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SIDS-Risk Factors and Prevention

30 Jan

What is SIDS?

  • Short for sudden infant death syndrome
  • Death in a child under 1 year of age that is not explained after a thorough investigation
  • Most common cause of death in children 1 month-1 year age
  • Terrifying
  • Devastating

I cannot imagine the despair that would be associated with living through something so difficult.

What are the risk factors for SIDS?

Mommy factors:

  • Young maternal age
  • Maternal smoking during pregnancy

Baby factors:

  • Preterm birth or low birth weight
  • Face-down sleeping position
  • Sleeping on a soft surface with bedding accessories such as loose blankets and pillows
  • Bed-sharing
  • Overheating

What can we do about SIDS?

Obviously, there are some factors for SIDS that cannot be controlled and some that can. Below I’ve listed several factors that are the most controllable in the prevention of SIDS.

If you are pregnant and under 20, that does increase your child’s risk.

Smoking while pregnant and exposure to environmental smoke after the baby is born both increase the risk of SIDS.  If you can’t find a reason to quit smoking for yourself, please stop for you baby…it not only protects from SIDS but also decreases respiratory illness and has effects on asthma.

Whether or not your baby is premature is also another factor that, for the most part, cannot be controlled. However, a premature baby is protected even more by sleeping on its back.

The Back to Sleep campaign has been one of the most successful public health initiatives I know about.  It dramatically reduced the incidence of SIDS with something so simple.  Parents often ask me about side sleeping and sleep positioners.  I usually tell them that I don’t know if they are safe or not and thus choose not to use them.

The bed environment is another safety measure that people are becoming more aware of as a potential risk factor for infant death.

Babies should sleep on an approved firm mattress intended for use with babies.  Softer sleeping surfaces have consistently been shown to increase the risk of SIDS, especially when babies are placed face-down on these softer surfaces.

Loose beddings, such as  blankets or quilts, have also been shown to increase SIDS.  In this category I also typically add the big soft crib bumpers because they have also been shown to be a suffocation hazard.  So, take the pictures of the nursery (crib bumpers and all) put them up on Facebook and then take the bumpers down and put them in the closet until the child is over 1 year.

Overheating has also been shown to be a risk factor for SIDS.  I often see my little babies in multiple onesies with the swaddling blanket and a big heavy blanket.  This is probably too much.  Get the house comfortable for you and put the child in one extra layer than what you have and they should be comfortable at that temperature.

I have seen arguments for co-sleeping as a means for improving bonding and facilitating breastfeeding. One thing I can say for certain regarding co-sleeping is that co-sleeping does significantly increase the incidence of suffocation.  The risk of suffocation is 3x higher in infants who co-sleep and 10x higher in those infants who co-sleep under 3 months of age.  You can check an abstract from a large study on the topic here (Bed sharing and the risk of SIDS: can we resolve the debate?).  Parents may choose to co-sleep despite this risk and there are some defined/well-studied biological and psychological benefits but I feel that parents should be made aware of this when making their decision.

Room sharing, by contrast, has been shown to decrease the risk of SIDS and is also proven to benefit breastfeeding and bonding.

Pacifier use has also been shown to decrease the incidence of SIDS and I support the use of pacifiers in all families who chose to use them after breastfeeding (latch, etc) have been well established.

Breastfeeding has been inconsistent in evidence about its effect but the best study done on the subject did show a modest decrease in risk by breastfeeding.

Special monitors that monitor breathing, etc have not been shown to protect babies against SIDS.

So, as you can see there are many controllable risk factors that can be used to help protect your baby against SIDS.  In my experience, if families are aware of these factors and do their best to take care of these issues, it significantly reduces their anxiety about SIDS.

Sorry, there was less humor in this post…stay tuned for more light-hearted stuff soon…

Night Terrors-Who’s More Terrified?

22 Jan

As I sit watching the Biggest Loser, confidently (or at least trying to be confident) listening to my 20 month old scream his head off…I thought a post on night terrors (or sleep terrors) might be timely.

Night terrors usually occur between 4-12 years of age and occur during the first 3rd of sleep.  They are a non-REM sleep problem which makes them slightly different from nightmares that occur during REM (dream) sleep.

Quick Facts about Night Terrors:

  1. Children appear highly agitated
  2. They are not responsive to parent’s attempts at comforting (which is why I’m still watching Jillian scream at some poor lady who’s crying her eyes out)
  3. They generally DO NOT remember the episode
  4. Night terrors are very common: In one study of 2-6 year-olds, 40% had night terrors.

What are the Causes of Night Terrors?

  1. Genetics are involved in sleep terrors (ask your parents, you’re probably just “payin’ for your raisin'”).
  2. Lack of sleep (not napping)
  3. Increased nighttime awakenings (sleep apnea, reflux)

What Do You Do About Night Terrors?

  1. Infrequent night terrors (2-3 per month) should be ignored (still watching Jillian, but he’s been done screaming for 10 minutes)
  2. Gentle awakening-with frequent night terrors, studies have shown that gently awakening the child about 30 minutes prior to the time that the episode occurs might decrease the frequency of night terrors
  3. Medications-I will occasionally  recommend melatonin for children with various problems with sleep including night terrors but I would not recommend you doing this based on this article.  There have also been reports of melatonin causing night terrors (scientists can never get their story straight).  Talk to your doctor if you are interested in medical treatment for your child’s problems with sleep.

Take Home Points:

  1. Night terrors are common.
  2. Children don’t remember the episodes (so the answer to the question in the title is that you are more terrified).
  3. Most night terrors do not require treatment and should be ignored.

 

 

I Think He’s Teething-His Tongue is Purple

5 Jan

Ok, so I’ve never heard that one…but I’ve heard just about everything else…Fever, congestion, diarrhea, fussiness, putting things in their mouth, not sleeping well, you name it and someone has attributed it to teething.

So what symptoms really do come up before babies cut their teeth? When can we expect teeth to erupt? What can we do for our child when they are teething?

The best study I have found about teeting was done in 2000 and included lots of kids and 475 tooth eruptions. Click here to see the study.

The symptoms that they found to be associated with fever were the following:

  • biting
  • drooling
  • gum-rubbing
  • sucking
  • irritability
  • wakefulness
  • ear-rubbing
  • facial rash
  • decreased appetite for solid foods
  • mild temperature elevation

The following symptoms were NOT associated with teething:

  • congestion
  • sleep disturbance
  • stool looseness or increased stool number
  • decreased appetite for liquids
  • cough
  • rashes other than facial rashes
  • fever over 102 degrees F
  • vomiting

I have seen some studies that will include congestion in the symptom list for teething. i think one of the main misconception is about fever. I commonly have parents ask if 102-103 temp could be caused by fever and the studies are pretty clear that if the fever is that high, it probably isn’t just teething. See my post on fever (FEVER! Should we go to the ER?) for more information about this.

So how do you treat the pain associated with teething?

There are lots of products available must of which are not helpful and can be potentially harmful.

This quotes comes from the healthychildren.org article on teething (click to see full article):

“To ease your baby’s discomfort, try gently rubbing or massaging the gums with one of your fingers. Teething rings are helpful, too, but they should be made of firm rubber. The teethers that you freeze tend to get too hard and can cause more harm than good.) Pain relievers and medications that you rub on the gums are not necessary or useful since they wash out of the baby’s mouth within minutes. Some medication you rub on your child’s gums can even be harmful if too much is used and the child swallows an excessive amount.”

Avoid products with benzocaine and lidocaine (oragel and other gels). These have been known to cause a problem in babies called methemoglobinemia where your child will turn BLUE. I mean smurf crazy blue and is obviously a medical emergency. Also, avoid products with belladonna (teething tabs) as this has known to be poisonous and doesn’t have studies proving that it decreases pain anyway.

If our children are particularly fussy from teething, we will Tylenol and if over 6 months old Motrin according to weight appropriate dosing sporadically for a day or 2 until symptoms subside.

The main thing is that you have to be flexible with your child and allow them a little extra grace for changes in sleep and feeding habits. Teething can be disruptive to schedules and the extra fussiness can make things stressful. Hang in there, this phase is temporary.

Are You Sleeping? Are You Sleeping?

29 Dec

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Are you the lucky mom and dad with a 3 month old that is sleeping through the night?

Are you the exhausted mom and dad walking through the world half in a daze because your 1 year old only give you 2-3 hour stretches at night?

Let me just start by saying that I am not trying to push this strategy upon anyone.  These are strategies that I have used with my children and my patients in order to help them achieve a goal.  I wrote this blog post in response to a request from a patient in our practice who wanted advice on the topic.  Families have lots of different ways they handle sleep from rigid scheduling to no scheduling at all.  I find this to be a gentle moderate plan that my families have liked.

No matter how bad your sleeping situation is, you are not alone.  Despite what you probably feel like you hear, only about 10% of 3 month olds are sleeping through the night.  The crazy thing is that people will lie about it also.  Studies have shown because of the pressure of wanting their child to sleep through the night about 25% of parents of 6 month olds will say they are sleeping through the night even when they aren’t.

However, there are a few things that you can do that can help make the transition easier.

1) I think that if your child has normal growth and development, they do not need to eat during the night after 4 months.  Getting rid of the night time feedings by providing other means of soothing during night time awakenings is one of the best ways to eliminate them.  You can do this by substituting a pacifier or even providing small amount of water to help them transition back to sleep during the night.

2) Another major thing that you need to work on is getting them to go to sleep on their own, in their crib.  If you rock them fully to sleep and then do the dance where you place them in bed and slide your arms out; tiptoeing quietly as if you are on broken glass to the door to avoid waking them, they will not know how to put themselves back to sleep during the night.  I recommend a bed time routine and placing them in bed when they are drowsy but awake.

3) After you have gotten rid of the feedings and have them falling to sleep alone, I recommend slowly decreasing the amount of support that is required to get them back to sleep.  At first, you can pick them up and rock them.  Second, comfort them in their bed.  Third, only talk to them from the door.  At some point they will become less reliant on your support for sleep and be able to make the transitions by themselves.

Here are some things that will absolutely make getting them to sleep through the night more difficult:

1) Put them to sleep in the living room watching TV with you and then transfer them to their bed.  Can you imagine if you fell asleep on your bed and woke up on the kitchen floor?  You’d probably be crying for your momma too.

2) Keep them sleeping in your room until they graduate high school.  Again, would you like to be sleeping in the room with your parents snoring and burping and all the other things that go along with being a loud adult?  Having them sleep in your room with you at night is a convenience for feeding purposes only.  They are not safer to be in your room with you than they will be down the hall.

3) Feed them every time they wake up at night because it is the easiest way to get them back down.  Adults who wake up every night for a midnight snack really do feel hungry during the night.  Your babies are feeling the same way when they wake up at night but continuing to feed them only makes this more likely to occur the next night.

Believe me, these steps are simple but they will involve some difficult nights, especially at the beginning.  But, look at it as an investment in your future sleep.  And besides, you probably didn’t read this far on my post unless you are up in the middle of the night rocking a fussy baby.

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