Apr 24, 2009
A big part of pediatrics is what we call “anticipatory guidance” and preventive medicine. This is where we get to impart our wisdom on parents, particularly the vulnerable, first-time ones. For them, everything is new, exciting and, yes, anxiety provoking. We hope that we can teach and guide them to raise medically and psychologically healthy children. One of the first and most important things we can do is stress the importance of immunizing children on time. I know – I have talked about this ad nauseum!! But that is because when newborns, children and, yes, adults, are not adequately immunized, they are at risk of developing serious illnesses. As you may recall, I blogged a couple of months ago about the haemophilus influenzae outbreak in Minnesota, where several children became ill and one died. Well, guess what? Now there are cases of measles in my hometown, Rockville. It appears that an unimmunized adult contracted it and has infected several others, including an 8 month old child who is too young to have received the routine immunization.
But, believe it or not, I am not blogging about immunizations today. It appears that this is just an example of what happens years after a successful plan has been implemented. Because we don’t see many of these infections anymore, we aren’t routinely reminded of the importance of preventing them. We seem to have forgotten that the reason we don’t see many of these deadly infections is precisely because children have been vaccinated. So … the vaccination rate drops, and as the vaccine rate drops, the risk of contracting one of these illnesses rises. I can guarantee that if we had an epidemic of measles here, with kids dying, parents would be lining up to ensure their kids were adequately immunized.
Well … it’s the same with ALWAYS putting your infant to bed on the back. Multiple studies have demonstrated a significant increase in the risk of sudden infant death syndrome (SIDS) with placing your infant stomach-side down to sleep. My recollection from when this recommendation first came out is that almost all parents put their infants on their backs to sleep. Now, however, more and more parents are telling me that they are putting their infants on their stomachs to sleep because they sleep better. Or, they are watched by a grandparent during the day, who puts them to sleep on their stomachs. Well … it is even worse to put an infant on its stomach sometimes rather than always (not that I am EVER recommending stomach sleeping).
A study published in this month’s journal, Pediatrics, evaluated 333 infants in Germany over a 3 year period. As noted in previous studies, those who were placed prone to sleep were at greater risk of dying from SIDS, particularly those who were not used to sleeping prone. Other factors which increased the risk of SIDS were covers, sleeping at a friend or relative’s house, and sleeping in a living room. The only factor which decreased the risk of SIDS was the use of a pacifier at night. With such compelling evidence which supports many other studies on SIDS risk factors, there is no reason to place our infants on their stomachs to sleep – ever. This includes when they are with any caretaker, including grandparents, nannies, and other relatives.
So let’s not become complacent about treatments that work. Continue to immunize. Continue to place infants on their backs to sleep.