An Ontario hospital says the campaign to prevent sudden infant death syndrome (SIDS) by ensuring that babies sleep on their backs is having an unexpected side effect.
Staff at the Children's Hospital of Eastern Ontario (CHEO) in Ottawa are advising local physicians that babies may develop flattening on one side of the head and related problems if they always sleep in the same position; permanent deformation can occur if the condition is not corrected early. Although the effects of occipital plagiocephaly are mainly cosmetic, the hospital says the condition may “lead to long-term social and emotional consequences.”
By fall 2001, CHEO's Neurosurgery Clinic had already seen 207 children with the condition, compared with 5 children in all of 1994. Staff began noticing an increase after a SIDS-awareness campaign promoting sleep in the supine position was launched in 1999; 84 cases of occipital plagiocephaly were reported at CHEO that year and 126 in 2000, and it now gives brochures to FPs, pediatricians and parents. “We advocate that doctors tell parents about routinely changing the baby's orientation in the crib, as well as encouraging lots of early tummy play and keeping babies off of their backs when they're awake,” says nurse practitioner Karen Dubé.
The Canadian Paediatric Society agrees. Its position statement says babies should be placed on the back to sleep, but in different positions on alternate days.
If a problem with skull shape is discovered early enough, a simple change in sleeping position can help, but in more serious cases a corrective helmet may be needed for a minimum of 6 months. The brochure says babies should continue to sleep on their back but their position in the crib should be changed regularly, with the head at a different end of the crib each night. (This will make it more likely that they will alternate which side of their head they sleep upon.)
Dr. Keith Aronyk, a pediatric neurosurgeon, says the Stollery Children's Hospital in Edmonton regularly sees babies with occipital plagiocephaly, and it has begun educating public-health nurses, pediatric residents and students.
Health Canada says the benefits from sleeping on the back still far outweigh any potential risks posed by occipital plagiocephaly (www.hc-sc.gc.ca/english/media/releases/2001/2001_113e.htm). It notes that the number of SIDS-related deaths in Canada has declined from 385 in 1989 to 138 in 1999, the year the anti-SIDS campaign was launched.