Sudden Infant Death Syndrome (SIDS) has decreased dramatically in Canada since 1993 when Health Canada first recommended putting babies to sleep on their backs. The internationally supported “Back to Sleep” campaign in 1999 reinforced the message. According to the Public Health Agency of Canada, by 2009 there was a 71 percent decrease in SIDS to 0.3 per 1,000 live births, from one baby per 1,000 live births in 1981.
SIDS was on the decline prior to 1999, but the recommendation to put babies to sleep on their backs made a significant impact, says Alexandra Martiniuk, an associate professor of epidemiology and community health at the George Institute for Global Health in Sydney, Australia, who is also affiliated with the University of Toronto. “That, as well as the messages of removing items from the sleep space such as pillows and toys, using a flat, firm mattress, eliminating cigarette smoke from baby’s room, and ideally not sleeping in the same bed with baby if under influence of alcohol or drugs.”
However, with the decrease of SIDS, doctors are now seeing an increase in plagiocephaly (also known as flat head syndrome), to one in five babies. “Most cases are mild or moderate but some are severe,” says Alexandra. “For some children it improves on its own and for others treatment is needed.” Problems associated with plagiocephaly include developmental delay, physical appearance (for some children it can mean their ears or eyes are out of alignment), difficulty fitting into bike, snowboard or hockey helmets, and potential teasing due to looking different.
Alexandra recently studied attitudes and behaviours around preventing flat head syndrome. The findings were published in the journal Child: Care, Health and Development.
She and fellow researchers interviewed 121 Canadian and Australian parents and grandparents, and found they were taking unnecessary risks to prevent flat heads in their babies. “They are worried about SIDS, too, of course, but flat head syndrome feels more likely, more real because they know children with a flat head but very rarely has any parent known a child who died of SIDS. As well many parents had a child with mild flat head so they were trying to improve it.”
The study found adults were not putting babies to sleep on their backs, or not following other SIDS guidelines such as using pillows in the crib, placing a rolled up pillow beneath the crib mattress, or using a hanging-type bassinette that supposedly relieves pressure on different parts of the head. But these behaviours can increase the risk that baby will roll to one side and suffocate.
Alexandra is concerned that as parents become preoccupied with preventing plagiocephaly, we may start to see an increase in SIDS.
The best way to prevent plagiocephaly is to ensure your baby has some tummy time each day, says Alexandra. “Just a few minutes will help strengthen neck muscles and reduce the risk of flat head. Alternate the position of baby while awake and alternate sides if you’re breastfeeding,” she adds. “Use different seats too, not just the car seat.”
Originally published in ParentsCanada magazine, Nov/Dec 2016.