JANNA AND RICHARD HOLMES had been canning applesauce since early that morning, boiling and processing the endless supply of apples while their 4-month-old, Nathan, sat propped in an infant seat at their feet.
Late in the afternoon, when Nathan got fussy, Janna laid him down on her bed and went back to the kitchen to tackle more apples, checking in on the infant every half hour or so. On the last check, worried that he hadn't moved at all, she put her hand on his tiny, still back.It has been almost 10 years since Nathan Holmes died of sudden infant death syndrome, and in that time SIDS has continued to be the mystery apparent in its name: We know the cruelty of SIDS' swiftness and finality, but we still know little about its cause. There are in fact no symptoms, only an outcome. By its very definition, to have the syndrome is to have died from it.
But now there does appear to be hope - if not of finding what SIDS really is, at least of reducing the chances that a baby will die so unexpectedly and unexplainably.
Neonatologist Ronald Stoddard admits that the answer seems too simple to be scientific: Lay babies down to sleep on their backs.
Stoddard, who is co-director of the intensive care nursery at Utah Valley Regional Medical Center, had heard this admonition before. "But in the back of my mind I wondered about the science behind it," he says.
Last winter, though, Stoddard attended a conference where he heard about a British study that "removed any doubt from my mind." At Stoddard's invitation, the author of that study, British pediatrician Peter J. Fleming, will be in Salt Lake City Friday to present his work at the annual meeting of the Utah Perinatal Society.
Fleming has studied SIDS deaths in Avon, an English county with a population roughly the size of Utah and an incidence of SIDS comparable to both the U.S. and Utah average - 1.5 to 2 per 1,000 live births. Five years into the study, Fleming and his colleagues found that the incidence of crib death was nine times higher in babies put to bed on their stomachs.
At the completion of the study, pediatricians launched a campaign to convince British parents to lay children on their backs at bedtime. The campaign might have been ignored if it hadn't been for the death, at the same time, of a much-publicized infant - the child of a famous talk show host - "the Oprah Winfrey of England" according to Stoddard.
"They had an incredible compliance rate," says Stoddard about the campaign. The result, three years later, is that the SIDS death rate has dropped from over 1.5 to .5 per 1,000 live births.
So far in the United States, he says, there has been "dismal compliance," despite efforts by the American Academy of Pediatrics since 1992 to convince parents to lay babies on their backs.
A more aggressive "Back to Sleep" campaign was launched this past summer by the U.S. Department of Health and Human Services, which estimated that 43 percent of American infants still sleep on their stomachs. Up until two years ago, of course, pediatricians told parents to put babies on their stomachs - to keep the babies from choking if they spit up.
When Janna Holmes, herself a newborn intensive care nurse, had her youngest child 2 1/2 years ago she, too, put the baby on its tummy to sleep. Now she hopes to help alert new parents to put their babies on their backs.
Despite 30 years of research, doctors are still baffled by crib death. Theories have come and gone, trying to pinpoint the cause of the unexplainable deaths.
The current theory is that there is no one single cause of SIDS. But doctors now think there have to be at least two major factors in place for a SIDS death to occur:
- Some sort of prenatal "insult," most likely to the cells in the brain's respiratory center. Cells that should rhythmically fire to remind the baby to breathe appear to malfunction. This may be due to any one of a number of problems that compromised the delivery of oxygen to the fetus during pregnancy - problems that include anemia, low blood pressure or infection in the mother, or secondhand smoke from a mother who smoked during pregnancy. There is no test for this brain abnormality and babies with it appear healthy.
- A "trigger" that affects the baby's breathing. This could include an infection (about 50 percent of SIDS babies have had a respiratory or gastrointestinal infection in the week before their deaths), soft bedding and overheating.
Soft bedding - a comforter, pillow, beanbag chair, sheepskin, maybe a waterbed - can create a puddle of the baby's expired air, thus creating an oxygen deficiency.
Overheating can occur when babies are wrapped in too many blankets. Infants do not have good temperature control; apparently the rise in temperature acts the way a fever might.
Although most babies might cry or wiggle if their oxygen level got uncomfortably low, SIDS babies apparently just keep on sleeping.
Putting a baby on its back increases his ability to breathe should both a "respiratory center" problem and a "trigger" be present. But it doesn't completely erase the possibility of SIDS.
"There are certain cases of crib death that, no matter what you do, you can't prevent," says Stoddard.
Parents are not to blame for their baby's SIDS death, stresses Carol Pia, SIDS program manager for the Utah Department of Health's Family Health Services. But the new evidence that placing babies on their backs cuts down the risk of crib death "is the first thing in a long time that seems to make a difference."
Dr. Peter Fleming will speak at 9 a.m. Friday, Sept. 30, at the Utah Perinatal Society's 17th annual meeting in the Salt Lake Hilton, 150 W. 500 South. Cost of the lecture is $25.
The Utah SIDS Alliance, a support group for parents, meets every third Thursday. On Saturday, Oct. 8, the group will plant 53 trees in honor of Utah infants who have died of SIDS during the past year. The planting will be at the DACP Park in Kaysville. For more information about the alliance call 261-4222.
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Additional Information
Improving baby's odds
To reduce the risk of SIDS
-Place baby to sleep on its back
-If the baby will not sleep on its back, place it on its side, wedging a firmly rolled receiving blanket between the mattress and the baby's tummy. Pull the lower arm forward to reduce the chance that the baby will roll onto its tummy.
-Do not overheat the baby by swaddling it in too many blankets.
-Make sure all bedding is firm, even for impromptu naps away from home. Avoid placing the baby on comforters, sheepskin, foam pads, pillows or waterbeds.
-Pregnant women should quit smoking and should be monitored for anemia and low blood pressure.