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Stopping SIDS

A startling fact about Sudden Infant Death Syndrome has public health officials rethinking their target audience.

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Last week, Selina Badie and her family celebrated a bittersweet ceremony for her son, Darryl, who would have turned 3 on March 11.

"My husband and I visited the cemetery today, and later we're going to have cake and ice cream," Badie, 30, said on the afternoon of her son's birthday. "My grandmother will say a prayer, and we'll light candles around his picture and light the cake, and we'll sing 'Happy Birthday.'"

Darryl Badie III is one of the painfully short lives that make up a troubling statistic: African-American babies are more than twice as likely as whites to die of Sudden Infant Death Syndrome (SIDS). Formerly known as "crib death," SIDS is a fatal and sometimes inexplicable loss of oxygen during sleep. A report published in the American Academy of Pediatrics' journal Pediatrics earlier this month highlighted the alarming racial discrepancy among SIDS deaths.

Though SIDS is a leading cause of infant mortality in the country, its occurrence has declined nationally since 1992, thanks to SIDS education programs for parents, day-care workers and other caregivers. But SIDS' relative persistence in African-American communities has led public health officials to retool their educational materials and outreach practices to target the greatest risk group for SIDS: low-income black families.

"More culturally sensitive materials have been developed to reach the African-American community. That's very recent, within the past two years," says Tracy Hubbard, SIDS Coordinator for the Louisiana Office of Public Health (OPH).

Louisiana follows national statistics in that most SIDS deaths occur among black babies. State health statistics show that of the roughly 60 to 80 SIDS cases documented annually in Louisiana, about 15 are from Orleans Parish.

"Since 1993 or 1994 the SIDS rate has dropped in Orleans Parish, but it hasn't dropped nearly as much in African-American families as it has in Caucasians," says Dr. Robert Beckerman, medical director for OPH's SIDS team. "It's a two-and-a-half times higher risk (for blacks)."

SIDS education programs are based on the American Academy of Pediatrics' "Back to Sleep" campaign, launched in 1994. Central to that campaign is a push for healthy infants to sleep on their back or side. Other elements that reduce the risk of SIDS include breastfeeding; quitting smoking while pregnant or while near the baby; avoiding bringing the child into an adult bed to sleep; removing extra bedding, pillows and stuffed animals from cribs; and taking care to not overdress or overheat the infant.

Those recommendations reduce the chance of oxygen depletion and suffocation, Hubbard explains. "If a baby has medical problems, other sleep positions may be better, but healthy babies should be placed on their backs," she says. "On the side is an alternative position, but on the back is best.

"When they're sleeping on their stomachs, they sleep a lot deeper and longer. During their first year of life they're learning how to breathe, and sometimes they forget to breathe," she says. "If they're lying on their stomachs, they're in such a deep sleep they can't wake up."

Hubbard says the Office of Public Health is becoming more aware of cultural factors that may contribute to SIDS. "We have found that in the African-American community, the grandmother of the baby often has a lot of influence. ('Back to Sleep') is a fairly new message, and we are trying to bring it to those grandmothers who are not coming to prenatal training, who probably laid their own babies to sleep on their stomachs."

Selina Badie didn't know about SIDS in 2001, when Darryl was born. A baby that she and her husband had long awaited, Darryl was premature and had bouts of infant apnea, in which the brain fails to signal the muscles to breathe. Badie says hospital nurses told her to put Darryl to bed on his side, and that the night before the 3-month-old died, her husband had laid Darryl on his back.

But in the morning, the boy was unresponsive. "My husband said he had placed him on his back, but when I got up he was face down," Badie recalls. "I tapped his leg and he didn't move. I screamed, 'My baby is dead!' I turned him over. His lips were blue."

After Darryl's death, Badie found out about SIDS. "No one had forewarned us about the possibility of this happening," she says. "That is something I should have known about, because I'm black, and it happens more in blacks."

The Badies sought therapy through OPH's family counseling service, Project LAST (Loss And Survival Team). Badie became a peer counselor, and is now working with Hubbard to educate African-American families about SIDS. "Even though we know SIDS cannot totally be prevented, we can help families reduce the risk factors that cause it to happen," Badie says.

Project LAST director Paulette Carter says most parents she's encountered who have lost a baby to SIDS were unaware of the risk factors. "Or they were aware of them but said, 'Well, my baby wouldn't sleep on her back,' or 'My mother put me on my stomach, so I didn't think it was an issue,'" Carter says. "We have a lot of parents whose children won't sleep on their own, so they sleep with the parents."

Letting an infant sleep with adults or older children can lead to "overlay," where a sleeping person rolls onto the baby, Carter says. Or, the infant can quickly become smothered by pillows or bedding. "I've been to many homes where they don't have a crib, and the child just sleeps with the parents. It's an accepted practice, not just in African-American communities but in all communities," Carter says. "People are wanting that family bed."

The SIDS team is working with non-traditional venues, especially churches, to bring SIDS information to African Americans. It has also launched a 30-second TV spot aimed at black populations across the state. "When they tell you that your child died of SIDS and you don't know anything about it, you want answers," Badie says.

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