Preventing Tragedy

Though the data from the Kaiser study of fans is promising, the link between the use of fans and a decrease in SIDS isn't definitive, says Carl Hunt, a consultant to the National Institutes on Health and a board member of the American SIDS Institute. "Reduced breathing of stale air when using a fan … is only speculation at this time. What they've shown is an association, but that doesn't mean that use of the fan causes less risk of SIDS. It may be that families who use fans have a lower risk for SIDS anyway."

In the meantime, SIDS experts (and the authors of the fan study) stress that parents should continue to follow the Back to Sleep guidelines and should not rely on a fan alone. "We wouldn't want people to think this can be done in lieu of the things we know work," says Hoffman. Betty McEntire, executive director of the American Sleep Institute, stresses that parents should not stop doing what's been proven to work. "It's easy to say, 'OK, my baby sleeps better on his stomach, and I'm just going to get a fan'," she says. "The best things we know work are a smoke-free [environment], Back to Sleep and bare crib—no cover, no bumper pads, no pillows and the bed in the mother's room. Those things are tried and true."

Many other mysteries remain. SIDS is more common in winter months. No one knows why. Breastfeeding is also associated with a lowered risk of SIDS. No one knows why. "There's no evidence at all to indicate whether that's a causal relationship or just an association," says the NIH's Hunt. "It may mean those are families at lower risk for SIDS anyway."

That's also true for pacifier use, which is associated with a lower risk, too. "The only potential downside is there's been some concern that early introduction of pacifiers will reduce the chance of successful breastfeeding," he says. "The American Academy of Pediatrics' recommendation is to introduce the pacifier once breastfeeding is well established."

This blizzard of confusing information may be why some parents haven't implemented the Back to Sleep recommendations. "There's still some sentiment out there that 'I slept prone when I was an infant, and my mother and grandmother did, and I did fine'," says Hunt. "There's also some sentiment out there that 'I heard such and such infant who slept on their back died anyway, so what's the big deal?' … It takes a long time to get public-health messages fully distributed."

And it is true that there are no guarantees even for parents who follow all the guidelines. "A significant number of babies dying of SIDS today were sleeping on their backs," says Hunt. But the bottom line is that following the standard recommendations is still a parent's best chance of keeping their infant safe, even if researchers don't know exactly why these techniques seem to help. "At the end of the day, it doesn't matter [why they're effective]," says Hunt. "Although the physiology is not worked out, it's one of these situations where we understand the benefit of a change before we understand the mechanism. We've known for decades that smoking increases the risk for cancer, that's very solid. We don't understand the physiology of that that well, but we know it's true."

Visit the National Institute of Health's Web site for a complete guide to reducing the risk of SIDS.

© 2008