Further declines may come from reducing maternal smoking

The incidence of sudden infant death syndrome in England and Wales fell by two thirds between 1989 and 1993. The decline in deaths followed the “back to sleep” health education campaign (started in 1991), which advised parents to place babies on their back or side to sleep, to avoid overheating and smoky environments, and to contact a doctor if their baby was unwell.1 Similar campaigns were conducted in Australia, New Zealand, and several other countries, with a decrease in the incidence of sudden infant death syndrome of 50% or more.2 In Tasmania a within-cohort analysis of more than 30 factors that might have contributed to the decline in incidence found that 70% of the decline could be attributed to the reduction in the proportion of infants who usually slept prone.3 Much of the research effort is now focused on understanding the mechanisms through which the prone position exerts its effect and on identifying the causal pathway for sudden infant death in infants who do not sleep in the prone position.

Two papers in this week's …