Skip to main content
American Journal of Public Health logoLink to American Journal of Public Health
. 2000 Apr;90(4):527–531. doi: 10.2105/ajph.90.4.527

Suffocated prone: the iatrogenic tragedy of SIDS.

U Högberg 1, E Bergström 1
PMCID: PMC1446204  PMID: 10754964

Abstract

Epidemiologic research has shown that prone sleeping is a major risk factor for sudden infant death syndrome (SIDS). In a public health review from Sweden, we explored the historical background of the SIDS epidemic, starting with the view of the Catholic Church that sudden infant deaths were infanticides and ending with the slowly disseminated recommendation of a prone sleeping position during the 1960s, 1970s, and 1980s. The story of the SIDS epidemic illustrates a pitfall of preventive medicine--the translation of health care routines for patients to general health advice that targets the whole population. False advice, as well as correct advice, may have a profound effect on public health because of the many individuals concerned. Preventive measures must be based on scientific evidence, and systematic supervision and evaluations are necessary to identify the benefits or the harm of the measures. The discovery of the link between prone sleeping and SIDS has been called a success story for epidemiology, but the slow acceptance of the causal relationship between prone sleeping and SIDS illustrates the weak position of epidemiology and public health within the health care system.

Full Text

The Full Text of this article is available as a PDF (213.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brackbill Y., Douthitt T. C., West H. Psychophysiologic effects in the neonate of prone versus supine placement. J Pediatr. 1973 Jan;82(1):82–84. doi: 10.1016/s0022-3476(73)80017-4. [DOI] [PubMed] [Google Scholar]
  2. CARPENTER R. G., SHADDICK C. W. ROLE OF INFECTION, SUFFOCATION, AND BOTTLE-FEEDING IN COT DEATH; AN ANALYSIS OF SOME FACTORS IN THE HISTORIES OF 110 CASES AND THEIR CONTROLS. Br J Prev Soc Med. 1965 Jan;19:1–7. doi: 10.1136/jech.19.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Davies D. P. Cot death in Hong Kong: a rare problem? Lancet. 1985 Dec 14;2(8468):1346–1349. doi: 10.1016/s0140-6736(85)92637-6. [DOI] [PubMed] [Google Scholar]
  4. Dwyer T., Ponsonby A. L., Newman N. M., Gibbons L. E. Prospective cohort study of prone sleeping position and sudden infant death syndrome. Lancet. 1991 May 25;337(8752):1244–1247. doi: 10.1016/0140-6736(91)92917-q. [DOI] [PubMed] [Google Scholar]
  5. Dwyer T., Ponsonby A. L. The decline of SIDS: a success story for epidemiology. Epidemiology. 1996 May;7(3):323–325. [PubMed] [Google Scholar]
  6. Engelberts A. C., de Jonge G. A. Choice of sleeping position for infants: possible association with cot death. Arch Dis Child. 1990 Apr;65(4):462–467. doi: 10.1136/adc.65.4.462. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Fleming P. J., Gilbert R., Azaz Y., Berry P. J., Rudd P. T., Stewart A., Hall E. Interaction between bedding and sleeping position in the sudden infant death syndrome: a population based case-control study. BMJ. 1990 Jul 14;301(6743):85–89. doi: 10.1136/bmj.301.6743.85. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Gilman E. A., Cheng K. K., Winter H. R., Scragg R. Trends in rates and seasonal distribution of sudden infant deaths in England and Wales, 1988-92. BMJ. 1995 Mar 11;310(6980):631–632. doi: 10.1136/bmj.310.6980.631. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Markestad T., Skadberg B., Hordvik E., Morild I., Irgens L. M. Sleeping position and sudden infant death syndrome (SIDS): effect of an intervention programme to avoid prone sleeping. Acta Paediatr. 1995 Apr;84(4):375–378. doi: 10.1111/j.1651-2227.1995.tb13653.x. [DOI] [PubMed] [Google Scholar]
  10. McKee M., Fulop N., Bouvier P., Hort A., Brand H., Rasmussen F., Kohler L., Varasovszky Z., Rosdahl N. Preventing sudden infant deaths--the slow diffusion of an idea. Health Policy. 1996 Aug;37(2):117–135. doi: 10.1016/s0168-8510(96)90056-1. [DOI] [PubMed] [Google Scholar]
  11. Milerad J., Lagercrantz H., Norvenius G., Wennergren G. Dyster utveckling sedan 1970-talet. Incidensen av plötslig spädbarnsdöd har fördubblats i alla nordiska länder. Lakartidningen. 1992 May 27;89(22):1996–1998. [PubMed] [Google Scholar]
  12. Mitchell E. A., Scragg R., Stewart A. W., Becroft D. M., Taylor B. J., Ford R. P., Hassall I. B., Barry D. M., Allen E. M., Roberts A. P. Results from the first year of the New Zealand cot death study. N Z Med J. 1991 Feb 27;104(906):71–76. [PubMed] [Google Scholar]
  13. Norvenius S. G. Some medico-historic remarks on SIDS. Acta Paediatr Suppl. 1993 Jun;82 (Suppl 389):3–9. doi: 10.1111/j.1651-2227.1993.tb12863.x. [DOI] [PubMed] [Google Scholar]
  14. Petersson P. O., von Sydow G. Letter: Cot deaths in Sweden. Br Med J. 1975 Aug 23;3(5981):490–490. doi: 10.1136/bmj.3.5981.490-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Wennergren G., Alm B., Oyen N., Helweg-Larsen K., Milerad J., Skjaerven R., Norvenius S. G., Lagercrantz H., Wennborg M., Daltveit A. K. The decline in the incidence of SIDS in Scandinavia and its relation to risk-intervention campaigns. Nordic Epidemiological SIDS Study. Acta Paediatr. 1997 Sep;86(9):963–968. doi: 10.1111/j.1651-2227.1997.tb15180.x. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES