Infants who share a bed with other children are at a higher risk of sudden infant death syndrome (SIDS) than are other infants, according to a new analysis of a study of mostly African-American SIDS deaths in Chicago.

The report appears in the medical journal Pediatrics.

The analysis also found that two known risk factors for SIDS - sleeping on soft bedding and sleeping on the stomach - pose a far greater risk of SIDS when they occur together than the sum of both risk factors added together.

Developing Greater Understanding

The report confirms several studies reporting that SIDS risk was lower among infants put to bed with a pacifier and reinforced earlier findings that sleeping on a sofa also increases infants' risk of SIDS.

The study was supported by the National Institute of Child Health and Human Development (NICHD) and the National Institute on Deafness and other Communication Disorders (NIDCD), both at the National Institutes of Health (NIH), as well as the Centers for Disease Control and Prevention (CDC).

The researchers studied all infants from the ages of birth to one year who had died of SIDS in Chicago between November 1993 and April 1996. There were 260 SIDS deaths during that time.

"This study provides important new information regarding SIDS risk factors," said Dr. Duane Alexander, Director of the NICHD. "The next step is to get this information to the parents and families who can use it to reduce the risk of SIDS among their own infants."

According to CDC Director Dr. Julie Gerberding, "The SIDS rate for African-American babies is more than twice that for white infants. Families need counseling on ways to reduce the risk of SIDS. For example, they need to know they should avoid putting an infant to sleep with other children."

The research is part of the Chicago Infant Mortality Study, designed to identify risk factors for SIDS that place African-American infants at roughly double the SIDS risk of Caucasians.

"Our study found a dramatic increase in SIDS risk for prone sleeping on soft surfaces, highlighting the need to eliminate these unsafe sleep practices," said Dr. Fern R. Hauck, lead investigator of the study. "Additionally, infants should never be placed to sleep on a couch with anyone or in a bed with other children."

Getting the Word Out

The study authors conclude that physicians should counsel new parents not only about the benefits of placing infants to sleep on their backs, but also about the risk their study had uncovered.

"Parents are influenced strongly by their physicians in choosing the sleep position for their infants," they wrote. "Other infant care practices, such as bed sharing and use of soft bedding, may also be influenced by medical providers, particularly if reinforced by the media."

To reduce the racial disparity in SIDS rates, the authors advised taking families' economic circumstances into consideration. For example, some parents may not be able to afford firmer mattresses or to have enough beds for all their family members. The authors called for research on how best to meet these needs.

"On the basis of the findings of this study, they [parents] should receive instruction that emphasizes supine (on the back) sleeping, firm bedding, not using pillows, and not sharing a bed with other children or sleeping with another person on a sofa, while being sensitive to parental concerns and cultural traditions."

The researchers noted that sleeping on the stomach, and sleeping on soft bedding - both known to increase the risk of SIDS independently - posed a much greater risk for SIDS when occurring together than might be expected.

For example, soft bedding appeared to pose 5 times the risk of SIDS as firm bedding; sleeping on the stomach increased the risk of SIDS 2.4 times. Yet infants who slept stomach down on soft bedding had 21 times the risk of SIDS as infants who slept on the back on firm bedding.

Always consult your child's physician for more information.

Children's Juice Intake Adds Extra Calories

"Parents think that because fruit juices are natural that they are a healthy drink, so they don't put a limit on how much their children consume," says study author Dr. Sarita Dhuper, director of pediatric cardiology and the pediatric obesity clinic at the Brookdale University Hospital and Medical Center.

In truth, however, Dhuper says fruit drinks are a major source of calories on their own. Moreover, she says, their high sugar content may increase a child's appetite for even greater amounts of food, thus further contributing to weight gain.

"Our study found that juice consumption is almost shocking. For some kids, there seems to be no limit to what they can drink in a given day," says Dhuper, who presented her findings at the annual meeting of the Pediatric Academic Societies.

Pediatric nutritionist Pam Birkenfeld agrees with the finding.

"Parents tend to think that because fruit juice is fat-free and comes from nature, it's OK," she says. "But what they often don't realize is that it is a very concentrated source of calories that generally does not fill you up, just out," says Birkenfeld, a dietician at Nassau University Medical Center in East Meadow, N.Y.

"In some obese children, juice consumption went as high as 50 ounces per day," Dhuper says. "There were just no limits."

The study calls for parents to dramatically limit their children's juice consumption, and for pediatricians to incorporate information on the links between fruit juices and obesity in all well-child visits.

Always consult your child's physician for more information.

Online Resources

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American Academy of Child & Adolescent Psychiatry

American Academy of Pediatrics

American Psychiatric Association

American Psychological Association

Centers for Disease Control and Prevention (CDC)

National Institute of Child Health and Human Development (NICHD)

National Institute of Mental Health (NIMH)

National Institutes of Health (NIH)

National Institute on Deafness and other Communication Disorders (NIDCD)

SIDS Risk Increases With Bed-Sharing And Soft Bedding

Developing Greater Understanding

Getting the Word Out

Children's Juice Intake Adds Extra Calories

Mood Disorders Can Affect Babies and Toddlers

Watching for Signs

Building Trust

Online Resources

Mood Disorders Can Affect Babies and Toddlers

Experts say children under age 3 can suffer from symptoms of depression, including disruptions in eating and sleep.

What causes mood disorders in children is not well known. There are chemicals in the brain that are responsible for positive moods.

Other chemicals in the brain, called neurotransmitters, regulate the brain chemicals that affect mood. Most likely, depression (and other mood disorders) is caused by a chemical imbalance in the brain.

Life events (such as unwanted changes in life) may also help cause this chemical imbalance.

In recent years, researchers have discovered the youngest humans can even suffer from post-traumatic stress disorder, once thought to be only an illness of adults.

"The picture has totally changed," says Alicia Lieberman, director of the Child Trauma Research Project at San Francisco General Hospital.

Watching for Signs

Researchers have found that parents who continually fail to create a bond of trust with their babies may set them up for insecurity later in life, says Alice Sterling Honig, a child development expert at Syracuse University.

"You're not going to have this feeling of trusting that someone is really for you," she says.

Psychologists, of course, cannot ask infants how they feel.

"We don't put babies on couches," Lieberman says. Instead, they rely on instinct and a guide to symptoms of mental health problems among children up to age 3. The guide, by the infant advocacy group Zero to Three, is similar to the popular DSM-IV, a handbook of psychological disorders among older children and adults.

Even without a guide, many psychologists can detect problems in a baby by just looking at him or her, Lieberman says. Stressed-out babies look "sad, withdrawn, frightened, and disorganized," she says.

Some babies as young as 4 months will not smile or laugh, she says, and they may show signs of stress seen in much older people - digestive problems and weight loss.

As they get older, toddlers who have been exposed to severe stress reveal the after-effects through "post-traumatic play," Lieberman explains. "Their play is rigid and repetitious."

Mood disorders in children also put them at risk for other conditions (most often anxiety disorder, disruptive behavior, and substance abuse disorders) that may persist long after the initial episodes of depression are resolved.

Building Trust

Without the benefit of drugs or psychotherapy, counselors can only change the lives of infants by convincing their caregivers to do things differently.

Dr. Stanley Greenspan, a child psychiatrist at George Washington University, says experts are teaching parents and other caregivers to adjust how they interact with an infant depending on how he or she reacts to sensations.

A hypersensitive baby who is sensitive to noise and sound might need extra soothing and comforting, for example.

Therapists must often teach parents to compliment their infants instead of criticize them and make sure the these children feel safe in times of stress, Honig says.

Whatever the treatment, experts agree that helping infants handle the challenges of life will pay off down the line.

"The biggest myth is that it doesn't make a difference what you do in the early years, that people's traits are genetic and you can't have a favorable influence," Greenspan says. "That's not true."

Always consult your child's physician for more information.