The national incidence of SIDS decreased 56 percent from 1992 to 2003, according to background information in the article. This decline is largely attributed to the increased use of the supine sleep position (lying on the back with head facing up) after the introduction of the "Back to Sleep" campaign in 1994. In more recent years, the decrease in SIDS has leveled off. "Although caretakers should continue to be encouraged to place infants on their backs to sleep, other potentially modifiable risk factors in the sleep environment should be examined to promote further decline in the rate of SIDS." The association between room ventilation and SIDS risk is a factor that has not received sufficient attention. Inadequate room ventilation might facilitate the pooling of carbon dioxide around an infant's nose and mouth, increasing the likelihood of rebreathing. The movement of air in the room may potentially reduce the risk of SIDS.

Kimberly Coleman-Phox, M.P.H., and colleagues at Kaiser Permanente's Division of Research in Oakland, Calif., analyzed information from interviews of mothers of 185 infants who had died from SIDS and mothers of 312 randomly selected infants from the same county, maternal race/ethnicity and age. Mothers were asked about fan use, pacifier use, open window in the room at the infant's last sleep, room location, sleep surface, number and type of covers over the infant, bedding under the infant and room temperature.

Compared with infants who did not die from SIDS, at the last sleep, more infants who died from SIDS:

• were placed on their stomachs or sides (68.9 percent vs. 43.9 percent)
• did not use a pacifier (95.9 percent vs. 76.4 percent)
• were found with bedding or clothing covering the head (11.4 percent vs. 4.5 percent)
• slept on a soft surface (12.1 percent vs. 6.8 percent)
• shared a bed with someone other than a parent (14 percent vs. 5.5 percent)

The use of soft bedding underneath the infant and room temperature at last sleep were the same for both groups of children.

Having a fan on during sleep was associated with a 72 percent decrease in SIDS risk compared to sleeping in a room without a fan. Fan use in warmer room temperatures (above 21 degrees Celcius/69 degrees Fahrenheit) was associated with a 94 percent decreased risk of SIDS compared with no fan use. Fan use also was associated with a decreased risk of SIDS in infants who slept in the prone or side position, shared a bed with someone other than their parents or did not use a pacifier.

Despite the effectiveness of placing infants on their backs to sleep in lowering SIDS risk, approximately 25 percent of child care providers do not regularly follow this practice. "Use of the prone sleep position [lying with the front or face downward] remains highest in care providers who are young, black or of low income or who have low educational attainment," the authors conclude. "In this study, the frequency of fan use was similar in young and less educated women as in other women; thus, fan use can be easily adopted by these populations.

"Although improving the methods used to convey the importance of the supine sleep position remains paramount, use of a fan in the room of a sleeping infant may be an easily available means of further reducing SIDS risk that can be readily accepted by care providers from a variety of social and cultural backgrounds."

Note: If no author is given, the source is cited instead.

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