There is no more frightening thought for new parents than that of Sudden Infant Death Syndrome. As a pediatrician, but also as a father, I know I at least had some pretty uneasy thoughts about it with each of our infant sons. Like every other parent, I put it out of my mind as something I couldn't do anything about, realising that I couldn't live life in fear of a rare occurrence.

SIDS has been studied "up one side and down the other," and still remains something of a mystery. We have strong suspicions about the cause or causes of SIDS but no firm answers or guaranteed prevention. SIDS remains the number one killer of infants from one month to one year of age (since we have so drastically reduced or eliminated the infectious diseases that used to carrry off so many infants).

What we do know is that certain statistical associations exist with SIDS, and from these parents can perhaps get some useful information.

The first is sleeping position. We now believe that SIDS is often apparently caused by smothering in the bedclothes. An infant ordinarily will respond to blockage of the nose and mouth by the mattress or covers with an instinctive turning of the head. Apparently, some babies have an inborn response that is weaker than normal. These babies may in the course of sleep turn their heads just enough to bury their faces in the bedding and smother. The baby's brain fails to respond normally to this intense smothering stimulus (asphyxiation response) by lifting and turning the head as it should. Much weight is attributed to this theory now that a number of studies in a number of countries showed dramatic reductions in SIDS cases by simply recommending that parents teach their infants to sleep on the back.

Breast feeding has been said to be protective (that is, a lower statistical chance of SIDS in breastfeeders) in some studies. A recent English study cast doubt on this finding, however; these researchers think the effect observed in the past may be related to other (perhaps socioeconomic) factors. I suppose these would probably be less co-sleeping and less smoking in higher socioeconomic households.

Higher socioeconomic status seems to be associated with a lower risk of SIDS. Why? Perhaps the next reason:

Parental smoking seems to be a risk factor for SIDS. Nicotine from passive cigaret smoke apparently suppresses the baby's respiratory control center.

Other factors were found to be important in their study. Whether the child slept totally covered up (whether the parents did this on purpose or the child habitually snuggled down under the blanket) was the single biggest risk factor - it is apparently quite bad to allow this. The other factor was warmer room temperature. We generally recommend that the room be kept somewhat cooler and the baby bundled up - cool air on the face is a respiratory stimulant.

The same British study discussed co-sleeping. Some studies have associated infants sleeping with the parents as a risk factor for SIDS, however, the British researchers only found a risk association when the parents were smokers.

The British researchers were struck by a protective effect of pacifier use, which I find very interesting. I have recommended pacifiers for years for the first few months - but only to prevent later thumb sucking. Perhaps I was doing some good preventing SIDS as well.

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