Monday, March 24, 2014

Assume The Position

        Nap time! Putting the baby down for a nap, sounds like it should be the easiest thing in the world to do, doesn't it? I mean, it's sleep were talking about here. It's natural. Everyone does it, all of their lives. In fact sleeping is so natural that it's mostly involuntary, like breathing. That's why we refer to it as "falling asleep". "Falling asleep" is like "falling in love", it's not something you do it's something that happens to you. (The exception of course is those poor souls who suffer from insomnia. I've been there and trust me, when you can't quite seem to accomplish something that your body demands that you do, it is no picnic.) But insomnia aside, nap time should be simple, right? Wrong! Unfortunately, when it comes to babies everything usually turns out to be harder than it should be. Sleeping is no exception.

        There are many factors that impact baby's sleep time. I touched on some of them in my second post "Getting the System Down". Wellness, fullness, tiredness, contentedness, they all have an effect on how long and how well the little ones sleep. All of these factors, however, are peripheral. Babies require a lot of sleep. And discounting the occasional bad day, once babies settle into a pattern (and this can take some time to establish), they usually can be counted on to sleep regularly and often. But that is not what we are talking about here. There is another problem that has recently sprung-up in this modern age of pediatric science. And though it can sound absurd, especially to those of us born into an earlier generation, it is a serious one. What I'm talking about is sleeping position.

        For thousands of years it was simple. You put the baby down, a few pats, a few "hushes", tiptoe away, done. Now, when nap time arrives and you gleefully snatch up your little stinker and caper joyously to the cradle, or crib, or bassinet, or whatever you use to contain the little darling, you are faced with a decision. How do I lay baby down? On her stomach? On his back? On its side? The decision, though seemingly innocuous, is fraught with potential consequences, even danger. Yes, danger. Inoculation (the dreaded shots) has driven back the baby-getters of old – The Measles, The Mumps, Diphtheria, but in our lifetimes a new monster has crept into the nursery. You know what I'm talking about, though mothers don't even like to think its name let alone say it – the SIDS.

        Sudden Infant Death Syndrome, what used to be called "crib death", is the leading cause of death in infants younger than one year old. SIDS is particularly worrisome because there is no known cause or symptoms and strikes infants that are seemingly healthy (how frightening!). When an infant dies in its sleep and no other cause can be found, the death is determined to be due to SIDS. This begs the question of whether it is a real condition or merely a label for any death by unknown cause. And I must admit, that when it first reared its ugly head and gained widespread attention in the eighties many of us were skeptical about its validity. There is, however, too much data on the subject to write it off as merely another instance of doctors not knowing what they are talking about (the wise mother never forgets that doctors are not infallible). There are, no doubt, instances when the real cause of death is merely overlooked and the diagnosis of SIDS is incorrectly made. However, there are so many SIDS occurrences identical to each other that we have to admit it is a real condition, at least for the purpose of determining how to care for our babies.

        Over the years many suggestions to reduce the potential for SIDS have sprung up. The use of a pacifier, keeping baby cool while it sleeps, eliminating tobacco-smoke exposure, better prenatal care, the list goes on.  There are even products and devices that claim to reduce the risk. I don't know about the usefulness of any of this stuff. You can find out all about them on the Internet. What I do believe is that babies sleeping on their stomachs is a major contributing factor to this horror.

         In 1992 only 13% of mothers placed their babies on their backs to sleep. The rest were sleeping on their stomachs. This was normal and had been for who knows how long. Then, in 1994, after a connection between SIDS and sleeping on the stomach had been established, the Safe To Sleep campaign (originally known as the Back To Sleep campaign) was launched to educate the public and convince mothers to place their babies on their backs to sleep. By the year 2006 the percentage of babies sleeping on their backs had increased from 13% to 76% and the incidence of SIDS had dropped by 50%. That's pretty good, and a pretty good indication that babies sleeping on their backs helps prevent SIDS.

        The practice of having babies sleep on their backs, however, is not without problems. Babies sleep less soundly and less deeply and for shorter periods of time when on their backs. This may be exactly why it has a positive impact on the incidence of SIDS. Unfortunately, this makes our jobs as mothers and care givers harder. (Get used to it. What is best for our babies is often hard for us.) The easy sleeping baby is the best baby of all. I want an easy sleeping baby so bad, but wouldn't you know it, the best position for easy sleep is also dangerous. We used to think it was the other way around. Babies are always spitting up, so when I was a young mother we were afraid of babies choking if they slept on their backs, like little Janis Joplins (when you are a mother there is always something to worry about isn't there?). But apparently studies show that is not a real danger. What you do have to watch out for is the flattening of the back of baby's head. Babies skulls are still growing and therefore soft and having them lie on their backs over a long period of time can cause the back of their heads to become flat. I've seen this, and believe me; you do not want this to happen to your baby. To prevent it, we just have to keep an eye on it and make sure they spend a lot of their awake time on their stomachs. Kiley's head still looks nice and round.

        This is my fifth posting and the first one that wasn't fun to write. But it has been on my mind ever since Kiley came to me, as I am sure it is on the minds of many others. It is not something we like to think about, because it is frightening. But we do think about it, because mothers are brave when it comes to their children, and it is our nature to face the fear when they are in danger. We do what we must to ensure their safety. So, come on Kiley. It's nap time. I know you like to sleep on your stomach, most babies do. Sorry, but you are going to have to assume the position – On Your Back. You might not sleep easier, but I will.


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