Danger hides in these cozy scenes: an infant sleeping on its tummy on a plush sheepskin rug; twin newborns snoozing side by side in a crib; a crib decked with so many blankets, pillows, and stuffed animals that there's nearly no room for a baby. If you've thumbed through some popular parenting and women's magazines lately, chances are you've seen images depicting these or similar scenes. And while they may make for good photographs, they set bad examples for parents, experts say. Those situations, they say, are not safe for sleeping babies.
"There are a lot of mixed messages that are being sent to families," says Rachel Moon, a pediatrician at Children's National Medical Center in Washington who has probed several widely read parenting and women's magazines and found that many photos in articles and advertisements clash with what the American Academy of Pediatrics recommends parents do to keep infants safe while asleep. More than a third of the photos of sleeping babies showed the infants in perilous positions, and two thirds of those depicting cribs and other sleep environments showed situations that the organization deems dangerous, Moon and other researchers reported today in Pediatrics.
"That's a problem," says Moon. "Studies have shown that where the baby sleeps and how the baby sleeps are very important in terms of SIDS risk reduction." SIDS, or sudden infant death syndrome, remains the chief killer of infants under age 1. Experts use the SIDS label to describe the abrupt, unexpected death of a seemingly healthy baby, usually during sleep, that neither autopsy nor death-scene examination can explain.
Putting babies to sleep on their tummies is a recognized culprit in some SIDS cases. Since the AAP and other organizations launched the "Back to Sleep" campaign in the early '90s, urging parents to place babies face-up to sleep, the rate of SIDS has dropped by more than 50 percent, according to the Centers for Disease Control and Prevention. Moon worries that gain could erode if parents become confused by images in the media.
SIDS "is one of the most devastating things that can happen to a family," says Judith Palfrey, a pediatrician and president-elect of the AAP. "All we can do is recognize that there are certain things"—like tummy sleeping—"that are correlated with this very bad outcome."
Don't count on photos in the popular press to showcase appropriate behavior. Here are some of the things the AAP does and doesn't recommend that parents do to lower the risks of SIDS and causes of accidental infant death, including suffocation and entrapment during sleep:
- Do put a baby to sleep on her back, not on her side or stomach. It's thought that some SIDS babies have an abnormality in the brain region that regulates breathing and the ability to wake up, says Bradley Thach, a professor of pediatrics at Washington University in St. Louis. Babies put in a "suffocating situation" respond by turning their heads to get fresh air. But, according to the theory, babies with this brain abnormality may not, Thach says.
- Avoid "soft bedding," says Moon. "We mean blankets, we mean pillows, we mean soft bumper pads, stuffed animals, anything that's soft," she says. Soft sleep surfaces, such as couches, and cushy comforters also pose risks. "People aren't getting the message about soft bedding, and I think a lot of it is because it's being sold," adds Moon. "People don't believe that manufacturers would sell things that are dangerous for babies." Parents also may get gifts from friends who don't know that babies don't need a whole layette set, complete with blankets, pillows, and bumper pads, Moon says.
- Avoid bed-sharing. Room-sharing, on the other hand, is advised. "Bed-sharing is a very large problem," says Thach. He says adds that 70 percent of the SIDS victims he and his colleagues have seen in St. Louis died while sleeping with an adult. (Note: This piece of the AAP recommendation remains contentious; it has drawn fire from groups that advocate bed-sharing to foster breast-feeding and closeness between parent and child.) And just because celebrities (like Jennifer Lopez, left) have been photographed gazing adoringly at their multiple infants sleeping side by side, that doesn't make it safe to let twins or siblings share a crib. Co-sleeping infants pose a big risk to each other, says Moon.
- Avoid letting infants overheat during sleep.
- Avoid exposing infants to cigarette smoke, including while they're in the womb.
- Do consider informing babysitters of these risks, since an estimated 20 percent of SIDS cases occur while babies are in the hands of others. A possible factor: The SIDS risk associated with tummy sleeping may be particularly high for babies who are used to sleeping on their backs, experts say.
- Do consider putting babies to bed with pacifiers, which have been associated with a decreased risk of SIDS. It's still unclear why, according to the AAP.
- If all else fails, says Moon, remember: "Babies sleep safest on their backs, in a crib next to their parent's bed without anything else [inside] but the baby."