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Concerns regarding recommendations

 

Dr. Rafael Pelayo from Stanford University and a number of other pediatric sleep researchers in the US have stated that they believe that the American Academy of Pediatrics' recommendations regarding cosleeping and pacifier use may have unintended consequences. They have stated that the SIDS prevention strategy of the American Academy of Pediatrics which keeps infants at a low arousal threshold and reduces the time in quiet sleep may be unhealthy for children. They state that slow-wave sleep is the most restorative form of sleep and limiting this sleep in the first 12 months of life may have unintended consequences to both the sleep and the infant.[81]

 

According to a 1998 study by British researchers that compared back-sleeping infants to stomach-sleeping infants, there were developmental differences at 6 months of age between the two groups. At 6 months of age, the stomach-sleeping infants had higher gross-motor scores, social-skills scores, and total-development skills scores than the back-sleeping infants. The differences were apparent at the 5% statistical significant level. But, at 18 months, the differences were no longer apparent. The researchers deemed the lower-development scores of back-sleeping infants at 6 months of age to be transient and stated that they do not believe the back-sleeping recommendations should be changed.[82] Other scientists have stated that the conclusion that the negative effects of back-sleep at 18 months of age is transient is based upon very little evidence and that no long-term randomized trials have been completed.[83]

 

Other side effects of the back-sleeping position include increased rates of shoulder retraction, positional plagiocephaly, and positional torticollis.[84] Some scientists dispute that plagiocephaly is a negative side effect. Dr. Peter Fleming, who is co-author of the study that deemed delays at 6 months of age to be transient, has stated that he does not think plagiocephaly is a negative side effect of back-sleep. In an interview with the Guardian, Dr. Fleming stated "I do not think it is a medical problem—it is more of a cosmetic one. Mothers may feel it is a syndrome and a problem when it really is nonsense."[85] A research study on children with plagiocephaly plus a confounding condition such as premature birth or failure to thrive, found that 26% had mild to severe psychomotor delay. This study also showed that 10% of infants with plagiocephaly had mild to severe mental development delay.[86]

 

Because of the delays caused by back-sleep, some medical professionals have suggested that the "normal" ages at which children had previously attained developmental milestones should be pushed back. This would enable medical professionals to consider "normal" children who previously were considered developmentally delayed.[87]

 

Additional studies have reported that the following negative conditions are associated with the back-sleep position: increase in sleep apnea; decrease in sleep duration; strabismus; social skills delays; deformational plagiocephaly; and temporomandibular jaw difficulties.[84] In addition, the following are symptoms that are associated with sleep apnea: growth abnormalities; failure-to-thrive syndrome in infants; neurocognitive abnormalities; daytime sleepiness; emotional problems; decrease in memory; decrease in learning; and a delay in nonverbal skills. The conditions associated with deformational plagiocephaly include visual impairments;; cerebral dysfunction, delays in psychomotor development and decreases in mental functioning. The conditions associated with gross motor milestone delays include speech and language disorders. In addition, it has been hypothesized that delays in motor skills can have a negative impact on the development of social skills.[88][89] In addition, other studies have reported that the prone position prevents subluxation of the hips; increases psychomotor development;, prevents scoliosis; lessens the risk of gastroesophageal reflux; decreases infant screaming periods; causes less fatigue in infants; and increases the relief of infant colic.[90] In addition, prior to the "Back to Sleep" campaign, many babies self-treated their own torticollis by turning their heads from one side to the other while sleeping in the prone position.[91] Supine-sleeping infants cannot self-treat their own torticollis.



 

Pacifiers

 

According to a 2005 meta-analysis, most studies favor pacifier use.[5] According to the American Academy of Pediatrics, pacifier use seems to reduce the risk of SIDS, although the mechanism by which this happens is unclear.[92] SIDS experts and policy makers haven't recommended the use of pacifiers to reduce the risk of SIDS because of several problems associated with pacifier use, like increased risk of otitis, gastrointestinal infections and oral colonization with Candida species.[92] A 2005 study indicated that use of a pacifier is associated with up to a 90% reduction in the risk of SIDS depending on the ambient factors, and it reduced the effect of other risk factors.[93] It has been speculated that the raised surface of the pacifier holds the infant's face away from the mattress, reducing the risk of suffocation. If a postmortem investigation does not occur or is insufficient, a suffocated baby may be misdiagnosed with SIDS.

 

A 2010 study at Monash University suggests pacifiers can prevent SIDS by changing sleep patterns. They believe a pacifier ensures the baby remains in a light sleep and is more easily aroused if he or she feels uncomfortable.[94] The most recent 2011 study confirms that pacifier usage also reduces SIDS risks from other known SIDS risk factors[95]

 


Date: 2015-12-17; view: 655


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