and I think this should be replicated by other research teams, but certainly, putting a fan in your/your baby’s room can’t hurt, right?

Unless it’s 20 below, of course 🙂 .

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25 Responses

  1. Actually, having a ceiling fan running on low when the heat is blasting actually helps conserve energy. You don’t want to waste energy heating the top 4 feet of your room when everyone occupies the bottom 6. So the fan pushes the hot air down onto you.

    Little known fact from the frigid north.

    I doubt they studied that but, they meant a portable fan, right?

  2. I’m excited to see that they’re figuring things out. SIDS is my biggest worry when my babies are small.

  3. I will check it out in the medical library. I am a little confused because it said some babies were in the prone position or side position and I have had it beat into my head that every baby should sleep on their back. There is even a “Back to sleep campaign” in my neck of the woods but I will try and get the full article if we have that journal.

  4. pinky, there is a huge back to sleep campaign, but lots of parents don’t follow it. My daughter slept on her back until she could roll over, but now she almost always sleeps on her stomach. I still put her down on her back because that’s what’s recommended, but she rolls over 90% of the time.

  5. The problem with these kind of studies is that you can never satisfy all of the opinions. When my daughter was born I learned that white noise (such as a fan) was once recomended but now they think it may cause hearing problems. But a fan will reduce SIDS (i guess better deaf than dead 🙂 ). It’s like the pacifier “controversy”; use it to reduce SIDS, but it may interfere with nursing, and possibly cause teeth problems if used for too long (or if you live in Israel you kids may end up going to high school with the pacifier). All these is enough to drive anyone insane… so I ignore it. DD slept on a porta crib on her back until she turned herself, after that there is little I can do but pray. The rest I try to use common sense and ignore all the suggestion to try on her whatever latest fad hit town (homeopathy and reflexology and in now)

  6. There is not enough Propaganda on this website.

    Pacifiers and Back Sleep prevent Slow Wave Sleep which is the most restorative type of sleep. But, no studies are done on the negative impact of the SIDS Back to Sleep campaign because it’s easier just to regurgitate propaganda and not have to think. Terrific!

    The SIDS statistics are utterly unreliable.

    And for all those who use the term “Back to Sleep” to mean Back Sleep you are misusing the phrase. The term Back to Sleep applies to 10 different components of which back sleep is only one.

    I feel sorry for all the kids who were never at risk for SIDS and yet will live for the rest of their lives with developmental delays, milestone delays, social skills delays, plagiocephaly, strabismus, torticollis, and possibly even autism all because of people who would rather listen to propaganda like unthinking trolls than question it’s validity.

    T. McCabe

  7. And I’m sure you have something resembling evidence to back up your assertion that “back to sleep” causes “developmental delays, milestone delays, social skills delays, plagiocephaly, strabismus, torticollis, and possibly even autism “? Or that there is a rise in all of these that corresponds to the start of the campaign?

  8. Please Don’t believe me. But, I suggest you look at these studies and form your own opinion:

    A. DEVELOPMENTAL DELAYS AND SIDE EFFECTS:
    Infants who sleep supine compared to infants who sleep in the prone position are impacted in the following ways:
    – Social skills delays at 6 months (Dewey, Fleming, et al, 1998)
    – Motor skills delays at 6 months (Dewey, Fleming, et al, 1998)
    – Increased rates of gastroesophageal reflux (GER) (Corvaglia, 2007)
    – Below norm AIMS scores (Majnemer, Barr, 2005)
    – Milestone delays (Davis, Moon, et al., 1998)
    – Increased duration of sleep apnea episodes during REM sleep at both 2.5 months and 5 months (Skadberg, Markestad, 1997)
    – 6% decrease in sleep duration (Kahn, Grosswasser, et al.,1993)

  9. (FYI: I have no idea why the smiley faces appear in place of the 9 in 1998)

    B. PLAGIOCEPHALY AS AN INDICATOR OF STRICT ADHERENCE TO BACK SLEEP ADVICE:
    I am not suggesting that correlation equals causality or that plagiocephaly is a cause but rather a marker:
    – 1 in 300 infants had plagiocephaly in 1974 (Graham, Gomez, et al., 2005)
    – 1 in 60 infants had plagiocephaly in 1996 (Graham, Gomez, et al., 2005)
    “Infants with deformational plagiocephaly were found to have significantly different psychomotor development indexes and mental developmental indexes when compared with the standardized population.”
    Kordestani, et al. in their study “Neurodevelopmental Delays in Children with Deformational Plagiocephaly”

    C. SIDS STATISTICS ARE UNRELIABLE:
    “A lot of us are concerned that the rate (of SIDS) isn’t decreasing significantly, but that a lot of it is just code shifting,’ said John Kattwinkel, chairman of the Centers for Disease Control and Prevention’s special task force on SIDS.”
    Scripps Howard News Service Interview
    http://www.shns.com/shns/g_index2.cfm?action=detail&pk=SIDS-10-08-07

  10. D. ANECDOTAL OBSERVATIONS OF MEDICAL
    PROFESSIONALS:

    “There are indications of a rapidly growing population of infants who show developmental abnormalities as a result of prolonged exposure to the supine position.”
    Dr. Ralph Pelligra regarding the impact of the Back to Sleep Campaign
    http://cgi.thescientificworld.co.uk/cgi-bin/processHtml.pl?Id=2005.03.71.html&format=Dreamweaver

    “Since the implementation of the “Back to Sleep” campaign, therapists are seeing increasing numbers of kindergarten-aged children who are unable to hold a pencil.”
    Susan Syron, Pediatric Physical Therapist

    “In its fundamental purpose it has been largely successful. The incidence of SIDS has been reduced dramatically. However, as many orthotists can attest, this important gain has not been without its lesser comorbidities. The one we tend to think of has been the rapid increase in the incidence of positional plagiocephaly and positional brachycephaly. However, there have been whispers and rumors of other effects.”
    Phil Stevens, MEd, CPO regarding side effects of the Back to Sleep Campaign.
    http://www.oandp.com/edge/issues/articles/2006-12_02.asp

  11. E. PELAYO LETTER TO THE JOURNAL OF PEDIATRICS AND THE REPLY TO HIS CONCERNS:

    “The potential implications of a SIDS risk-reduction strategy
    that is based on a combination of maintaining a low
    arousal threshold and reducing quiet (equivalent to
    slow-wave sleep) in infants must be considered. Because
    SWS is considered the most restorative form
    of sleep and is believed to have a significant role in
    neurocognitive processes and learning, as well as in
    growth, what might be the neurodevelopmental consequences
    of chronically reducing deep sleep in the first
    critical 12 months of life?”

    Dr. Raphael Pelayo, Stanford University

    “physiologic studies demonstrate that infants who sleep
    supine have decreased sleep duration, decreased non-
    REM sleep, and increased arousals; this effect peaks at
    2 to 3 months of age and is not evident at 5 to 6 months
    of age, thus coinciding with the peak incidence for
    SIDS at 2 to 4 months of age. The SIDS risk-reduction
    strategy of supine sleep will result in a lower arousal
    threshold and a reduction in quiet sleep.”

    U.S. SIDS Task Force (chaired by Dr. John Kattwinkel)

  12. F. THE THEORETICAL MECHANISM OF HOW SLOW WAVE SLEEP IMPACTS MEMORY AND LEARNING:
    In a currently utilized model that explains the process in which slow wave sleep is involved in memory consolidation the hippocampus acts as a temporary storage facility for new memories which are then transferred to the neocortex during slow wave sleep (SWS) [8]. In this model, acetylcholine acts a feedback loop inhibitor inside the hippocampus during REM sleep and wakefulness. The activity during the high cholinergic wakefulness period is believed to provide an environment which allows for the encoding within the hippocampus of new declarative memories. The low cholinergic environment during SWS is thought to then allow these memories to be transferred from the temporary storage of the hippocampus to their permanent storage environment in the neocortex and for memory consolidation [9, 10].

    A significant way of decreasing slow wave sleep in infants is by changing their sleeping position from prone to supine. It has been shown in studies of preterm infants [11, 12], full-term infants [13, 14], and older infants [15], that they have greater time periods of quiet sleep and also decreased time awake when they are positioned to sleep in the prone position.

    8. Hasselmo, M.E. 1999. Neuromodulation: Acetylcholine and memory consolidation. Trends Cogn. Sci. 3: 351–359.
    9. Buzsáki, G. 1989. Two-stage model of memory trace formation: A role for “noisy” brain states. Neuroscience 31: 551–570.
    10. Hasselmo, M.E. 1999. Neuromodulation: Acetylcholine and memory consolidation. Trends Cogn. Sci. 3: 351–359.
    11. Myers MM, Fifer WP, Schaeffer L, et al. Effects of sleeping position and time after feeding on the organization of sleep/wake states in prematurely born infants. Sleep 1998;21:343–9.
    12. Sahni R, Saluja D, Schulze KF, et al. Quality of diet, body position, and time after feeding influence behavioral states in low birth weight infants. Pediatr Res 2002;52:399–404.
    13. Brackbill Y, Douthitt TC, West H. Psychophysiologic effects in the neonate of prone versus supine placement. J Pediatr 1973;82:82–4.
    14. Amemiya F, Vos JE, Prechtl HF. Effects of prone and supine position on heart rate, respiratory rate and motor activity in full term infants. Brain Dev 1991;3:148–54.
    15. Kahn A, Rebuffat E, Sottiaux M, et al. Arousal induced by proximal esophageal reflux in infants. Sleep 1991;14:39–42.

  13. G. DEMOGRAPHICS AND TIMELINE OF THE AUTISM EPIDEMIC AND THE SIDS BACK TO SLEEP CAMPAIGN
    Again, correlation does not equal causation. I document this evidence in my blog (see below) but it’s too long to put here. But, if you look at the timeline of the Autism Increase (I’m not making a value judgement as to whether it’s real or due to increased programs/monitoring, changes in crieteria, etc.) using IDEA data and the U.S. supine sleeping campaign using NISP data then you will see a very close trend. in addition, As I also document in my blog the demographics of parents most likely to adhere to the SIDS Back Sleeping advice is similar to the Demographics of parents who are most likely to have an autistic child. Could be a coincidence but I simply think it is not.

  14. H. POSSIBLE CONFLICTS OF INTEREST BY CHIEF ADVOCATES:
    In the U.S. the primary advocate of the SIDS Back to Sleep Campaign has been Dr. John Kattwinkel. He had a 3 day old daughter die in 1966 which is a tragedy. Unfortunately, he may have a bias toward preventing SIDS (good for a lay person but not for serious research) and disregards developmental delays.
    In the UK the primary advocate of the Cot Death Back sleeping campaign has been Peter Fleming who is now credited with saving 100,000 babies lives worldwide. To give up the honor of having saved 100,000 babies lives worldwide creates a bias in my opinion.

  15. I. My Conclusion
    I don’t have enough room to detail it here but pleae see my blog. After all the above evidence the most important piece is that many of the symptoms of Autism Spectrum Disorders are also similar to the side effects of the supine sleep position (e.g. social skills delays, motor skills delays).

    Please see my blog for more information on my Theory or just like at the two jpeg graphs (scroll down about 1 page) for a quick summary of it:

    http://fourfactortheory.blogspot.com/

  16. Please do not serial comment on my blog.

    As for the meat of your argument: I was too hasty in my C&P of your claims, as indeed there is a known connection between positional plagiocephaly and MILD AND TRANSITORY motor and social skills delay, which can all but be eliminated by a decent amount of tummy time while the baby is awake. The studies you urged me to look at which deal with motor delays make the same point; none of the other studies as much as claim that ‘back to sleep’ should be stopped as a result of any of the findings; in fact, Skadberg et al (the study regarding apnea) the conclusion was:”The observation of decreased variation in behaviour and respiratory pattern, increased heart rate, and increased peripheral skin temperature during prone compared with supine sleep may indicate that young infants are less able to maintain adequate respiratory and metabolic homoeostasis during prone sleep.”

    It may be that Kattwinkel and Fleming are terribly biased (though you don’t make a very good case for this), but it’s unlikely that everyone studying the subject is.

    Malloy and McDorman have discussed the diagnostic shift from SIDS to other categories; they agree that the “back to sleep” campaign was associated with a sharp decrease in all infant deaths, which could not be explained by a diagnostic shift alone.

    What could be explained entirely by diagnostic changes is the ‘autism epidemic’; See here.

    In short: I’ll take having my kid crawling two weeks later than planned over her dying of SIDS any day of the week.

  17. You ask for my reasons and then you tell me not to comment so long. Great.

    BTW, I’m well aware the articles I quote draw different conclusions. Did you read the part of the “tummy time” study that it said all babies started out sleeping on their backs. The study on “tummy time” never used babies who always slept on their stomachs – read the Methodology of the Majnemer study and you would easily see that.

    Finally, I think it’s great that you make the choice that your willing to accept developmental delays on behalf of your child. I think all parents should be told about the developmental delays at the same time they are told about the SIDS Back to Sleep Campaign and Tummy Time.

    You should respect other parents enough to give them all the facts about Developmental Delays, Tummy Time, and Back Sleep.

    It is still my conclusion that infants who are on their backs say 23 hours and 50 minutes a day (which many infants in the U.S. are) in extreme cases (outliers) will eventually be diagnosed with autism. I still believe that.

  18. I hate to serial comment but one more point:

    You say “MILD AND TRANSITORY”. Hmmm…How do you know that? Show me the study. Not the quote but the study.

    You know why you can’t show me a study because they’ve never studied the impact of the Back to Sleep Campaign past the age of 18 months. Considering most psychologists and doctors will tell you it’s nearly impossible to diagnose a child with many developmental delays prior to the age of three your quote “MILD AND TRANSITORY” should be changed to:

    MILD AND TRANSITORY AS TESTED IN ONE STUDY UNTIL INFANTS WERE 18 MONTHS OF AGE.

    BTW, the 18 month old back sleepers in that study (Fleming) still had developmental delays but they were lags that weren’t statistically signifcant.

    Again, my apologies for serial commenting but it’s hard to write about this serioius topic in easy to read soundbites.

    BTW, I want the best for infants. Unfortunately, there’s an old quote:

    “The enemy of the best is often the good.”

    It’s good to prevent SIDS. But, human beings have the right to developm to their full potential. And if the Back to Sleep campaign is more harmful than “Mild an Transitory” Developmental Delays I think that’s important.

  19. I say the delays are mild and transitory because 1) that’s what the study says and implies. If at 18 months the developmental lags are not statistically significant, that means any differences between two groups may well be due to chance and not indicative that one group of children is, in fact, lagging developmentally. The logical inference from the findings would be that the differences between the two groups at 6 months were slight to begin with and resolved themselves by 18 months. and 2) what I see in practice. The usual would be a 2-4 month old with a slightly flat head, a bit of a head lag or a little less ability to lift the head in a prone position than I’d like. So I tell Mom to give more tummy time (and all mothers are told by the well-baby clinics to give tummy time along with the admonition for ‘back to sleep’), follow up a few weeks later and poof – gone or largely improved in, oh, 90+% of cases. The ones who aren’t are those who likely would have developmental delays regardless of sleep position.

    You want to claim that there are developmental delays beyond that period? You’re the one who has to bring proof of this, not me. And as I’ve said, you’re not doing a very convincing job of it. “I really believe this” isn’t proof of anything but your state of mind.

    BTW, I read Skadberg – the authors decided to define apnea as a pause in breathing > 3 seconds which is not consistent with any pathology (or any recognized definition I’m aware of). In fact, none of the apneas experienced by the babies were pathologically long as far as I can tell.

  20. Thank you for your feedback. I totally agree with you that I am not doing a convincing job and have to find more examples to prove (or at least convince people of the possiblity) of my hypothesis. Just to clarify I do not think supine sleep “causes” autism I think toddlers with the most extreme develpmental delays caused are being “diagnosed” with Autism Spectrum Disorder. I think this is primarily due to the inhibition of Slow Wave Sleep (which prevents SIDS) and that tummy time may help to a degree with motor skills and head shape but will not resolve the negative impact on plasticity caused by inhibition of Slow Wave Sleep. As Dr. Kattwinkel and many others have stated pacifiers and supine sleep inhibit Slow Wave Sleep.

    If it turned out that children most often died of SIDS in REM sleep and someone discovered that if you put a babies head on 3 pillows for example and it inhibited REM sleep during the first year of life would you start recommending to parents that they put their kids head on 3 pillows? Or would you say that might be true but I think it’s possible that a proper amount of REM sleep might be important for an infants growth and development so we’ll have to do more research? I’d pick the latter and many others would pick the former.

    It’s possible that putting every infant in America on an anti-cancer regimen might reduce the case of pediatric cancer cases by 50% or so but would the develpmental delays for the kids who were never at risk of Cancer be worth it. Probably not.

    I truly thank you for your feedback and I’ll have to do more research to convince others of my hypothesis.

  21. I don’t think it would be advisable to eliminate REM sleep, as that is known to have detrimental results on humans. So three pillows would definitely be out as a solution to SIDS/SUDI. But that’s hardly equivalent to a small reduction in Slow Wave Sleep ,and if adverse effects from that reduction might have been a concern back when the campaign started, there is enough empirical evidence that children who sleep on their backs grow up, by and large, into perfectly normal human beings.

    BTW, it helps if you approach the data with the idea that your hypothesis might not be true, rather than torturing the data to fit your hypothesis (though the latter is a natural tendency).

  22. Thank you. Your feedback has been extremely helpful and you are very right that it’s always very easy to believe your own hypothesis. Considering that my main concern is the inhibition of slow wave sleep I will research that further and it’s possible that inhibiting it somewhat during the first year of life is not that big of a detriment to a childs develpment. I’m also going to research further why infants need to be put to sleep on their backs past the age of 6 months considering SIDS statistics show that the highest rate of SIDS occur between 2 and 5 months of age as Dr. Kattwinkel of the SIDS Task Force has stated. This ranges encompasses the onset of the develoment of SWS (~2 months) and the typical time a child has the ability to raise his head up (~5 months). I’m not sure the tradeoff beyond 6 months of age is worth it. I’ll have to analyze that along with the correctness of my hypothesis further. Hopefully, a screening test for SIDS is eventually developed and then parents could put a child to sleep the way they thought was best.

    Thank you very much.

  23. Here’s my deal on Tom’s thoughts. If back to sleep were such an unmitigated tragedy, why aren’t we seeing all these damaged kids walking around? Oh, I know, there aren’t any. This is all just a figment of the imagination too buried in woo to think clearly about these issues.

    Personally, I know two autistic kids (two degrees of separation from me) and that’s it. Their parents spend more time treating them with speech and occupational therapy that works for the child than dreaming up made up causes.

    Sadly, I do personally know one family whose daughter died of SIDS and I think they would do anything to encourage people to do what they could to ensure a safe sleeping environment for a child. That does seem to be Back to Sleep.

  24. Tom: I think you’re right that it’s really not that important in over-6-month-olds. However, by that sort of age babies are generally rolling over anyway and will just settle themselves into whatever position is most comfortable for them, so I can’t see that it matters much either way.

  25. “If back to sleep were such an unmitigated tragedy, why aren’t we seeing all these damaged kids walking around? Oh, I know, there aren’t any.”

    Good Point. But, regarding the autism statistics – whether you think the increase is due just to expansion in diagnostic criteria and/or increased awareness or an actual increase in autism the U.S. Dept. of Education has reported a 144% increase from 8 year olds with autism in 2000 to 8 year olds with autism in 2007.

    Here are the numbers along with their birth year and the% of children who slept supine that year (obviously correlation does not equal causation):

    8 year olds in the year 2000 (born in 1992) = 10,055 with Autism
    8 year old in the year 2007 (born in 1999) = 24, 669 with Autism (146% Increase)

    Infants that slept on their backs in 1992 = 13.0%
    Infants that slept on their backs in 1999 = 65.7% (405% Increase)

    Again, correlation does not equal causation. But, I do think more long-term research on the overall safety of the SIDS Back to Sleep campaign and pacifier advice should be undertaken. In addition, most of this data is already available in the Historical ALSPAC (Avon Longitudinal Study of Parents and Children). I can’t get my hands on that data (it’s under lock and key) but if anyone knows how I could or has any recommendations on how I could get that data please let me know. Thanks for all your comments they have been extremely helpful.

    NISP Infant sleep position data:
    http://dccwww.bumc.bu.edu/ChimeNisp/NISP_Data.asp

    U.S. Dept. of Ed. Autism Data (along with other data):
    https://www.ideadata.org/PartBChildCount.asp

    My Website (in progress):
    http://fourfactortheory.blogspot.com/

    (scroll down to the two jpegs for a quick summation of by theory).

    Thanks again!.

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