"Back is best."
Those were the words spoken by Eileen M. Carlins about how to let children sleep, during a symposium Thursday morning at Pennsylvania College of Technology. Sudden Infant Death Syndrome (SIDS) is the leading cause of death in infants from a month to a year of age.
"There is so much we know today that we didn't know years ago," said Carlins, director of support and education for SIDS of Pennsylvania.
Dan French, president of 3D Creative Services Inc., shows his daughters, Brooke, 10, left, and Alison, 13, how to work his company’s infant safe sleep display. The display, finished by midnight on Wednesday, was created for Charles E. Kiessling Jr., Lycoming County coroner, to be used as an informational tool.
In 1994, the American Academy of Pediatrics Task Force on SIDS started the "Back to Sleep" campaign, encouraging people to rest babies on their backs.
The SIDS rate in the nation halved by 1999, Carlins said.
Some parents lay their children on their stomachs because they say the infants sleep better that way, said Dr. Michael Goodstein, attending neonatologist at York Hospital and director of York County Cribs for Kids.
"Some babies will sleep themselves to death," said Goodstein, the medical director for Cribs for Kids National Infant Safe Sleep Initiative.
Babies who sleep on their stomachs are less reactive to noise, experience sudden decreases in blood pressure and heart rate control, experience less movement, have higher arousal thresholds and have longer periods of deep sleep - all of which are risk factors for SIDS, he said.
He also has had people tell him that they let their child sleep on their stomachs so they don't choke.
"You may swallow some spit-up, but it's OK," Goodstein said.
Bedsharing, when an infant sleeps with parents or siblings, also is not recommended.
One of the examples Goodstein provided was of a 10-year-old girl who heard her infant sibling crying. Their mother was asleep, so the older girl soothed the infant and then put her sibling in bed with her. The eldest child rolled over and suffocated her sibling.
SIDS victims were 5.4 times more likely to have shared a bed with other children, he said, citing a Chicago Infant Mortality Study done in May 2003.
He heard mothers say they know where their babies are when they're asleep and would never crush them. Yet he has seen cases where parents shifted in their sleep.
"There is enough weight in a human arm to suffocate a baby," he said.
Goodstein said that an unsafe sleeping environment includes soft bedding, pillows, quilts, comforters, sheepskins, stuffed animals, toys and bumpers.
Any place other than the baby's crib, such as a sofa, recliner, rocking chair or an adult bed, can be dangerous because an infant could become trapped, wedged, injured, rolled on or suffocated.
What he did recommend, instead of bedsharing, is roomsharing, which means placing the crib in the parents' room, near the bed.
Roomsharing solves two problems he hears about.
Some women want to share a bed with their babies so they can breastfeed easier. Instead, he recommends breastfeeding and then putting the baby back in the nearby crib.
"While bedsharing may facilitate breastfeeding, it is not essential for successful breastfeeding," Goodstein said.
Some parents want to sleep with their children as a way to protect them from bullets if they live in an unsafe neighborhood. One way to get around that is to place the adult bed closer to the bed and the crib on the other side of the bed.
Almost consistently from 1990 to 2005, the state has had higher infant mortality rates than the country.
"This is a silent epidemic," Goodstein said. "No one's talking for these babies."
Cribs for Kids, a national infant safe sleep education and crib distribution program, began in Pittsburgh in November 1998 after Judith A. Bannon, executive director for the organization, heard that three of the five SIDS deaths that summer resulted when parents slept with their children because there was no crib available.
"We need to give these people cribs," she said.
At first, 72 women called in about needing cribs and the calls continued. With the cribs - and later the cheaper but effective Pack N Plays - came education about how children should sleep.
Cribs for Kids has been credited with a 50 percent drop in SIDS and sleep-related deaths in Allegheny County since 1998.
County Coroner Charles Kiessling has seen different scenarios when he gets called for an infant death. He showed pictures of a bed with ruffled sheets and numerous pillows, where a bottle was tucked in to the pillows, signifying it was where the baby was. The crib sat nearby.
"People will put babies down just about anywhere and, unfortunately, babies will die just about anywhere," he said.
Having to tell parents the reason their baby died is because they slept in bed with it, or due to another preventable cause, is "the very worst."
"I never want to do that again," Kiessling said.
From 2000 to 2005, 29 teenagers were killed in motor vehicle crashes in the county. As a way to raise awareness in schools, posters were designed and distributed with pictures of the teens who died and where they were from.
Since then, there have been 12 teenage fatalities, he said.
With awareness, "hopefully, infant deaths will go down, too," Kiessling said.