We Asked a Pediatrician About Your Most Common Questions and Concerns (cont'd)
Q: What can parents do to reduce their baby's risk of SIDS?
A: Changing advice on the sleep position [to recommending that babies be put to sleep on their back] is probably the biggest intervention that's been made in the last ten years. It looks like, depending on the study you read, we've seen somewhere between a 17 and 34 percent reduction in the incidence of sudden infant death syndrome with the "back to sleep" program.
This is something where we get some interference from the grandparents, who say, "Everyone was put to sleep on their tummy and you all survived." Obviously not all of SIDS is caused by this, and those other causes are being investigated. Two to 4 months used to be the peak age for SIDS. After 4 months, a lot of it is suffocation with inanimate objects, those kinds of things. We don't recommend bumper pads in the crib anymore. There is no reason for a bumper pad in a crib. Unfortunately there have been some very active young babies who have gotten their heads in between the bumper pad and the crib and basically strangulated on it, or the straps that are used to tie them on have become wrapped around little fingers or toes.
Q: Can you offer any tips for parents in search of a night's sleep?
A: There are a couple of tricks or tips that we tell parents for getting a good night's sleep. Some babies come out with their days and nights mixed up, and that can be a huge problem. So accentuating the light and dark cycles, making sure that even when they're sleeping during the day you keep it light in the room. When they're awake at night, keep it fairly dark because we all set our biological clocks by light and dark cycles. If there are other siblings, you don't need to keep them quiet. A lot of parents are chastising their 2- or 3-year-old to be quiet because the baby's asleep, but my recommendation is to let the noise level go and the baby will set his own clock. Some parents are trying to force their baby to stay awake, and you can't do that. You're pretty much a slave to their schedule, but you can change things this way, and that usually works for the best.
Somewhere around 6 weeks or so you can try to fit yourself into a schedule. There's something called the five-minute rule. It's used with breast-fed babies, and it starts around 6 weeks. That's about when babies can start to spread out their sleep at night. In a study published in Pediatrics in 1993, two researchers asked a group of moms to give their babies a really good "focal feeding" between 10 and midnight — a full 20 minutes on one breast, or 10 minutes on each breast, and then put the baby down. Then, when their babies woke up for that 1 or 2 a.m. feeding, they asked them to try a "five-minute rule." The parents could do anything except feed the baby. So this isn't the "let them cry" rule that people talk about later on, but the parents would go into the room, pick them up, hold them, rock them, change the diaper, do whatever they could to calm them for five minutes. If they weren't crying lustily afterward, they put them down in the crib to see if they could go back to sleep without a feeding. What they were doing was training [the babies] to not take a feeding, because for his entire life — 4 to 6 weeks — he's been fed every two to three hours. Now his liver is mature enough to store up sugar and make it through the night, but he just doesn't know it. So this five-minute rule helps them to know that.
In the study they compared the group doing this to a control group, and all the babies in the five-minute group were sleeping through the night (which they defined as six hours) at 2 months of age, whereas only 40 percent of the control group were sleeping through the night at 2 months. Some babies just fall into this pattern on their own, of course, but this can be very effective for many nursing babies.
