By Elizabeth Pantley, Author of The No-Cry Sleep Solution for Toddlers & Preschoolers (McGraw-Hill)

We parents today have demanding schedules, and we juggle multiple tasks all day long. There’s too much to do, and never enough time to do it. The bedtime routine often gets slotted as one more “thing to do” after which we can get on to yet another task on our never-ending to-do list.

I’d like to present you with a new way of looking at your child’s bedtime routine: as a wonderful opportunity for a nightly ritual of quiet connection and bonding. Sort of like a forced savings account – a daily slice of time out of a busy day, given to you so that you can bask in the joys of parenthood and build the foundation for a close lifetime relationship. Pretty heady stuff, when you look at it this way, isn’t it?

Simply said, you must get your child ready for bed each and every night. The time will be spent, one way or another. Would you like it to be peaceful, nurturing and bonding – or rushed and stressful? You have the power to set the tone of your evenings, so why not choose a pleasant routine? You will enjoy it more, and your child will no longer resist bedtime –won’t that be marvelous!

Begin your routine earlier
If you are starting your child’s bedtime routine fifteen or twenty minutes before you’d like him to be asleep, it will inevitably create problems. This provides barely enough time for the essentials, little time for pleasure, and no time at all for the inevitable dawdles and delays. As a parent, you’re watching the clock move forward, stressing over the time, and trying to rush things along. Your child, who senses your tension and feels pressured, reacts by dawdling, or fashioning new requests that simply must be met, but of course, there’s no time, so a meltdown occurs. Following this pattern, night after night, makes both parent and child dread bedtime, further increasing the stress, and making things even worse. So goes the cycle, from bad to worse, night after night.

The answer is to avoiding all this turmoil is to allow plenty of time for the pre-bed routine. For most families this means allocating at least an hour from the time the process begins to lights out. While an hour or more may seem like a lot to spend on a bedtime routine, most families with struggles end up spending more time than this dealing with a fussy child who won’t cooperate. And said fussy child gets so worked up that once in bed he’s wide awake and takes a long time before nodding off.

Decide in advance on the best bedtime for your child, and then identify a specific time that you will begin the getting ready for bed routine. You may have to work backwards from this time to be sure that dinner and post-dinner activities are completed by the time you wish to start your pre-bed plan.

Once you understand the power of a long-enough routine to ward off the problems, and if you look at this time as an opportunity to spend some peaceful time connecting with your sweet child, then this hour can be something wonderful to look forward to each night.

Excerpted with permission by McGraw-Hill Publishing from The No-Cry Sleep Solution for Toddlers & Preschoolers (McGraw-Hill) 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 Elizabeth Pantley, Author of No Cry Sleep Solution

A good way to encourage good sleep is to get familiar with your baby’s sleepy signals, and put her down to sleep as soon as she seems tired. A baby cannot put herself to sleep, nor can she understand her own sleepy signs.

A baby who is encouraged to stay awake when her body is craving sleep is typically an unhappy, fussy baby. Over time, the pattern develops into sleep deprivation, which further complicates and interferes with your baby’s developing sleep maturity.

Pia, mother of eight-month-old Carrson talks about this problem, “I discovered that I had been putting Carrson to bed purely by the clock, not at all by his tiredness. Once I changed this dynamic and began identifying his sleepy signals he fell asleep easier and slept longer.”

Watch the clock, too!
Most newborns can only handle one or two hours of wakefulness at a time. A three-month-old gets tired after two to three hours of awake time. A one-year-old can be cheerful for about three to four hours, and a two-year-old about five to six hours. Once your child has passed his happy wakefulness stage he’ll quickly become overtired. He’ll then be easily overstimulated and find it harder to fall asleep and stay asleep.

Find that magic moment
Using the clock as a guide, and your child’s sleepy signals as indicators, you can find the magic moment when your baby is tired, but not overtired. When you witness those signs it’s a quick but calm trip right to bed – don’t launch into a prolonged pre-bed routine since your child may then get a second wind!

Typical sleepy signals
Every child is unique and has his own sleepy signs, and you can watch and learn these. Your child may demonstrate one or more of these signs that tell you he is tired and ready to sleep – now:

• reducing his level of movement and activity
• becoming more quiet
• losing interest in people , toys and playtime
• rubbing his eyes
• looking glazed or unfocused
• having a more relaxed jaw, chin and mouth (droopy looking)
• becoming whiny and cranky
• fussing or crying
• losing patience or having tantrums
• yawning
• lying down or slumping in his seat
• watching television or a movie with a blank expression
• caressing a lovey or blanket
• asking for a pacifier, bottle or to nurse

Your child may demonstrate one or two of these sleepy signs, or even something entirely different. The signs may change at each stage of development. The key is to watch your child and encourage him to go to sleep when he is tired.

Excerpted with permission by McGraw-Hill Publishing from No Cry Sleep Solution (McGraw-Hill) 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 Elizabeth Pantley author of The No-Cry Discipline Solution (McGraw-Hill 2007)

Does your child move at an excruciatingly slow pace? Do you find it frustrating when you need to get somewhere and you’re rushing about – yet you have to keep prodding him along? Children live according to a much slower clock than we adults do. They don’t give a moment’s thought to what they might be doing next. They prefer to enjoy each moment for what it is. They pause as they watch the cat sleep, examine the color patterns in the carpet, and ponder the reasons for having toes. If you think about it, it’s a shame that we can’t all live on “kid-time.” But since we can’t, here are a few tips to keep things moving along.

Give specific step-by-step directions.
Make incremental requests that your child can easily follow. Give your child one or two tasks at a time, and when complete, assign the next. “Please put your puzzle in the box and go to the bathroom.”

Make a list.
Write down the sequence of tasks to be completed and give the list to your child with a pencil to cross things off as they’re done.

Give an incentive to finish.
Encourage your child to finish the task with a “When/Then” statement, such as, “When you get in the car, then you can have your crackers.”

Analyze your own daily schedule.
Determine if you are trying to do too much. If you are, see if you can make some changes. Start focusing on the priorities in your life, eliminate some of the unnecessary time-wasters, and slow yourself down a little bit.

Check your child’s nap and sleep schedules.
Children who aren’t getting a proper amount of sleep will lack energy and tend to move slowly and dawdle.

Don’t rush your child with the words, “Come on!” or “Hurry up!”
These requests tend to frustrate children and then they rush to the point of taking extra time to make up for the mistakes that happen when they move too fast.

Don’t reinforce the pattern.
Children often dawdle out of habit. A parent will announce, “Time to go” and then be distracted by a phone call or a household task (so then it really isn’t time to go.) Children come to expect that you’ll repeat yourself numerous times before they have to respond. Practice this: think before you speak, make a very specific request, and then follow through.

Don’t expect speed.
Allow a reasonable amount of time for your child to meet your request. Watch your child to learn his pace. Just because you are in a hurry doesn’t mean your child will move any faster than his usual speed.

Avoid miscommunication.
Make clear, specific statements that don’t leave room for misunderstanding. As an example, instead of the vague statement, “Get ready to go,” clarify by saying, “Right now, would you please put on your shoes and your coat, and get in the car.”

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 Patti Teel

If you’re a parent, it’s important to realize that in order for your child to be physically and emotionally healthy as well as a successful student, it’s vital for him to get a sufficient amount of quality sleep.

As research continues to emerge, we are realizing that a good night’s sleep is as important as proper nutrition — affecting mood, immunity, and the ability to learn. Unfortunately, children’s sleep problems are extremely common. In 2004, the National Sleep Foundation reported that a whopping 69 percent of children under the age of ten have sleep difficulties. Factors that contribute to this modern day malady include lax rules, difficulty transitioning from the family bed, stress, overstimulation and the media.

While the number of children with sleep problems is staggering, by improving sleep hygiene and teaching children to relax, the majority of them are relatively easy to solve. But most parenting books on the subject focus on babies and give scant attention to the most useful long term solution for children — which is to teach them to purposely relax their bodies and minds so that they can relax and fall asleep.

The majority of sleep experts advise parents to abruptly withdraw their attention at bedtime–with no mention of teaching a child self-soothing skills. But many parents are looking for help after having shared their bed or assisted their child to fall asleep for months or even years. When children are abruptly expected to fall asleep without any assistance it sets the scene for the all too familiar nightly bedtime battle.

If parents consistently ignore their children’s anguished pleas for attention, after weeks of tears and tantrums, children will eventually begin to fall asleep on their own. But in the same amount of time, parents could have avoided the battles–by teaching their kids to relax themselves to sleep while gradually and systematically decreasing their attention.

Children’s two most frequent sleep problems involve not being able to fall asleep and awakening during the night unable to fall back asleep. Brief night awakening is normal; however, once kids learn to fall asleep independently at bedtime, they will be able to fall back asleep when they briefly awaken during the night.

For children, learning to relax and fall asleep on their own is an important step towards independence. However, the benefits of conscious relaxation far outweigh even this worthwhile achievement. By learning to purposefully relax and calm themselves, children will become more resilient and better equipped to deal with life’s inevitable ups and downs.

Ways to solve your child’s sleep problems:

Pinpoint the problem by keeping a sleep journal.
For at least a week, record your child’s sleep habits. This will help you to recognize the behaviors or habits that are contributing to a child’s sleep difficulties or alert you to a more serious problem. If you determine that you need a physician’s assistance, your observations will be invaluable in helping your doctor make an accurate assessment.

Have a set bedtime.
Children should consistently go to bed at the same time every night. Even on the weekends, bedtime should not vary by more than one hour a night or a total of two hours for the entire weekend.

Have a consistent bedtime routine.
Create a consistent bedtime ritual — in a predictable calming environment that serves as a bridge between the excitement of daytime and the restful quiet of nighttime.

Practice relaxation techniques.
During the bedtime routine, take a few minutes to practice self-soothing relaxation techniques such as progressive relaxation, attending to the breath, and visualization.

If your child has trouble falling asleep, use the Fade Technique.
Gradually, give your child less and less direction as he uses self-soothing techniques to relax and fall asleep. At first, you may want to sit on the edge of your child’s bed while he or she follows the relaxation directions on The Floppy Sleep Game Book CD. Or, you can teach your child to relax through a relaxation routine that you create yourself. Over a period of time, as your child becomes more familiar with the relaxation routine, sit further and further away until he or she no longer needs you in the room to relax and fall asleep.

About The Author
Dubbed “The Dream Maker” by People magazine, Patti Teel is a former teacher and the author of The Floppy Sleep Game Book, which gives parents techniques to help their children relax or fall asleep. She is holding Dream Academy workshops at schools, hospitals, and libraries across the country where parents and children learn the playful relaxation techniques from her book and widely acclaimed children’s audio series. Children at the Dream Academy workshops practice the three R’s by resting their bodies, relaxing their minds, and refreshing their spirits. Visit her online at www.pattiteel.com.

by Patti Teel

Food has a huge impact on a child’s well-being. It can energize, increase hyperactivity or induce fatigue. Just as a lack of sleep can jumble a child’s thinking or cause learning problems, so can an inadequate diet. Each child is a unique individual, and it’s unreasonable to think that “one size fits all” diet advice is realistic.

Children seem to be born not only with an emotional temperament but with a food temperament. For instance, my son has always had a particular suspicion and aversion to any food that is green; however, he doesn’t care much for sweets. In direct contrast, my youngest daughter has always loved vegetables and from the time she was a toddler, her favorite food was broccoli. Unfortunately, she also inherited my sweet tooth.

Diet is critical for children’s health and everything that we eat affects us. However, it affects each of us a little differently, depending on our individual makeup and metabolism. For instance, some children are highly sensitive to sugar and any form of sweets in their diet. For them, sugar consumption can aggravate many problems such as hyperactivity, anxiety, nervousness, irritability, and poor concentration—all of which can lead to sleep difficulties.

We all know that children are healthier and sleep better if they eat a healthy diet containing a variety of foods from all the food groups. Unfortunately, some children can be incredibly picky. I don’t think it’s a good idea to cater to a child’s every whim or to battle over food. Fill your house with healthy foods and snacks and don’t get in the habit of buying junk food. That way, when your children are hungry, they will have no choice but to eat healthy and nutritious foods.

In addition, children are much more likely to be interested in eating meals that they have helped plan and prepare. Buy a healthy children’s cookbook and have fun planning and preparing nutritious meals and snacks together.

Healthy Tips:

By Patti Teel

More children than ever before are being diagnosed with special needs “neurobiological disorders” such as ADHD, clinical depression, sensory integration dysfunction, autism and Asperger’s syndrome. Children with these disorders are very likely to have sleep difficulties. In addition, the problems that characterize the disorders will be greatly exacerbated by a lack of sleep.

I cannot stress enough the importance of good sleep hygiene and relaxation skills. Children with neurobiological disorders are often stressed—as they struggle to control their behavior, “fit in,” and try to keep up with their schoolwork. They may also suffer from sleep-related side effects of medications that they are taking. Medications to treat mood disorders, stimulant medications used to treat attention deficit/hyperactivity disorder and some of the medications used to treat tics in Tourette’s syndrome can all contribute to sleep problems.

If sleep problems continue to plague your child, work with your physician. Consider alternative therapies such as nutritional and dietary supplements, biofeedback and Chinese medicine. This is likely to be an adjunct to the care provided by your child’s primary-care physician. To ensure maximum benefits and avoid any negative interactions between traditional medication and alternative remedies, be sure that all of your child’s health-care providers work together. When you find the right healing modality for your child, you are likely to see a big improvement.

All children do best with healthy sleep habits. However, everything needs to be “buttoned down” if your child has special needs. For instance, while many children would have some difficulty settling down after a stimulating evening, it might cause a child with a neurobiological disorder to be up half the night. And while a consistent bedtime is always recommended, a child with autism is likely to feel very unsafe and unsettled if his bedtime routine is disrupted. For many children, it’s as if their reactions have been cranked up to full throttle. Of course, each child is different and you will know best what sets off a problem in your own child. However, in general, the same rules apply—only more so.

Tips for a Good Night’s Sleep

by Armin Brott

As hard as it may be to imagine, there exists a rather basic parenting issue that regularly generates even more controversy than circumcision or the disposable-versus-cloth diapers-debate: whether or not to have your child sleep in the same bed as you and your partner.

Fortunately (or unfortunately, depending on where you stand on the issue), there’s absolutely no consensus on which views is the “right” one. And just to make sure that there’s no real way to decide this issue once and for all, there’s very little serious scientific data supporting either position.

Our older daughter slept in a bassinet in our room for a month or so until we moved her into her own room, and the middle one slept in bed with us for six months before being asked to leave. Personally, I kind of liked being able to snuggle up with a warm, smooth baby, but after being kicked in the head, stomach, back, face, and chest every night for six months I was glad to go back to an adults-only sleeping arrangement. My youngest also started off in our bed but moved to her own room after only 6 weeks or so.

Here are some of the most common issues that come up in discussions of the family bed:

• Independence. Proponents of co-sleeping or the family bed point to the fact those in most countries (comprising about 80 percent of the world’s population), parents and children sleep in the same bed. They claim that kids are being forced to be independent too early and that human evolution simply can’t keep pace with the new demands our culture is placing on its children. They maintain that before a child can become independent she must feel that the world is a safe place and that her needs will be met. Kids who sleep in a family bed turn out to be more independent, more confident, and more self-assured than those who don’t. Critics, however, say that what works in other countries doesn’t always work here. In America, early independence is critical, and babies should therefore quickly learn to be away from their parents, especially if both work and the children have to be in day care.
• Sleep: the baby’s. Despite what you might think, co-sleeping children tend to sleep more lightly than children who sleep alone (blankets rustling and parents turning over in bed wake them up). But light sleeping isn’t necessarily a bad thing. In fact, there seems to be a correlation between lighter sleep and a lower incidence of SIDS.
• Sleep: yours. It’s perfectly normal for even the soundest-sleeping kids to wake up every three or four hours for a quick look around the room. The vast majority (about 70 percent) soothe themselves back to sleep after a minute or two. But about 30 percent will spot something they just have to play with (you or your partner, for example), and they’re up for hours.
• Safety. Many parents are afraid that they’ll accidentally roll over their sleeping child if the whole family is sharing the same bed. While this is a perfectly legitimate concern, most adults—even while asleep—have a highly developed sense of where they are. It’s probably been quite a while since you fell out of bed in the middle of the night.
• Sexual spontaneity. No kidding. But there are plenty of other places to make love besides your bed.
• Breastfeeding. There’s no question that it’s a lot easier for a nursing mother to reach across her bed for the baby than to get up and stagger down the hall. Some research indicates that this may encourage mothers to breastfeed longer. Problems arise, however, when fathers feel (and they often do) displaced by the nursing baby and decide that the only place to get a good night’s sleep is on the couch.

Things to Consider About Sharing Your Bed with Your Child

• Keep politics out of your decision-making. Sleep with your child because you and your partner want to, not because you feel you have to.
• Don’t be embarrassed. You’re not being soft, negligent, or overindulgent— it’s a choice made by millions of fine parents.
• Make sure your bed is large enough to accommodate everyone. (But no waterbeds—baby could roll between you and the mattress.) Put the bed against the wall and have the baby sleep on the wall side, or get a guard rail if she’s going to sleep on the outside edge. And remember, overly soft mattresses¸ comforters, and pillows may pose a risk of suffocation.
• Make sure everyone’s toenails are trimmed.
• Rethink your decision right now if you’re obese, you drink or take any medication that might make you hard to wake up, or if you’re generally such a sound sleeper that you’re worried you might roll on top of your baby without noticing.
• Think before you start. Once your baby has been sleeping in your bed for six to eight months, it’s going to be awfully hard to get her out if you change your mind.

Things to Consider About Not Sharing Your Bed with Your Child

• Don’t feel guilty. You’re not a bad or selfish parent for not doing it.
• There is absolutely no evidence that sleeping with your child will speed up the bonding/attachment process.
• It’s okay to make an occasional exception, such as when a child is ill or has had a frightening experience. If you’re making your decision because of safety issues, you may be able to compromise by setting up the baby’s crib in your bedroom or by getting a “sidecar”—basically a three-sided crib that attaches to the side of your bed.

About the Author:
Armin Brott, hailed by Time as “the superdad’s superdad,” has written or co-written six critically acclaimed books on fatherhood, including the newly released second edition of Fathering Your Toddler: A Dad’s Guide to the Second and Third Years. His articles have appeared in The New York Times Magazine, Newsweek, American Baby, Parenting, Child, Men’s Health, The Washington Post among others. Armin is an experienced radio and TV guest, and has appeared on Today, CBS Overnight, Fox News, and Politically Incorrect. He’s the host of “Positive Parenting,” a weekly radio program in the San Francisco Bay Area. Visit Armin at www.mrdad.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

References
American Academy of Pediatrics, Task Force on Infant Sleep Position and Sudden Infant Death Syndrome. “Changing Concepts of Sudden Infant Death Syndrome: Implications for Infant Sleeping Environment and Sleep Position.” Pediatrics 2000 March; 105 (No.3):650-6.

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

Arnold, J., McClain, M.E., and Shaefer, S.J.M. “Reaching Out to the Family of a SIDS Baby.” In: Woods, J.R., and Woods, J.L.E. (Eds.). Loss During Pregnancy or in the Newborn Period: Principles of Care with Clinical Cases and Analysis. Pitman (NJ): Jannetti Publications, Inc., 1997.

Centers for Disease Control and Prevention. “Guidelines for Death Scene Investigation of Sudden, Unexplained Infant Deaths: Recommendations of the Interagency Panel on Sudden Infant Death Syndrome.” Morbidity and Mortality Weekly Report 1996; 45 (No. RR-10).

Corr, C.A., Fuller, H., Barnickol, C.A., and Corr, D.M. (Eds.). Sudden Infant Death Syndrome: Who Can Help and How. New York: Springer Publishing Co., 1991.

Filiano, J.J., and Kinney, H.C. “A Perspective on Neuropathologic Findings in Infants of the Sudden Infant Death Syndrome: The Triple Risk Model.” Biology of the Neonate 1994; 65(3-4):194-7.

Hauck, F.R., Moore, C.M., Herman, S.M., Donovan, M., Kalelkar, M., Christoffel, K.K., Hoffman, H.J., and Rowley, D. “The Contribution of Prone Sleeping Position to the Racial Disparity in Sudden Infant Death Syndrome: The Chicago Infant Mortality Study.” Pediatrics 2002 Oct; 110(4):772-80.

Hauck, F.R., Herman, S.M., Donovan, M., Iyasu, S., Moore, C.M., Donoghue, E., Kirschner, R.H., and Willinger, M. “Sleep Environment and the Risk of Sudden Infant Death Syndrome in an Urban Population: The Chicago Infant Mortality Study.” Pediatrics 2003; 111(5), 1207-1214.

Hoffman, H.J., Damus, K., Hillman, L., and Krongrad, E. “Risk Factors for SIDS. Results of the National Institute of Child Health and Human Development SIDS Cooperative Epidemiological Study.” In: Schwartz, P.J., Southall, D.P., and Valdes-Dapena, M. (Eds). The Sudden Infant Death Syndrome: Cardiac and Respiratory Mechanisms and Interventions. New York: New York Academy of Sciences, 1988.

Hoffman, H.J., Willinger, M., Gloeckner, C., Wu, K-T., and Hillman, L.S. “Risk Factors by Race/Ethnicity in the National Institute of Child Health and Human Development (NICHD) SIDS Cooperative Epidemiological Study.” Paper presented at the Fourth SIDS International Conference, June 23-26, 1996.

Li, D.K., Petitti, D.B., Willinger, M., McMahon, R., Odouli, R., Vu, H., and Hoffman, H.J. “Infant Sleeping Position and the Risk of Sudden Infant Death Syndrome in California, 1997-2000.” American Journal of Epidemiology 2003 March 1; 157(5):446-55.

Mathews, T.J., Menacker, F., and MacDorman, M.F. “Infant Mortality Statistics from the 2001 Period Linked Birth/Infant Death Data Set.” National Vital Statistics Reports September 15, 2003; 52(2).

Moon, R.Y., and Biliter, W.M. “Infant Sleep Position Policies in Licensed Child Care Centers after Back to Sleep Campaign.” Pediatrics 2000; 106:576-580.

Moon, R.Y., Patel, K.M., and Shaefer, S.J.M. “Sudden Infant Death Syndrome (SIDS) in Child Care Settings.” Pediatrics 2000; 106 (2) 295-300.

National Institute of Child Health and Human Development, National Institutes of Health. From Cells to Selves. Targeting Sudden Infant Death Syndrome (SIDS): A Strategic Plan. Bethesda (MD): National Institute of Child Health and Human Development, 2001.

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.

National Institute of Child Health and Human Development, National Institutes of Health, Public Information and Communications Branch. Sudden Infant Death Syndrome. Bethesda (MD): National Institute of Child Health and Human Development, 1997.

Panigrahy, A., Filiano, J., Sleeper, L.A., Mandell, F., Valdes-Dapena, M., et al. “Decreased Serotonergic Receptor Binding in Rhombic Lip-Derived Regions of the Medulla Oblongata in the Sudden Infant Death Syndrome.” Journal of Neuropathology and Experimental Neurology 2000 May; 59(5): 377-84.

Scheers, N.J., Dayton, C.M. Kemp, J.S. “Sudden Infant Death with External Airways Covered.” Archives of Pediatric Adolescent Medicine 1998; 152:540-547.

U.S. Consumer Product Safety Commission, Office of Information and Public Affairs. Recommendations Revised to Prevent Infant Deaths from Soft Bedding. News Release #99-091. Washington, DC. April 8, 1999.

U.S. Consumer Product Safety Commission, Office of Information and Public Affairs. Retailers Join CPSC in Promoting Safe Bedding Practices for Babies-Each Year 900 SIDS Deaths May be Caused by Soft Bedding. News Release #00-078. Washington, DC. March 14, 2000.

Willinger, M., Hoffman, H.J., Wu, K-T., et al. “Factors Associated with the Transition to Nonprone Sleep Positions of Infants in the United States: The National Infant Sleep Position Study.” Journal of the American Medical Association 1998; 280:329-335.

Willinger, M., James, L.S., and Catz, C. “Defining the Sudden Infant Death Syndrome (SIDS): Deliberations of an Expert Panel Convened by the National Institute of Child Health and Human Development.” Pediatric Pathology September-October 1991; 11(5): 677-84.

Valdes-Dapena, M. “The Postmortem Examination.” Pediatric Annals 1995 July; 24(7): 365-372.

By Elizabeth Pantley, Author of No Cry Sleep Solution

According to sleep research, and motherly experience, the length and the quality of naps affect nighttime sleep. (And, conversely, nighttime sleep affects naps.)

Babies differ in their napping needs – but here’s a general guide that applies to most babies:

When should your baby nap?
Timing of naps is important. A nap too late in the day will negatively affect nighttime sleep. Certain times of the day are better for napping because they suit your baby’s biological clock; these optimum periods balance sleep and wake time to affect nighttime sleep in the most positive way.

All babies are different, but generally, the best nap times are as follows:
If baby takes three naps: midmorning/early afternoon/early evening
If baby takes two naps: midmorning/early afternoon
If baby takes one nap: early afternoon

Watch your baby’s sleepy signals!
Naps should happen immediately when your baby shows signs of tiredness. If you wait too long, she becomes overtired, “wired up,” and unable to sleep.

Once you are familiar with the your baby’s nap needs you can plan a nap routine to start the wind-down process. If consistent naps are new to you look more for your baby’s signs of tiredness and scrimp on the routine until you settle into a predictable pattern. In other words, don’t begin a lengthy pre-nap routine if your baby is clearly ready to sleep! Watch for these signs of fatigue; your baby may demonstrate one or more of these:

Decreasing activity quieting down losing interest in people and toys rubbing eyes looking “glazed” fussing yawning laying down caressing a lovey or asking for a pacifier, bottle or to nurse

Timing is very, very important!
You have probably experienced this scenario: Your baby looks tired and you think, “Time for a nap.” So, you wash her hands and face, change her diaper, answer a phone call, put out the dog, and head for baby’s crib or the family bed, only to find that she’s suddenly wide awake and anxious to play!

What happened? She has moved through her window of tiredness and gotten that “second wind” that buys her another hour or two of alert time before she re-enters her tired state. This can often happen later in the day. Suddenly, your baby is (finally!) ready for a nap at dinnertime, and the plot thickens- do you put her for a late nap and thus extend bedtime, or keep her awake and deal with a tired, fussy baby? Rather than face this ordeal, respond earlier to her signs of fatigue and get her in for her nap right at that time.

Once you have watched your baby carefully for a week or so, you should be able to create a nap schedule that works with her daily periods of alertness and tiredness, thus making your nap schedule easy to adhere to.

The nap routine
Once you’ve established a nap schedule for your baby, it is very helpful if you create a simple but specific nap routine. This routine should be different from your nighttime routine, although it can have similarities that signal sleep- for example, the presence of a lovely or special sleep-inducing music. Follow your nap routine the same way every day. (Except, as I mentioned before, if your baby is showing clear signs of being tired and ready to sleep. Then abbreviate or even eliminate your routine for that day.)

For a reluctant napper, your routine might include some relaxing motion, such as rocking/relaxing in a swing/walking in a sling or stroller, and some gentle lullaby music.

A nap routine doesn’t have to be long and involved to be effective. If your baby’s nap occurs about the same time every day there will be many subtle cues, such as the timing of his lunch, that tell your baby that nap time is nearing.

Better naps mean better nighttime sleep.

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 Elizabeth Pantley, author of The No-Cry Sleep Solution

The lack of adequate, restful sleep can affect your child’s mood, behavior, health, memory and growth. If there is anything standing in the way of a good night’s sleep it’s important to address the issue and solve the problem. Following is a list of typical sleep disrupters and possible solutions.

Nightmares
Children spend more time dreaming than adults do, so they have more dreams—both good and bad. After a nightmare saying “It was just a dream” doesn’t explain what they experienced – after all, most kids believe that the tooth fairy and Big Bird are real, too. After a nightmare, offer comfort just as you would for a tangible fear. If your child wakes with a nightmare

• Stay with your child until she feels relaxed and ready to sleep.
• Be calm and convey that what’s happening is normal and that all is well.
• Reassure your child that he’s safe and that it’s OK to go back to sleep.

Night Terrors
During a night terror your child will wake suddenly and may scream or cry. Her eyes will be open, but she won’t be seeing. She may hyperventilate, thrash around or talk incoherently. She may be sweating and flushed. She may seem scared, but your child is not really frightened, not awake, and not dreaming. She’s asleep, and in a zone between sleep cycles. A child having a night terror is unaware of what’s happening, and won’t remember the episode in the morning.

During a night terror you may try to hold your child, but often this will result in his pushing you away or fighting you off. The best response is a gentle pat, along with comforting words or Shhh Shhh sounds. If your child gets out of bed, lead him back. If he’s sitting up, guide him to lie back down. Keep an eye on him until he settles back to sleep.

Nighttime Fears
It’s normal for a child to imagine monsters that generate a fear of the dark. Even if you explain, and even if you assure him that he’s safe, he may still be scared. You can reduce his fears when you:

• Teach your child the difference between real and fantasy through discussion and book-reading.
• Find ways to help your child confront and overcome his fears. If dark shadows create suspicious shapes, provide a flashlight to keep at his bedside.
• Leave soothing lullabies playing, or white noise sounds running to fill the quiet.
• Give your child one, two, or a zoo of stuffed animals to sleep with.
• Put a small pet, like a turtle or fish, in your child’s room for company.
• Take a stargazing walk, build a campfire, or have a candlelight dinner to make the dark more friendly.

Preventing Sleep Disrupters
Some things have been found to reduce the number or severity of sleep-disturbing episodes. They are all based on good sleep practices and worth a try:

• Follow a calm, peaceful routine the hour before bedtime.
• Maintain the same bed time seven days a week.
• Avoid books and movies that frighten your child.
• Have your child take a daily nap.
• Provide your child with a light snack an hour before bedtime, avoiding spicy food, sugar or caffeine.
• Have your child use the potty just before she gets in to bed.

Is there a time to call a professional?
Always call a professional if you have concerns about your child’s sleep.

Copyright Elizabeth Pantley. (McGraw-Hill, 2003)

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.