by Elizabeth Pantley author of The No-Cry Discipline Solution (McGraw-Hill 2007)

If you ask parents to list the most frustrating discipline problems during early childhood, you would find that these three items appear on every list. They are so common that I call them The Big Three. All children master their own version of these behaviors – every parent has to deal with them!

Controlling their emotions
Most often these behaviors are caused by a child’s inability to express or control his emotions. Tiredness, hunger, boredom, frustration and other causes that ignite The Big Three can frequently be avoided or modified. When your child begins a meltdown, try to determine if you can tell what underlying issue is causing the problem. Solve that problem and you’ll likely have your sweet child back again.

Handling tantrums, fussing and whining
No matter how diligent you are in recognizing trigger causes, your child will still have meltdown moments. Or even meltdown days. The following tips can help you handle those inevitable bumps in the road. Be flexible and practice those solutions that seem to bring the best results.

Offer choices
You may be able to avoid problems by giving your child more of a say in his life. You can do this by offering choices. Instead of saying, “Get ready for bed right now,” which may provoke a tantrum, offer a choice, “What would you like to do first, put on your pajamas or brush your teeth?” Children who are busy deciding things are often happy.

Get eye-to-eye
When you make a request from a distance your child will likely ignore you. Noncompliance creates stress, which leads to fussing and tantrums – from both of you. Instead, get down to your child’s level, look him in the eye and make clear, concise requests. This will catch his full attention.

Tell him what you DO want
Instead of focusing on misbehavior and what you don’t want him to do, explain exactly what you’d like your child to do or say instead. Give him simple instructions to follow.

Validate his feelings
Help your child identify and understand her emotions. Give words to her feelings, “You’re sad. You want to stay here and play. I know.” This doesn’t mean you must give in to her request, but letting her know that you understand her problem may be enough to help her calm down.

Teach the Quiet Bunny
When children get worked up, their physiological symptoms keep them in an agitated state. You can teach your child how to relax and then use this approach when fussing begins.

You can start each morning or end each day with a brief relaxation session. Have your child sit or lie comfortably with eyes closed. Tell a story that he’s a quiet bunny. Name body parts (feet, legs, tummy, etc.) and have your child wiggle it, and then relax it.

Once your child is familiar with this process you can call upon it at times when he is agitated. Crouch down to your child’s level, put your hands on his shoulders, look him in the eye and say, let’s do our Quiet Bunny. And then talk him through the process. Over time, just mentioning it and asking him to close his eyes will bring relaxation.

Distract and involve
Children can easily be distracted when a new activity is suggested. If your child is whining or fussing try viewing it as an “activity” that your child is engaged in. Since children aren’t very good multi-taskers you might be able to end the unpleasant activity with the recommendation of something different to do.

Invoke his imagination
If a child is upset about something, it can help to vocalize his fantasy of what he wishes would happen: “I bet you wish we could buy every single toy in this store.” This can become a fun game.

Use the preventive approach
Review desired behavior prior to leaving the house, or when entering a public building, or before you begin a playdate. This might prevent the whining or tantrum from even beginning. Put your comments in the positive (tell what you want, not what you don’t want) and be specific.

When it’s over, it’s over
After an episode of misbehavior is finished you can let it go and move on. Don’t feel you must teach a lesson by withholding your approval, love or company. Children bounce right back, and it is okay for you to bounce right back, too.

Excerpted with permission by McGraw-Hill Publishing from The No-Cry Discipline Solution (McGraw-Hill 2007) by Elizabeth Pantley http://www.pantley.com/elizabeth

About the author:
Elizabeth Pantley is the author of several books, including Gentle Baby Care : No-cry, No-fuss, No-worry — Essential Tips for Raising Your Baby, The No-Cry Sleep Solution: Gentle Ways to Help Your Baby Sleep Through the Night, Kid Cooperation (with an introduction by William Sears, MD), Perfect Parenting, as well as her latest The No-Cry Sleep Solution for Toddlers and Preschoolers and is also president of Better Beginnings, Inc. She is a popular speaker on family issues, and her newsletter, Parent Tips, is seen in schools nationwide. She appears as a regular radio show guest, and has been quoted in Parents, Parenting, Redbook, Good Housekeeping, American Baby, Working Mother, and Woman’s Day magazines. Visit Elizabeth’s web site http://www.pantley.com/elizabeth.

By Demetria Clark, www.heartofherbs.comPregnancy has always been a time when I have been so thankful for my knowledge of essential oils and aromatherapy. I am not one of these women that carry pregnancy beautifully, I gain tons of weight, swell, have heartburn, gas and sleep all the time. Even though I am not the perfect pregnancy specimen I feel like it. I first saw the results of aromatherapy and pregnancy when I lived with midwives as a teen. I then took and expanded upon this knowledge when I myself became pregnant. Another wonderful thing I discovered about aromatherapy when pregnant and after the babies are born is that it gives you a reason to take the time to heal yourself and pamper yourself. What better that pampering “medicine”.

I originally formulated these blends for myself over five years ago they have since become ones used by pregnant woman, midwives and doulas all over the country.

Nausea Spray

1. In four ounces of distilled water in a spray bottle add 20 drops Spearmint 15 drops Lemon Essential oil 5 drops Sweet Orange Essential oil.
2. Shake well and mist air when feeling nauseas.

You can also try using Ginger, Neroli and Rosewood to find a mixture that works for you.

Leg Cramp Oil

This is great for leg cramps, varicose veins, varicosities and sore backs.

2 ounces St. John’s Wort Oil.
5 Drops Neroli.
5 Drops Grapefruit Essential oil.
This leg oil is fabulous. This is so soothing and relaxing on tired muscles.

Belly Balm – Stretch Mark Prevention Oil

This oil feels so wonderful going on. It is smooth, moisturizing and it can really help with itching that often becomes present when our skin starts stretching.

In a double boiler melt
1 cup coconut oil
1/4 cup Cocoa Butter
1/8 cup Apricot, Almond or Grapeseed Oilv 1/8-cup Kukui nut oil, Shea Butter or Mango Butter ( I love using Mango Butter)
When the oils are all melted, allow it to cool and add the essential oils and pour into another container for the mixture to be stored in.
10-20 drops Sandalwood (try to find an ethical source)
15 drops Patchouli
15 Drops Sweet Orange

You can try varying amounts of oils and types of essential oils but I love this combination. You can also use Rosewood, Rose, Lavender, Tangerine and Neroli. Massage all over thighs, breasts, stomach and everywhere else that needs nourishing and moisturizing. I have also used this on my face, living in the Green Mountains we get frigid winds and my fair skin often needs a protector.

Labor Mists

Relax and Focus
This is a relaxing blend to promote clarity and focus.
In a four-ounce spray bottle almost fill it with distilled water.

Add
20 drops Grapefruit essential oil 15 drops Sweet Orange Essential oil 10 drops Spearmint Essential oil Shake well and mist labor room, or you can make a compress using a wet cloth and misting the cloth, apply to forehead or the laboring Moms back. This mist is great for Dad too.

Transition can be a trying and tiring time for the mother. We want to support her and use a mist blend that will ground, calm and help uplift her spirits.

Add water to mister container as above and add 15 drops Mandarin 10 drops Bergamot 10 drops Lavender 10 drops Clary Sage

This is a strong blend and it should be used away from the mother. Never spray the mother directly. The point of using mists during labor is to be as non invasive as possible. Every person is different and their needs are individual and different also. Make sure that you understand the person you are making the blend for. The wrong blend can assault the senses and we must all realize in our need to help we make may something not so beautiful for the mother.

Disclaimer- Use essential oils with education and care. Research each oil before use, especially with pregnancy, labor, and children’s health.

About the Author
Demetria Clark is the Director of Heart of Herbs Herbal School in Vermont. She is also a Labor support doula and mom to two great boys.

Every woman dreads stretch marks, and most women have them on some part of their body, whether they have ever been pregnant or not. A woman’s thighs, hips, buttocks, and breasts are all common places that they can be found. But what are they, what causes them, and is there anything to be done to avoid them?

Stretch marks first show up during puberty, and both girls and boys get them. They are caused by rapid gain weight or growth in an area of your body. Collagen, a protein that is partly responsible for skin strength and elasticity is stretched quickly and often leaves scars that are called stretch marks. People who are obese and weight lifters often have stretch marks as well.

Pregnancy is a very common time for a woman to get stretch marks. If she doesn’t have them already on her breasts, they can often pop up because of the rapid increase of growth and fatty tissue that develops as a woman’s breasts prepare to breastfeed her baby. However, a woman’s stomach is the most common place for stretch marks to appear during pregnancy.

Stretch marks generally show up during the third trimester when a woman’s belly begins to rapidly get bigger. During the third trimester the baby is gaining most of his weight, and it is then that he grows at the fastest rate during the pregnancy.

There are several products on the market for pregnant women to use to help avoid getting stretch marks, and to help them go away after your pregnancy is over. Some women swear by them, while others claim that they don’t work. In reality, whether or not you get stretch marks is determined by how much elasticity you have in your skin. If you have a lot of elasticity, you probably will not get stretch marks, or they will at least not be severe.

Stretch marks cannot be remedied gotten rid of by a simple cream. While they may start out a pink or purplish color, they will eventually fade to match the color of your skin, like other scars do. Some people will use artificial tanning sprays and lotions to help make them less noticeable. If your stretch marks really bother you, visit a dermatologist or plastic surgeon to see what options they can make available to you.

If you are lucky you will never get a stretch mark. However, if you do, remember that you are not alone and that most women in the world are just like you and have stretch marks too.

By Beverley Brooke

It is important that you remember that weight gain is a normal and healthy part of pregnancy. You have to gain weight in order to provide a healthy and comfortable home for the child that you will be nurturing for the next nine months.

Most women want to know what the ideal weight is during pregnancy. Honestly, there is no one answer. Weight gain will vary from woman to woman. There is no one “ideal” weight during pregnancy, just like there is no one “ideal” weight that is just right for al women.

That said there are certain guidelines that you can follow to ensure that the weight you gain during pregnancy is healthy.

An early sign of pregnancy that can sometimes last through the third trimester is nosebleeds. Nosebleeds are more common during pregnancy than many people realize. What causes them?

While minor nosebleeds are harmless, they can be embarrassing and often happen at the most inconvenient times. When pregnant, a woman has an increased amount of blood running through her body. Her blood vessels are more sensitive and the vessels in the nose expand. When the air is dry and the nostrils dry out, the veins are vulnerable and often a nose bleed occurs.

How to Stop One
If you get a nose bleed while pregnant, you should first attempt to stop it in the same way you would a normal nosebleed. Apply pressure to the nostril for at least 10 minutes with your head tilted back and above your heart. You can also try putting ice in the area to help the veins close up. If after 10 minutes your nose bleed does not stop, talk to your doctor to see if there is something else you can do.

How to Prevent a Nose Bleed

• Drink plenty of fluids. Keeping your body hydrated will also help keep your nose from drying out – dehydration can cause the veins to break and a nose bleed to begin.
• Blow gently. If you must blow your nose, blow it easily. Blowing too hard can put extra pressure on the veins and cause them to burst.�
   
• Use a humidifier. If the air is dry around you, try getting a humidifier to run in your home and bedroom. Keeping the air moist will prevent nosebleeds.�
   
• Lubricate your nose. You can use a nasal lubricant to help keep your nostrils moist, but stay away from nasal sprays and decongestants as they can further dry out your nose.

The general population knows very little about Group B Strep (GBS), and many pregnant women have never heard of it, or have only heard of it in passing. Most are shocked when, late in the third trimester their doctor or midwife ask them to be tested, and the test then comes back positive. There are many questions surrounding GBS. What is it? Is it an STD? How does it affect newborns? How is it transmitted to a newborn? How can you prevent infection, and are there alternatives to antibiotics?

What Is It?
GBS is a bacteria found in the lower intestines of 10-35% of all adults. In women it can also be found in the vagina. To test for it, your provider will swab the area between your vagina and anus and send it for a test sometime between the 35th and 37th weeks of your pregnancy. GBS should not be confused with the strep that causes sore throat, Group A Strep. GBS is not contagious, and in most cases it causes no harm to the adult that has it. However, in some cases, it can cause serious infection, known as Group B Strep disease.

Is It An STD?
Since it can be found in the vagina, many people assume that GBS is a STD, which is not true.It is simply a bacterium that is found in many people. It causes no discomfort and can not be transmitted sexually; therefore a carrier of GBS does not need to change their sexual practices.

How Does It Affect Newborns?
Approximately 8,000 babies born each year will contract a serious form of GBS disease. Of these 8,000, as many as 600 will die and another 20% will be left permanently handicapped. If a baby is infected with GBS, will appear either as an infection in the blood (sepsis), or as meningitis. It is also a frequent cause of pneumonia in newborns. It can also leave them with hearing or vision loss, as well as physical or learning disabilities.

How Is It Transmitted To A Newborn?
GBS is transmitted to a newborn during their descent through the birth canal. However, having a c-section is not recommended pas a way to prevent the infection in your baby, as the bacteria can also be found in your uterus and amniotic sac.

Prevention of Infection
If a pregnant woman tests positive for GBS, she can often be given a series of penicillin shots through an IV while in labor, prior to delivery. It is best to get these shots at least 4 hours prior to delivery. In most cases, if the woman has these shots, the baby will not be infected. If time does not permit for the woman to receive these shots, then immediately after birth the nurses will give your baby a shot of penicillin in the leg, to help prevent infection. In this case a mother will normally be asked to stay in the hospital for 48 hours in order for the neonatal team to watch the newborn for signs of infection.

Alternatives to Antibiotics
There have been no studies showing the success of alternative and/or home remedies in the prevention of the passage of GBS to your newborn. However, there are some that doctors and midwives may suggest you try.

Vaginal washing and immunotherapy have been suggested as a way to help clean out your vagina. Some practitioners have suggested supplements for the mother. These supplements include garlic, vitamin C, echinacea, and/or bee propolis. After a series of these supplements a woman can be retested to see if the bacterium has disappeared. This has worked in many, but not all cases of GBS in pregnant women.

By Cat Archer

First of all, most stretch marks do just fade over time, making them much less noticeable, and lots of people can live with them this way. You can also cover them up with make-up made especially for that purpose. For those who want to do better than just covering them up, other therapies are available, for example;

Laser Therapy
This type of therapy is promising option. The kind of laser a surgeon uses will be determined by the color and to a certain extent the age of the stretch marks. One type of laser will stimulate the production of cells that make pigment, another type of laser works by reducing the color of stretch marks.

The reason that stretch marks appear is because of the skin becoming stretched past it’s natural limit. Another form of laser treatment actually stimulates collagen production to restore elasticity in the stretch marks themselves. This stretching of the skin does not just happen in pregnancy, but can also occur when a person grows rapidly such as during puberty. The damage caused by this stretching is actually done in the skin’s middle layer, the dermis.

Blue Light Therapy
Another treatment for stretch marks is blue light therapy – this form of therapy can be helpful in treating acne as well as stretch marks. It works with a combination of gel and light, and together these are used to remove stretch marks.

Creams
A much well established and low tech treatment for stretch marks is to use creams that help moisturize skin, repair collagen and elastin growth. These creams will often contain combinations of cocoa butter, wheat germ oil, lanolin and vitamin E.

In reality though, these creams are at their most effective when used during the period that your skin is being stretched, as they will help keep your skin soft, supple, smooth and elastic. So ideally you need to apply creams during your pregnancy to help avoid the problem occurring in the first place – so treat them as a preventative measure. If you haven’t applied creams while the skin was being stretched, the sooner you begin afterwards, the better.

Who has to worry most about stretch marks? People who are genetically disposed to them – so see whether your mother has stretch marks and this might give you an idea of what could be in store for you. It has also been found that people who have darker skin tend to be less susceptible to stretch marks than those who have lighter skin.

Of course when you carefully monitor your weight gain during pregnancy, and apply creams that have been designed specially to help avoid stretch marks during pregnancy you should not find that stretch marks cause you such a problem once your bundle of joy has arrived.

At the end of the day there simply is not one fail-safe, 100 percent way to prevent or completely get rid of stretch marks, but a combination of some of these therapies should dramatically reduce their appearance or can eliminate them completely.

Do keep in mind that stretch marks themselves pose absolutely no threat to your health at all. They are more of a cosmetic issue, and they will fade with time.

About the Author
Cat writes many informative articles on subjects that are related to family and pregnancy. For more articles on pregnancy and Family Matters visit http://www.familyinformationsite.com.

by Gary Hendricks

Oh gosh … he’s at it again! Wailing and crying for God knows what reason. Do you have a problem with your child’s tantrums? Here’s a quick guide on how to handle them during those stressful moments.

Why Do Children Throw Tantrums?
Studies have shown that when children throw tantrums, they do not mean to be rude or manipulative on purpose. At their age, toddlers are just beginning to understand a lot more of the words they hear. However, given their limited vocal skills, they can’t communicate easily. And when your child can’t express how he feels, frustration mounts.

How Should I React?
Ok, most important rule is … don’t lose your cool. Repeat … don’t lose your cool. He or she may be making a huge scene in the public, embarrassing you in front of the in-laws, it doesn’t matter. Just grit your teeth and bear with it. My suggestion is to just sit down and be with your child while he or she rages.

I know it’s tough – particularly in public. Just try to stop thinking about what others think, any parent out there would understand the situation. Do not concede and give in. If you concede, you will be teaching your child that throwing a tantrum will allow him or her to get what they want.

If, however, your child gets to the point where they start hitting people or throwing things, just pick him up and carry him to a safe place, such as his bedroom. Explain in a firm voice why he’s there (e.g. “because you hit Grandma”).

Preventive Measures
Taking preventive measures also works. If you know your kid gets frustrated when hungry, carry snacks along with you. If you’re going from one place to the next, alert your child and let him know (e.g. “After you finish your storybook, we’re going for dinner”).

If all else fails, do consult your pediatrician who can give expert advice on your child’s tantrums and check if there are any physical or psychological problems.

About the Author
Need Some Advice on Parenting and Baby Care? Gary Hendricks has compiled the best articles on parenting, baby care and baby products at the Baby Product Guide.

by Dr. Michele BorbaDo you have a biter on your hands? Biting is among the most bothersome and embarrassing kid behaviors. I remember the horror the first time I saw one of child in our playgroup I quickly learned that biting is usually temporary, and much more common than I had thought. The other moms and I read up on biting behavior, and shared what we’d learned with one another. We learned that infants and toddlers often bite to relieve teething or gum soreness, or think it’s just a game. Preschoolers typically bite because they haven’t yet developed the coping skills to deal with stress appropriately or the verbal skills to express their needs. Whatever the reason, we knew that this behavior is clearly upsetting to all involved. And has been known to continue as kids get older if not dealt with. Our job was to nip this behavior before it becomes a habit. Here are a few Mommy Secrets and steps you can take to help you handle this annoying (but common) behavior:

Step 1. Confront the Biter A.S.A.P.
Step in the very minute your child bites and call it what it is: “That’s biting!” Then in a very stern voice say: “You may not bite people!” Firmly express your disapproval, and quickly remove your child from the situation. Remember Mom: No matter what you hear from other parents, do not bite your kid back! It is not helpful, and in fact, you’re only sending him the messages that kids can’t bite, but adults can.

If your kid has developed a history of biting, you’ll need to take emergency action. Arrange a private meeting amongst your child and other caregivers (such as his teacher, coach, daycare worker, babysitter) with whom he’s displaying the behavior. Create a consequence everyone understands: this could be the loss of a privilege, time out, or going home. You’ll want to all be on the same page and consistently enforced whatever consequence you all agreed upon. All the moms in our playground, for instance, decided to get on the same page together. Because we all responded the same way (yes, their was one mom who was a bit too laid-back, but we knew we couldn’t change her behavior), we were more successful in stopping our four-year-old Vampire Wannabees.

Step 2. Comfort the Victim and Boost Empathy
Kids always need to know that biting hurts! So in the presence of your kid focus your concern on the victim. “I’m so sorry! That must hurt. What can I do to help?” Doing so shows your child not only that his action caused pain but also how to convey sympathy. If possible, find a way to help your child to make amends. He might offer the victim a Kleenex or band-aid, draw a picture to apologize, say he’s sorry, or give the other child a toy. Do also apologize to the child’s parents on the spot or with a phone call. (Word to the wise: I learned the hard way that it is far better that I make the call then having the parent hear the story from someone else).

Step 3. Teach a New Behavior to Replace the Biting
If your toddler is teething, she’s probably biting because of sore gums. In that case, offer something appropriate to bite on: such as a frozen juice bar, a hard plastic teething ring, or toy to relieve the discomfort.

Kids often bite because they haven’t developed the verbal skills to communicate their needs or frustrations. Identify what skill your child lacks, and then teach a more appropriate way to respond that will replace the urge to bite. Practice the new skill together, until he can successfully use it on his own. One youngster bit because he didn’t know how to say he wanted a turn. Once his dad recognized the problem, he taught his son to say: “It’s your turn, then it’s my turn.” The biting quickly stopped. If your child has trouble verbalizing feelings or needs, teach him to say: “I’m getting mad.” Or: “I want to play.” Remember to let him know how proud you are when he uses good control.

Step 4. Anticipate Biting Behavior as the Best Prevention
If your child has developed a pattern of biting, then supervise those play times closely. You can then immediately step in and stop your biter before it happens. Put your hand gently over his mouth firmly saying: “You may not bite. Use your words to tell what you need.” Then show how: “I want a turn.” Sometimes you can distract your child from the situation: “Would you like to play with the clay or blocks?” You may have step in a few times before the biting is stopped, so watch closely then intervene pronto.

The most important part of this Mommy Secret to learn is that kids usually bite because they lack the ability to handle their frustrations. It’s up to us to help find better ways to get their point across.

About the Author
Michele Borba, EdD, is an internationally renowned educational consultant and recipient of the National Educator Award. She has presented workshops to more than 750,000 participants worldwide. She is the award-winning author of 20 books including Nobody Likes Me, Everybody Hates Me: The Top 25 Friendship Problems and How to Solve Them, Don’t Give Me That Attitude!, No More Misbehavin’ and Building Moral Intelligence. She is recognized for her practical, solution-based strategies to strengthen children’s behavior and social development. She has lectured to over one million participants and has been featured on NPR Radio, the Today Show, The Early Show, The View, Fox & Friends, MSNBC, and been interviewed by Redbook, Newsweek, U.S. News & World Report, and many others. She is an advisory board member for Parents magazine, is a former classroom teacher and mom of three. For more about Dr. Borba visit www.moralintelligence.com.

Sudden Infant Death Syndrome (SIDS) is the sudden death of an infant under 1 year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history (Willinger et al., 1991).

SIDS is…

• the major cause of death in infants from 1 month to 1 year of age, with most deaths occurring between 2 and 4 months
• sudden and silent–the infant was seemingly healthy
• a death often associated with sleep and with no signs of suffering
• a recognized medical disorder
• determined only after an autopsy, an examination of the death scene, and a review of the infant’s and family’s clinical histories
• a diagnosis of exclusion
• an infant death that leaves unanswered questions, causing intense grief for parents and families

SIDS is not…

• preventable, but the risk can be reduced by placing the baby on his or her back to sleep on a firm surface, by making sure the baby has a smoke-free environment, and by keeping the baby from being overheated
• suffocation
• caused by vomiting and choking or by minor illnesses such as colds or infection
• caused by the diphtheria, pertussis, tetanus (DPT) vaccines or other immunizations
• contagious
• child abuse or neglect
• the cause of every unexpected infant death

What Are the Most Common Characteristics of SIDS?
SIDS is unexpected, usually occurring in healthy-appearing infants under 1 year of age. A SIDS death occurs quickly and usually during sleep. SIDS is rare during the first month of life. Although SIDS can occur in older infants, most SIDS deaths occur by the end of the sixth month, with the greatest number occurring in infants between 2 and 4 months of age (AAP, 2000).

In the United States, more SIDS cases are reported in the fall and winter than in spring or summer. SIDS occurs more often in boys than in girls (approximately a 60- to 40-percent male-to-female ratio). African-American and American-Indian infants are two to three times more likely to die from SIDS as other infants (AAP, 2000; NICHD, 2001). Several Government agencies are intensifying efforts to reach these populations with the latest information about SIDS.

How Many Babies Die from SIDS?
Each year between 1983 and 1992, the average number of reported SIDS deaths ranged from 5,000 to 6,000. Over the past few years, especially since the mid 1990s, the number of SIDS deaths has declined significantly. The National Center for Health Statistics (NCHS) reported that in 2001 in the United States, 2,236 infants under 1 year of age died from SIDS (NCHS, 2003). Still, when considering the number of live births each year, SIDS remains the leading cause of death in the United States among infants between 1 month and 1 year of age and the third leading cause of death overall among infants less than 1 year of age (NCHS, 2003).

Although the overall SIDS rates have declined in all populations throughout the United States, disparities in SIDS rates and prevalence of risk factors remain in certain groups. SIDS rates are highest among African Americans and American Indians and are lowest among Asians and Hispanics (NICHD, 2001).

SIDS Deaths by Race and Hispanic Origin of Mother, 2001*

*Per 100,000 live births by group. Source: NCHS, 2003. Mathews, T.J., Menacker, F., MacDorman, M.F.,. Infant Mortality Statistics from the 2001 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports; Vol. 52, No. 12. Hyattsville, Maryland: National Center for Health Statistics. September 15, 2003.

How Do Professionals Diagnose a SIDS Death?
By definition, a SIDS diagnosis requires a complete autopsy, a thorough death scene investigation, and a clinical history. A death is diagnosed as SIDS only after all probable alternatives have been eliminated-in other words, SIDS is a diagnosis of “exclusion.” Often, the cause of an infant death can be determined only through a process of collecting information; conducting sometimes complex forensic tests; and by talking with parents, other caregivers, and physicians.

Medical and legal experts rely on three methods to determine a SIDS death:

• a thorough death scene investigation
• autopsy
• review of infant’s and family’s medical records and histories.

When a death is sudden and unexplained, investigators, including medical examiners and coroners, call on forensic experts, who apply their expertise in medicine and the law to help determine a cause of death. SIDS is no exception.

In most cases, the death investigation is led by the medical examiner or coroner for the county, district, or State in which the death occurred. Deaths suspected to be SIDS usually require law enforcement officers to conduct a thorough death scene investigation. The medical examiner/coroner gathers information from the death scene and case histories and presents this information to the pathologist (usually board certified or with credentials in forensic pathology). The pathologist conducts or supervises the autopsy and assesses results of the autopsy, death scene investigation, and case histories to determine whether a SIDS death has occurred. The pathologist issues a SIDS diagnosis when there is no other apparent cause for the infant’s death (Valdes-Dapena, 1995).

A Thorough Death Scene Investigation
Although it may be emotionally painful for the family, a death scene investigation will help shed light on the cause of death by providing a detailed record of the location and circumstances of the death. Therefore, the investigator will attempt to learn as much as possible about the events leading up to the death, even the very moment that the death occurred.

The Centers for Disease Control and Prevention (CDC) have developed guidelines for death scene investigation of a sudden, unexplained infant death (CDC, 1996). Local jurisdictions may use these guidelines or develop their own protocols for investigating sudden unexpected infant death.

Investigators will interview the parent or other individual who was caring for the child at the time of the death, as well as any other family members or adults who were present at the time of the death or before the death occurred. The investigator will ask open-ended, neutral questions such as, “Can you tell me what happened?” “How old was the baby?” “What did the baby weigh?” “What time was the baby put to bed?” “When did the baby fall asleep?” “Who last saw the baby alive?” “Who discovered the baby, and what did that person do?” “What position was the baby in when he/she was found?” “Were there covers over the baby’s head?” “Was CPR attempted?” “Did the baby share a bed with anyone else?” “What was the general health of the baby?” “Had the baby been ill recently?”

The individual investigating the death will take notes about the appearance of the room where the death occurred; condition and characteristics of the crib or sleeping environment; objects, if any, in the crib; medications at the death scene; and any unusual or dangerous items in the room, such as sharp objects or plastic bags. The investigator may make notes about the behavior of those present at the death scene. The investigator will also photograph the death scene and record the temperature of the room. It is likely that investigators will collect the infant’s bedding (e.g., sheets, blankets, etc.), any objects in the crib (e.g., toys or bottles), or any unusual or dangerous items found near the death scene.

Autopsy
An autopsy provides evidence of the cause of death through microscopic examination of tissue samples and examination of the body and vital organs. An autopsy is particularly important when a SIDS death is suspected because a definitive diagnosis cannot be made without a thorough postmortem examination. It is estimated that in 15 percent of cases suspected to be SIDS, the autopsy identifies another cause of death, such as a disease or genetic disorder, as well as unintentional injury or unnatural death (Valdes-Dapena, 1995). Also, if a cause (or causes) of SIDS is ever to be uncovered, it is likely that the cause will be detected from evidence gathered from a thorough pathological examination.

An autopsy may help parents and other caregivers deal with the death. According to noted authority Marie Valdes-Dapena, M.D., parents whose child has died need to know why the death occurred; they need to be reassured that their baby’s death could neither have been predicted nor prevented (Valdes-Dapena, 1995). Moreover, an autopsy leading to a diagnosis of SIDS will help remove the parents (or caregiver) from potential suspicion of wrongdoing by the legal system and by society in general.

Parents are usually anxious to consult with the pathologist after the autopsy. Discussing the autopsy results often helps most parents accept the reality of their infant’s death. The pathologist reviews the autopsy results, explaining in terms the parents can understand how these findings point to a determination of cause of death. The pathologist should also take the time to answer parents’ questions, responding with “compassion, understanding, and respect for the parents’ dignity and grief” (Valdes-Dapena, 1995).

Review of the Infant’s and Family’s Medical Histories
A comprehensive medical history is essential for a SIDS diagnosis. Along with a death scene investigation and an autopsy, a careful review of the infant’s and family’s history of disease, previous illnesses, accidents, and behaviors often helps to corroborate what is detected from the death scene investigation and the autopsy.

SIDS Deaths Require Special Understanding
Any sudden, unexpected death disturbs the sense of normalcy and security for the victim’s family. These deaths force family members and those around them to confront their own mortality (Corr et al., 1991). This is particularly true in the case of a sudden infant death. Simply put, babies are not supposed to die. Because the death of an infant is a disruption of the natural order, it is especially traumatic for parents, other family members, and friends (Arnold et al., 1997).

Like any sudden death, a SIDS death leaves a family with a sense of shock and loss and an urgent need to understand what happened. Lack of a discernible cause, the suddenness of the death, and possible involvement of law enforcement authorities make a SIDS death even more difficult. A SIDS death also leaves the family with a need for understanding from those close to the family-even the surrounding community.

A SIDS death is as tragic as a death from any readily definable disease or cause. Thus, investigators compiling or reviewing the case histories should be especially sensitive and recognize that the family may view this process as an intrusion, even a violation, of their grief. The interviewer should also be sensitive to the family’s cultural practices and traditions. The interviewer should point out to the family that although obtaining the case histories may be stressful, this information may reveal that the death could not have been prevented, which may provide some solace to a grieving family.

Are There Ways to Reduce the Risk of SIDS?
Currently there is no known way to prevent SIDS, but there are things that parents and caregivers can do to reduce the risk of a SIDS death. For example, researchers now know that the mother’s health and behavior during her pregnancy and the baby’s health before birth seem to influence the occurrence of SIDS.

Scientists also know that certain environmental and behavioral influences (called risk factors) can make an individual more susceptible to disease or ill health. Although risk factors are not necessarily the cause of a condition, by studying risk factors, scientists are able to better understand a disease or condition, which often leads to detecting a cause.

SIDS researchers and clinicians continue to try to identify risk factors that can be modified or controlled to reduce an infant’s risk for SIDS. For example, SIDS experts now know that the baby’s sleep position, exposure to smoke, and becoming overheated while asleep can increase the infant’s risk for SIDS.

Infant Sleep Position
In April 1992, the American Academy of Pediatrics (AAP) Task Force on Infant Sleep Position issued a statement recommending that infants be placed on their backs to sleep to reduce the risk of SIDS. Then, in 1994, the U.S. Public Health Service, AAP, the SIDS Alliance, and the Association of SIDS and Infant Mortality Programs cosponsored the Back to Sleep campaign, a national public service initiative to disseminate AAP’s recommendation that infants be placed on their back to sleep.

Between 1992 and 1998, among U.S. infants, stomach (prone) sleeping decreased from more than 70 percent to approximately 20 percent. During that same time frame, the number of SIDS deaths declined by more than 40 percent (Willinger et al., 1998; AAP, 2000; NICHD, 2001). Not surprisingly, most researchers, policymakers, and SIDS professionals agree that this significant decline occurred largely as a result of changing sleep position (AAP, 2000).

Rates of SIDS are over twice as high among American Indians and African Americans compared with Whites. Prone sleeping was found to be a significant risk factor for SIDS in an African- American urban sample (Hauck et al., 2002). These authors recommend educational outreach to the African-American community.

Another recent study of the relationship between infant sleep position and SIDS concluded that infants placed in an unaccustomed prone or side sleeping position are at a higher risk of SIDS (Li et al., 2003). This ethnically diverse, population-based, case-controlled study was conducted in 11 counties in California. The health message from this research is that babies should be on their backs for all sleep, including naps.

Exposure to Smoke
Researchers have concluded that if a mother smokes during or after pregnancy, she is placing her infant at a greater risk for SIDS (AAP, 2000). Some studies suggest that exposure of the newborn to tobacco smoke (whether or not the mother smokes) may be associated with increased risk for SIDS. In a 1997 policy statement, AAP cautioned, “Exposure of children to environmental tobacco smoke is associated with increased rates of lower respiratory illness and increased rates of middle ear effusion, asthma, and SIDS” (AAP 1997).

Overheating
According to AAP (2000), some evidence points to an association of the amount of clothing or blankets on an infant, room temperature, and the time of the year with an increased risk for SIDS. The increased risk associated with overheating is particularly clear when infants are placed on their stomachs (prone).

AAP cautions that the possible relationship between clothing and climate as stand-alone factors (or as a cluster of environmental risk factors) is less clear. Moreover, although the number of recorded SIDS deaths has been higher in the winter months, that increase may be due to the greater frequency of colds, flu, and other infections during the winter.

Infant Bedding
Researchers and consumer safety advocates continue to look for a possible link between SIDS and soft bedding (Scheers, Dayton, and Kemp, 1998). During 2000, seven major retailers joined with the U.S. Consumer Product Safety Commission (CPSC) to kick off a nationwide campaign promoting safe bedding practices for infants. Many retailers are developing public service campaigns to spread this message to parents and other infant caregivers.

The hope is that by circulating this information, infant deaths will be reduced and that those responsible for infant care will receive one consistent message about ensuring a safe sleeping environment for babies.

In recent safety alerts, CPSC has warned parents to guard against unfounded claims from manufacturers of some infant bedding materials that the use of certain products can reduce SIDS. Parents and other caregivers need to be aware that there is no product currently available that can guarantee prevention of a SIDS death.

Other Risk Factors
Although sleep position, smoke exposure, overheating, and infant bedding have been identified as risk factors for SIDS, researchers have identified a number of other factors that may put an infant at increased risk for SIDS.

Infant Care Practices and SIDS Risk Reduction
Several studies have examined various environmental influences or child-rearing practices that may help protect an infant from SIDS (Valdes-Dapena, 1995; Hoffman et al., 1996; NICHD, 2000). It is important to point out, however, that these factors, in and of themselves, are not reliable in predicting how, when, why, or if SIDS will occur.

For example, although researchers conclude that breastfeeding is beneficial, there is no clear-cut link between breastfeeding and reduced risk of SIDS. Other studies have found a lower rate of SIDS among infants who used pacifiers compared with infants who did not use pacifiers. Although results of these studies tend to be consistent, there is still no evidence that pacifier use prevents SIDS (AAP, 2000).

Maternal Risk Factors
Still other risk factors, called maternal risk factors, are associated with how the mother’s behavior and health affect the infant before and after birth.

Maternal risk factors include:

• age less than 20 at first pregnancy
• a short interval between pregnancies
• late or no prenatal care
• smoking during and/or after pregnancy
• placental abnormalities
• low weight gain during pregnancy
• anemia
• alcohol and substance abuse
• history of sexually transmitted disease or urinary tract infection (NICHD, 2001).

How to Lower Your Baby’s Risk of SIDS:

• Back Sleeping and Safe Bedding*
• make sure that everyone who cares for your baby puts the baby on his or her back to sleep
• use a firm, tight-fitting mattress in a crib that meets current safety standards
• remove pillows, quilts, comforters, sheepskins, stuffed toys, and other soft products from the crib
• dress your baby in sleep clothing so that you will not have to use any other covering over the baby
• place your baby so that his or her feet are at the bottom of the crib
• tuck a thin blanket around the bottom of the crib mattress, reaching only as far as the baby’s chest
• make sure the baby’s head remains uncovered during sleep
• keep your baby warm, but not too warm
• make sure that everyone who cares for your baby understands the dangers of soft bedding
• avoid adult beds, waterbeds, sofas, or other soft surfaces for sleep

*from AAP, CPSC, and NICHD AAP: www.aap.org CPSC: www.cpsc.gov NICHD: www.nichd.nih.gov

Current Research Findings and Theories
Most scientists now believe that babies who die of SIDS are born with one or more conditions that make them especially vulnerable to the internal and external stresses that occur in the life of any infant. Currently, many researchers argue that the clue to finding the cause(s) of SIDS lies in a further understanding of the development and functions of the brain and nervous system of SIDS infants.

These scientists theorize that some babies at risk for SIDS have defects in those parts of the nervous system that control breathing and heart rate. Maturation of the brainstem may be delayed in SIDS infants. Myelin, a fatty substance that facilitates nerve signal transmission, appears to develop more slowly in SIDS infants than in other babies.

“The detection of subtle abnormalities in SIDS brains indicates that not all SIDS infants are ‘normal’ despite their lack of clinical abnormalities. The occurrence of brain abnormalities supports the concept that a vulnerable, and not a normal, infant is at risk for SIDS. The idea of a vulnerable infant forms a key part of a triple-risk model for the pathogenesis of SIDS” (Filiano and Kinney, 1994).

The Triple-Risk Model
Pathology studies of SIDS infants support the view that these infants possess underlying vulnerabilities that put them at risk for sudden death, a concept advanced by the triple-risk model in describing the sequence of events leading to the death of an infant. A number of scientists are currently applying this model in their search for a cause(s) of SIDS.

Vulnerable Infant
The first key element of the triple-risk model depicts an infant with an underlying defect or abnormality, which makes the baby vulnerable. In this model, certain pathophysiological factors (e.g., defects in the parts of the brain that control respiration or heart rate, and that occur during early life) explain vulnerability to sudden infant death.

Adapted from Filiano and Kinney 1994.

Critical Developmental Period
The second element in the triple-risk model refers to the infant’s first 6 months of life. During this critical developmental period, rapid growth phases occur and changes in homeostatic controls take place. These changes may be evident (e.g., sleeping and waking patterns), or they may be more subtle (e.g., variations in breathing, heart rate, blood pressure, and body temperature). It may be that some of these changes may temporarily or periodically destabilize the infant’s internal systems.

Outside Stressor(s)
The third element of this model involves outside stressors. These may include environmental factors (e.g., exposure to tobacco smoke, overheating, or prone sleep position) or an upper respiratory infection that most babies can experience and survive, but that an already-vulnerable infant may not be able to overcome. In and of themselves, these stressors do not cause infant deaths, but in a vulnerable infant, “may tip the balance against an infant’s chances of survival” (Filiano and Kinney, 1994).

According to this model, all three elements must interact for a sudden infant death to occur-the baby’s vulnerability is undetected until the infant enters the critical developmental period and is exposed to an outside stressor or stressors.

Brain Abnormalities in SIDS Infants
A team of researchers funded by the National Institute of Child Health and Human Development (NICHD) has discovered that infants who die of SIDS may have abnormalities in several parts of the brainstem. This finding builds on the results of an earlier study that identified abnormalities in the region of the brain known as the arcuate nucleus in babies who died of SIDS.

“These findings show that SIDS infants have a more global biological deficit than we previously believed -one that may originate in fetal life,” explained Marian Willinger, Ph.D., of NICHD’s Pregnancy and Perinatology Branch, in a May 2000 press release. In the NICHD study, SIDS infants were found to have decreased binding of serotonin in the nucleus raphe obscurus, a brain structure linked to the arcuate nucleus, as well as four other brain regions. These areas of the brain are thought to play a crucial role in regulating breathing, heart beat, body temperature, and arousal (Panigrahy et al., 2000).

Back to Sleep Campaign
Since its inception in 1994, the Back to Sleep campaign has focused on heightening awareness among parents, health care providers, and other caregivers about the benefits of putting a baby to sleep on his or her back. Over the course of the campaign, almost 80 million brochures, posters, public service announcements, and informational videos have been distributed. The Back to Sleep campaign continues as a nationwide public health effort, with NICHD having major responsibility for disseminating information and educational materials on this crucial health topic.

Back in 1994 when the Back to Sleep campaign was first initiated, there were almost twice as many SIDS deaths among African-American infants than among White infants. Despite the almost 50 percent drop in the number of SIDS deaths in both groups, a significant disparity still exists (NICHD, 2002). To continue efforts to reach minority and hard-to-reach populations about the importance of placing an infant on its back to sleep, NICHD has partnered with community groups to provide outreach to minority and underserved communities.

SIDS Deaths in Child Care Settings
Twenty percent of SIDS deaths occur in a day care setting (Moon, Patel, and Shaefer, 2000). Although media and mailings have been largely effective in communicating BTS information to many child care centers, nonprone positioning and other risk reduction measures are not universally practiced among child care providers (Moon and Biliter, 2000). To promote these messages in child care settings, the Health Resources and Services Administration’s Maternal and Child Health Bureau is sponsoring the Healthy Child Care America Back to Sleep campaign. The campaign, which was officially launched in January 2003, is a nationwide effort to unite child care, health, and SIDS prevention partners to reduce the risk of deaths in child care settings (AAP, 2003).

Over the past 9 years, the Back to Sleep campaign has been extremely effective in helping reduce the number of SIDS deaths. AAP cautions, however, that while continuing to emphasize the “importance of infant positioning for sleep as an effective modifiable risk factor for SIDS,” it is also important to “focus increased attention on other modifiable environmental factors, to describe complications that may have arisen from modifying risk factors, and to make recommendations about other strategies that may be effective for further reducing the risk of SIDS” (AAP, 2000).

Partners in the Back to Sleep Campaign Outreach to Underserved Populations
Alpha Kappa Alpha Sorority
Chi Eta Phi Sorority
Chicago Department of Public Health
Congress of National Black Churches
District of Columbia Department of Public Health
National Association for the Advancement of Colored People
National Black Child Health Development Institute
National Coalition of 100 Black Women
National Medical Association
National Association of Black Owned Broadcasters
Pampers Parenting Institute
Zeta Phi Beta Sorority
Acknowledgments
Review panel members

Michael Corwin, M.D.
Co-Director
Massachusetts Center for Sudden Infant Death Syndrome

Anne Harvieux, C.I.C.S.W.
Program Administrator
Infant Death Center of Wisconsin

Jeffrey Jentzen, M.D.
Medical Examiner, Milwaukee County, Milwaukee, WI

John Leggatt, M.D.
Deputy Chief Medical Examiner, Milwaukee City, Milwaukee, WI

Mary McClain, R.N., M.S.
Massachusetts Center for Sudden Infant Death Syndrome

Marian Willinger, Ph.D.
Special Assistant for SIDS
National Institute of Child Health and Human Development

For Additional Information on SIDS and Infant Death, and for a List of State SIDS Coordinators, Please Contact:

National SIDS/Infant Death Resource Center (NSIDRC)
8280 Greensboro Drive
Suite 300
McLean, VA 22102
Phone: (866) 866-7437, (703) 821-8955
Fax: (703) 821-2098
E-mail: sids@circlesolutions.com
www.sidscenter.org

Other SIDS Resources
American Academy of Pediatrics (AAP)
The best way to contact the AAP is to access the Academy’s Web site: www.aap.org. To locate news releases and policy statements, search the site using “SIDS” as keyword.

Association of SIDS and Infant Mortality Programs (ASIP)
c/o Marie Chandick, ASIP President
New York State Center for Sudden Infant Death
School of Social Welfare/Stony Brook University
Stony Brook, NY 11794-8232
Phone: (631) 444-3690
Fax: (631) 444-6475
E-mail: marie.chandick@stonybrook.edu
www.asip1.org

C.J. Foundation for SIDS
Barry Bornstein, Executive Director
The Don Imus-WFAN Pediatric Center
Hackensack University Medical Center
30 Prospect Avenue
Hackensack, NJ 07601
Phone: (201) 996-5111, 1-888-8CJ-SIDS
Fax: (201) 996-5326
E-mail: barrycjf@aol.com
www.cjsids.com

First Candle/SIDS Alliance
1314 Bedford Avenue
Suite 210
Baltimore, MD 21208
Phone: (800) 221-7437, (410) 653-8226
Fax: (410) 653-8709
E-mail: info@sidsalliance.org
www.sidsalliance.org

National Center for Cultural Competence (NCCC)
SIDS/ID Component
Georgetown University Center for Child and Human Development
3307 M Street NW
Suite 401
Washington, DC 20007-3935
Phone: (800) 788-2066, (202) 687-5387
Fax: (202) 687-8899
E-mail: cultural@georgetown.edu
www.georgetown.edu/research/gucdc/nccc

National SIDS and Infant Death Program Support Center
Kathleen Graham, Director
1314 Bedford Avenue
Suite 210
Baltimore, MD 21208
Phone: (410) 415-6628, (800) 638-7437
Fax: (410) 415-5093
E-mail: kgrahamsids@yahoo.com
www.sids-id-psc.org

National SIDS and Infant Death Project IMPACT
8280 Greensboro Drive
Suite 300
McLean, VA 22102
Phone: (703) 902-1260, (800) 930-7437
Fax: (703) 902-1320
E-mail: lcooper@sidsprojectimpact.com
www.sidsprojectimpact.com

U.S. Consumer Product Safety Commission
4330 East-West Highway
Bethesda, MD 20814-4408
Phone: (800) 638-2772
(Consumer Hotline: Call toll-free to obtain product safety information and to report unsafe products.)
Fax: (301) 504-0124
E-mail: info@cpsc.gov
www.cpsc.gov

Contact Information for the Back to Sleep Campaign
The National Institute of Child Health and Human Development
Back to Sleep Campaign
31 Center Drive, Room 2A32
Bethesda, MD 20892-2425
Public Information: (301) 496-5133
Fax: (301) 496-7101
www.nichd.nih.gov
To order campaign materials, call toll-free: 1-800-505-CRIB

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American Academy of Pediatrics, Healthy Child Care Back to Sleep Campaign, 2003. www.healthychildcare.org.

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National Institute of Child Health and Human Development, National Institutes of Health. NICHD-funded Researchers Uncover Abnormal Brain Pathways in SIDS Victims. News Release. Rockville (MD): May 14, 2000.

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