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SIDS
William Sears, MD

Subtitled "A Parent's Guide to Understanding and Preventing Sudden Infant Death Syndrome", this book is frequently recommended by attachment parenting (AP) advocates as being a good program to follow for SIDS reduction. Sears promotes seven specific steps that parents should take to reduce the risk of SIDS:

1. Give your baby a healthy womb environment.
2. Do not allow smoke around your baby -- pre- or post-natally.
3. Put your baby to sleep on her back or side, not on her stomach.
4. Breastfeed your baby.
5. Give your baby a safe sleeping environment.
6. Avoid overheating your baby during sleep.
7. Practice the "high-touch" style of attachment parenting.

It's interesting to note that these practices are for the most part core AP practices, which is hardly surprising since Sears is well-known as an AP proponent. Unfortunately it's not clear to me that this makes him a credible authority on SIDS.

My biggest problem with this book is that it switches back and forth from solidly-established facts to plausible speculation. For some things, notably back-sleeping, Sears is able to quote many studies showing a demonstrable lowering of risk. But for other practices, notably co-sleeping (putting your infant to sleep in bed with the mother), Sears can only offer his own hunches and hypotheses of a possible mechanism why co-sleeping might help decrease the risk of SIDS. I fear, though, that many readers will not adequately understand what "hypothesis" means, and will come away from this book with the message that AP lowers the risk of SIDS.

Does it? This book was first published in 1995, and does not seem to have been revised since then. Sears expresses a hope in the book that SIDS research will verify his hypothesis on co-sleeping, but as far as I can find out, it hasn't done so. In fact, despite years of research on the subject, there still don't appear to be any studies that show a decrease in SIDS risk from co-sleeping.

The American Academy of Pediatrics' policy on bedsharing and SIDS (adopted in 1997) says in part "there are no scientific studies demonstrating that bed sharing reduces SIDS." (They don't come out against bed sharing, but are cautious about doing so safely). The more recent report of the AAP Task Force on Infant Sleep Position and Sudden Infant Death Syndrome lists the AAP's current recommendations:

1. Infants should be put to sleep on their backs
2. Cribs should conform to CPSC and ASTM standards.
3. Infants should not be put to sleep on soft surfaces.
4. Soft objects such as pillows, stuffed animals, comforters and sheepskins should be removed from the baby's sleeping environment.
5. Cosleeping should be done cautiously. ("It is the consensus of the Task Force that there are insufficient data to conclude that bed sharing under carefully controlled conditions is clearly hazardous or clearly safe.")
6. Overheating should be avoided
7. Tummy time is recommended while the infant is awake to prevent flat spots on the back of the head.
8. Devices designed to help keep an infant in one sleeping position are not recommended.
9. There is no evidence that monitoring decreases the chance of SIDS.

There is more to this book than Sears set of recommendations, of course. In particular, many parents will find the frank discussion of what we know about SIDS (the answer: not a whole lot, really) helpful. Tragically, a few parents will also benefit from the chapter on resources to help deal with the grief that comes from a SIDS death.

However, on the whole I don't think reading this book was an especially good investment of my parenting time. You can get a more up-to-date view of the solid information on SIDS from the AAP or from the SIDS Alliance web site. At the end of the day, I find Sears use of SIDS as a way to promote his views on childrearing intellectually dubious, much as I agree with those views in and of themselves.