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Selections from Journal Watch Pediatrics and Adolescent Medicine Copyright © 2006 Massachusetts Medical Society. All rights reserved.


Since the start of the “Back to Sleep” campaign in 1991 in the U.K., the number of deaths from sudden infant death syndrome (SIDS) in that country has declined by 75% (from 1600 in 1988 to fewer than 300 annually in recent years). To examine risk factors other than sleep position that contribute to SIDS, investigators examined all 300 unexpected infant deaths that were classified as SIDS in Avon from 1984 through 2003.

Although the absolute number of SIDS deaths associated with co-sleeping with a parent has halved from before the campaign (1984–1991) to afterward (1992–2003), the proportion of SIDS deaths that occurred among infants who slept with a parent rose from 12% to 50%. In addition, the proportion of SIDS deaths rose from 47% to 74% in families of low socioeconomic status and from 12% to 34% among preterm infants, and the prevalence of mothers who smoked during pregnancy rose from 57% to 86%. The mean age at death of SIDS infants (84 days) and the higher risk in male infants did not change significantly before and after the campaign, but the mean age at death of SIDS infants who were sleeping with a parent fell from 88 to 54 days after 1991. Since the campaign, breast-feeding has become less common among SIDS infants from poor families.

Comment ▸

Supine sleeping has had a huge impact on preventing SIDS. Now we must turn our attention to other important risk factors and work toward reducing co-sleeping, maternal smoking during pregnancy, and encouraging breast-feeding. The new epidemiology of SIDS …

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