Reminder: Put infants to sleep on their back

While putting infants to sleep on their backs is a well-accepted habit in most developed countries as a way to reduce the risk of sudden infant death syndrome, the good advice is not always taken in Israel.

As a result of an increase in SIDS in recent winters, the Health Ministry and a voluntary organization called Atid are launching a public awareness campaign of putting small babies to sleep in a supine, rather than a prone, position.

Every year, about 45 infants die suddenly, nearly 90 percent of them under the age of six months. Half of the deaths occur in the winter months between January and March.

Among the risk factors for crib deaths are overheating babies by dressing them in heavy clothing, smoking in the baby’s vicinity, using a soft mattress and too many blankets, and – most of all – putting the infant to sleep on his or her stomach. In the prone position, they have too little oxygen, low blood pressure, are less sensitive to noise and have difficulty waking up.

Smoking in the immediate area can be blamed for 24% to 32% of SIDS cases. Arab babies, whose fathers are more likely to smoke than Jewish fathers, are much more likely to be involved in crib deaths than Jewish babies.

Prof. Itamar Grotto, the ministry’s head of public health services, said on Monday that parents can prevent numerous cases of crib deaths by observing the guidelines.

“The risk of SIDS in babies put to sleep on their stomachs is five times higher in the winter than in the summer,” he said.

Dr. Anat Schatz, chairman of Atid, which conducts research on the prevention of crib deaths, added that using the supine position had been proven to prevent many cases of SIDS. The supine position should be used when infants sleep both in the daytime and at night, she added. When they are awake, they can be in the prone position, but they must be watched.

Although the ministry issued statements in 2000 recommending the supine position, surveys in 2009-2011 showed that only four out of 10 parents of infants actually took the ministry’s advice. The ministry also found that 80% of all babies who died suddenly were lying on their stomachs. Choking on foreign objects is also more common in the prone position.

The ministry does not recommended putting babies to sleep on their sides because they can easily tip over onto their stomachs. Infants should be put in the supine position from the start, while still in the hospital, because sleeping on their stomachs is more natural or comfortable, and after getting into the habit they do not easily go along with the change. Once they are old enough to turn over, they need not be forced to lie on their back.

Following the recommendations can reduce by 50% to 70% the number of SIDS cases, and countries where there is a high level of observing the guidelines have noticed a drastic reduction, Grotto said.

Do not leave any kind of foreign object in the crib like a blanket or diaper unless strongly tucked under the mattress, the ministry advises.

The use of mattress bumpers (“head protectors”), although fashionable and attractive, can be hazardous and cause suffocation.

When putting small infants to sleep, position them on their backs with their feet touching the bottom of the bed, the blanket up to their armpits and tucked under the mattress, which should be stiff and approved by the Israel Standards Institute. Babies should be dressed in thin layers of clothing – one layer more than an adult would.

The head should be exposed at all times.

Infants should never be allowed to sleep in a parent’s bed. In addition, breast-fed babies who receive natural antibodies against viral infections as they nurse are more protected against crib death than bottle-fed babies. Using a pacifier is recommended from the age of one month; such infants are more easily able to wake up and react to life-endangering situations.

The ministry said that relatives, babysitters and caregivers at home and outside the home should be reminded of the importance of following the guidelines.