How to talk to relatives who appear to the SIDS parent to be reckless
My husband was very upset to learn that, against the advice of her doctor, his sister is allowing her newborn to sleep on her stomach.
Any advice on whether and how to talk to relatives who appear to the SIDS parent to be reckless?
My experience is that most people who choose the prone sleeping position for their infant, in 1998, against all advice, don't understand SIDS risk and risk factors.
The data now on sleeping position and SIDS are simply overwhelming. There is no question that the prone sleeping position is associated with the highest risk, the supine with the lowest risk, with the side position conferring an intermediate risk. The side position likely carries an intermediate risk because it is unstable, allowing the infant to roll into the prone (high risk) position. Whether one wants to call it SIDS or accidental suffocation, the prone sleeping position is clearly dangerous for babies.
I often hear people say something like "I know X number of people whose babies slept prone and none of them died of SIDS". This sort of reasoning doesn't take into account that SIDS is a relatively rare event to start with. Even when the prone sleeping rate was 75% in the USA, the SIDS rate was approximately 1.3 to 1.4 per 1,000 live births. So, even with 75% of babies sleeping prone, still only about 2 per 1000 died. Or... put another way... 998 of every 1000 prone sleeping infants lived. So, of course, everybody will know 100's of people whose babies slept prone and lived.
However, on the non-survivors side, the results look quite different. If one looks nationwide, that SIDS rate of 1.3/1000 translates into 4,000 to 5,000 babies/year in the USA alone dying of SIDS. Any intervention (such as switching to the supine sleeping position) that reduces the SIDS rate by 50%, for example, saves 1000's of lives.
A baby sleeping prone has approximately 3 times the risk for SIDS compared to sleeping supine, all other things being equal. If the baby is premature or low birthweight, the risk increases dramatically (as much as 60 fold). Other risk factors can also amplify the risk of sleeping in the prone or side positions. The probability of SIDS is small to begin with, and even if increased 3 fold, the probability is still small. However, for those 2 babies per 1000, for those families, it is no longer a matter of probability... SIDS has happened to them. My experience is that when people really understand SIDS risk factors, they want to do everything possible to minimize the risk.
Chances are, with your relatives, you'll find that they really don't understand the risks involved.
John L. Carroll, M.D.
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