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