Today’s Milwaukee Journal Sentinel has the latest in a grim series of articles reporting on infants dying while sleeping with adults. A number of infant deaths in similar circumstances late last year led to City of Milwaukee health officials launching a “safe-sleep” information campaign. Billboards have been placed throughout the city, and the Health Department website includes information on keeping infants in a safer sleep environment. Parents are advised to place babies in their own safety-approved cribs or bassinets with no stuffed toys, blankets or bumper pads. Babies, we are told, should always sleep on their backs to reduce the risk of Sudden Infant Death Syndrome (SIDS).
As a person who has been studying children’s issues for many years, I find a number of things about this campaign to be noteworthy.For one thing, it is always refreshing to see resources expended on prevention of harm to children. Too often, remedies for child maltreatment consist of after-the-fact punishment of perpetrators and too-little-too-late psychological interventions with the injured or neglected children (assuming that they are lucky enough to survive). Provision of child-related information is a positive, preemptive step. While some child maltreatment is committed with malice, plenty of harm comes to children who are hurt by adults who simply don’t know enough to make better choices. For example, a child may be beaten for bed-wetting because a parent mistakenly believes that the child is deliberately being naughty. In fact, bed-wetting is not in the conscious control of the child and bedwetting is common until at least age 5 or 6. Parents who know this may be less likely to be filled with rage when the child doesn’t stay dry. [Of course, the separate issue of whether a beating is ever appropriate is less easily addressed by information campaigns alone.] The angry impulse to shake a crying child provides another example of harm caused by people who may not be terrible or filled with evil intent. In recent years, child advocates have attempted to educate the public on avoiding “shaken-baby syndrome” by providing information showing that even mild shaking can cause severe or fatal damage to a young child’s spine or brain because of children’s relatively larger heads and weaker neck muscles. If you’ve ever seen a sign or bumper sticker with “Never, never, never shake a baby” imprinted on it, you have absorbed this information.
Another interesting thing about this campaign is more troubling. We don’t always like to admit it, but certain child-rearing methods come in and out of favor with parents and professionals alike. We hope that this is because science progresses in a linear direction, providing us with steadily improving information over time. The truth, though, is probably more complicated. The fact is that there is a lot that science, medicine, and society do not understand, and a lot of the child-rearing or safety advice offered by experts is in fact somewhat cyclical in nature.
Speaking not just as a child advocate but as a mother whose oldest child is in her mid-twenties, let me add some perspective. The fact is that 20+ years ago, much of this expert advice was just the opposite. Adults’ sleeping with infants was not favored by experts then, either, but more for psychological reasons. Children needed to learn to soothe themselves to sleep, we were told, and the sooner they learned, the better. Recommendations for their cribs were different, however. Bumper pads were encouraged, so that babies would not bump their heads on the crib rails or somehow get their heads stuck in the rails (this second concern was a non-issue by the 1980s, though, because government regulations required bars on cribs to be closer together than they had been previously). The point I remember the most clearly, probably because it was so heavily emphasized, was that babies were at all times to be placed so as to sleep on their sides or tummies so as to avoid SIDS. I cannot count the number of times I woke my babies up while I maneuvered them into the approved sleeping position.
As I mentioned above, maybe we are just getting better information now, and more lives will be saved. I hope so. The theory of stomach-sleeping twenty years ago was that a back-sleeper might spit up milk and choke, thereby causing a SIDS death. I believe the theory now is that the baby’s own weight might compress his breathing passages if he is on his tummy, but the airways will be clearer with back sleeping. The truth is that researchers still do not understand what causes SIDS, and we are all desperate to try anything that we think will prevent it.
My final observation is that we have to be careful here, lest we add to the burdens of grief-stricken parents who have lost infants. We want to encourage parents to use the safest, most up-to-date methods in caring for their children. We should not, however, become too arrogant about what we know. It would be a serious mistake at this point, in my opinion, to try to treat parents who opt for unapproved sleeping techniques as neglectful parents. We simply do not yet know enough to make that judgment.