Beware of The Pillow

By Christine Gorman

Each year in the U.S. about 7,000 infants die in their cribs for no apparent reason. Because doctors cannot find anything physically wrong with them, these babies are listed as victims of sudden infant death syndrome, a mysterious disorder that seems to occur when infants somehow forget to breathe. But new % evidence from a pair of pediatricians at the Washington University School of Medicine in St. Louis suggests that a subtle form of suffocation may be the true culprit in one-quarter to one-half of all suspected SIDS cases. Their conclusion, published in last week's New England Journal of Medicine, reflects a growing suspicion among doctors that the position in which these babies slept, face down, may have played a major role in their death.

With the help of the Consumer Product Safety Commission, Dr. James Kemp and Dr. Bradley Thach obtained information about 25 infants who died face down. All of the babies had been sleeping on soft cushions, filled with polystyrene beads, intended for infants. The two colleagues began their investigation with a simple test. Each held one of the suspect pillows to his own face and tried to breathe through it. "If you breathe into it for a minute or two, you're O.K.," says Kemp, an expert in the physiology of infant airways. "But after that you really feel out of breath and uncomfortable."

Even though the cushion had not prevented them from breathing, the air they exhaled had become trapped in the beads. So when they inhaled, they drew in stale air that was low in oxygen. "You end up breathing back in what you've just breathed out," Thach explains. "All the oxygen gets used up." Adults have enough lung power to suck in sufficient oxygen through the pillow, but Kemp and Thach determined that babies could not. By testing rabbits that had the same lung size as infants, the pediatricians proved that rebreathing into the bead-filled cushions was fatal for babies. The two investigators also determined that any movement by the children to free themselves only buried their faces deeper into the pillows.

Although the Consumer Product Safety Commission announced a voluntary recall of the cushions last year, the pillows are still readily available in people's closets and at garage sales. Investigators are now trying to determine if other products, like bedclothes or stuffed animals, could also cause fatal rebreathing. In addition, the Missouri doctors' findings are sure to fuel the controversy surrounding a question that should have been answered long ago: What is the safest position in which to put a newborn down to sleep? Pediatricians in some European countries recommend placing infants on their side, while most American doctors still opt for the abdomen. Kemp's advice to parents: "Don't put your baby in a position where something soft can cover its face."