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Experts Underscore
Prevention
Infants who share
a bed with other children are at a higher risk of sudden infant
death syndrome (SIDS) than are other infants, according to a
new analysis of a study of mostly African-American SIDS deaths
in Chicago.
The report appears
in the medical journal Pediatrics.
The analysis also
found that two known risk factors for SIDS - sleeping on
soft bedding and sleeping on the stomach - pose a far greater
risk of SIDS when they occur together than the sum of both risk
factors added together.
Developing
Greater Understanding
The report confirms
several studies reporting that SIDS risk was lower among infants
put to bed with a pacifier and reinforced earlier findings that
sleeping on a sofa also increases infants' risk of SIDS.
The study was supported
by the National Institute of Child Health and Human
Development (NICHD) and the National Institute
on Deafness and other Communication Disorders (NIDCD),
both at the National Institutes of Health (NIH),
as well as the Centers for Disease Control and Prevention
(CDC).
The researchers studied
all infants from the ages of birth to one year who had died
of SIDS in Chicago between November 1993 and April 1996. There
were 260 SIDS deaths during that time.
"This study provides
important new information regarding SIDS risk factors," said
Dr. Duane Alexander, Director of the NICHD.
"The next step is to get this information to the parents and
families who can use it to reduce the risk of SIDS among their
own infants."
According to CDC
Director Dr. Julie Gerberding, "The SIDS rate for African-American
babies is more than twice that for white infants. Families need
counseling on ways to reduce the risk of SIDS. For example,
they need to know they should avoid putting an infant to sleep
with other children."
The research is part
of the Chicago Infant Mortality Study, designed to identify
risk factors for SIDS that place African-American infants at
roughly double the SIDS risk of Caucasians.
"Our study found a
dramatic increase in SIDS risk for prone sleeping on soft surfaces,
highlighting the need to eliminate these unsafe sleep practices,"
said Dr. Fern R. Hauck, lead investigator of the study. "Additionally,
infants should never be placed to sleep on a couch with anyone
or in a bed with other children."
Getting
the Word Out
The study authors
conclude that physicians should counsel new parents not only
about the benefits of placing infants to sleep on their backs,
but also about the risk their study had uncovered.
"Parents are influenced
strongly by their physicians in choosing the sleep position
for their infants," they wrote. "Other infant care practices,
such as bed sharing and use of soft bedding, may also be influenced
by medical providers, particularly if reinforced by the media."
To reduce the racial
disparity in SIDS rates, the authors advised taking families'
economic circumstances into consideration. For example, some
parents may not be able to afford firmer mattresses or to have
enough beds for all their family members. The authors called
for research on how best to meet these needs.
"On the basis of the
findings of this study, they [parents] should receive instruction
that emphasizes supine (on the back) sleeping, firm bedding,
not using pillows, and not sharing a bed with other children
or sleeping with another person on a sofa, while being sensitive
to parental concerns and cultural traditions."
The researchers noted
that sleeping on the stomach, and sleeping on soft bedding -
both known to increase the risk of SIDS independently -
posed a much greater risk for SIDS when occurring together than
might be expected.
For example, soft
bedding appeared to pose 5 times the risk of SIDS as firm bedding;
sleeping on the stomach increased the risk of SIDS 2.4 times.
Yet infants who slept stomach down on soft bedding had 21 times
the risk of SIDS as infants who slept on the back on firm bedding.
Always consult your
child's physician for more information.
Children's
Juice Intake Adds Extra Calories
"Parents think that
because fruit juices are natural that they are a healthy drink,
so they don't put a limit on how much their children consume,"
says study author Dr. Sarita Dhuper, director of pediatric cardiology
and the pediatric obesity clinic at the Brookdale University
Hospital and Medical Center.
In truth, however,
Dhuper says fruit drinks are a major source of calories on their
own. Moreover, she says, their high sugar content may increase
a child's appetite for even greater amounts of food, thus further
contributing to weight gain.
"Our study found that
juice consumption is almost shocking. For some kids, there seems
to be no limit to what they can drink in a given day," says
Dhuper, who presented her findings at the annual meeting of
the Pediatric Academic Societies.
Pediatric nutritionist
Pam Birkenfeld agrees with the finding.
"Parents tend to think
that because fruit juice is fat-free and comes from nature,
it's OK," she says. "But what they often don't realize is that
it is a very concentrated source of calories that generally
does not fill you up, just out," says Birkenfeld, a dietician
at Nassau University Medical Center in East Meadow, N.Y.
"In some obese children,
juice consumption went as high as 50 ounces per day," Dhuper
says. "There were just no limits."
The study calls for
parents to dramatically limit their children's juice consumption,
and for pediatricians to incorporate information on the links
between fruit juices and obesity in all well-child visits.
Always consult your
child's physician for more information.
Online
Resources
(Our Organization
is not responsible for the content of Internet sites.)
American
Academy of Child & Adolescent Psychiatry
American
Academy of Pediatrics
American
Psychiatric Association
American
Psychological Association
Centers
for Disease Control and Prevention (CDC)
National
Institute of Child Health and Human Development (NICHD)
National
Institute of Mental Health (NIMH)
National
Institutes of Health (NIH)
National
Institute on Deafness and other Communication Disorders (NIDCD)
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June 2003
SIDS
Risk Increases With Bed-Sharing And Soft Bedding
Developing
Greater Understanding
Getting
the Word Out
Children's
Juice Intake Adds Extra Calories
Mood
Disorders Can Affect Babies and Toddlers
Watching
for Signs
Building
Trust
Online
Resources
Mood
Disorders Can Affect Babies and Toddlers
Experts say children
under age 3 can suffer from symptoms of depression, including
disruptions in eating and sleep.
What causes mood disorders
in children is not well known. There are chemicals in the brain
that are responsible for positive moods.
Other chemicals in
the brain, called neurotransmitters, regulate the brain chemicals
that affect mood. Most likely, depression (and other mood disorders)
is caused by a chemical imbalance in the brain.
Life events (such
as unwanted changes in life) may also help cause this chemical
imbalance.
In recent years, researchers
have discovered the youngest humans can even suffer from post-traumatic
stress disorder, once thought to be only an illness of adults.
"The picture has totally
changed," says Alicia Lieberman, director of the Child Trauma
Research Project at San Francisco General Hospital.
Watching
for Signs
Researchers have found
that parents who continually fail to create a bond of trust
with their babies may set them up for insecurity later in life,
says Alice Sterling Honig, a child development expert at Syracuse
University.
"You're not going
to have this feeling of trusting that someone is really for
you," she says.
Psychologists, of
course, cannot ask infants how they feel.
"We don't put babies
on couches," Lieberman says. Instead, they rely on instinct
and a guide to symptoms of mental health problems among children
up to age 3. The guide, by the infant advocacy group Zero to
Three, is similar to the popular DSM-IV, a handbook of psychological
disorders among older children and adults.
Even without a guide,
many psychologists can detect problems in a baby by just looking
at him or her, Lieberman says. Stressed-out babies look "sad,
withdrawn, frightened, and disorganized," she says.
Some babies as young
as 4 months will not smile or laugh, she says, and they may
show signs of stress seen in much older people - digestive problems
and weight loss.
As they get older,
toddlers who have been exposed to severe stress reveal the after-effects
through "post-traumatic play," Lieberman explains. "Their play
is rigid and repetitious."
Mood disorders in
children also put them at risk for other conditions (most often
anxiety disorder, disruptive behavior, and substance abuse disorders)
that may persist long after the initial episodes of depression
are resolved.
Building
Trust
Without the benefit
of drugs or psychotherapy, counselors can only change the lives
of infants by convincing their caregivers to do things differently.
Dr. Stanley Greenspan,
a child psychiatrist at George Washington University, says experts
are teaching parents and other caregivers to adjust how they
interact with an infant depending on how he or she reacts to
sensations.
A hypersensitive baby
who is sensitive to noise and sound might need extra soothing
and comforting, for example.
Therapists must often
teach parents to compliment their infants instead of criticize
them and make sure the these children feel safe in times of
stress, Honig says.
Whatever the treatment,
experts agree that helping infants handle the challenges of
life will pay off down the line.
"The biggest myth
is that it doesn't make a difference what you do in the early
years, that people's traits are genetic and you can't have a
favorable influence," Greenspan says. "That's not true."
Always consult your
child's physician for more information.
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