Getting parents to stop smoking during pregnancy and to follow safe sleeping advice is key to tackling sudden unexplained infant deaths, according to an article in this week's BMJ. The term sudden infant death syndrome (SIDS) was introduced in 1969 as a recognised category of natural death that carried no implication of blame for bereaved parents.
Since then, however, a lot has been learnt about risk factors, such as smoking and the role of parenting in cot death, undermining the popular myth that cot death is a bolt from the blue that can strike any child from any family. So, in a special report, freelance journalist Jonathan Gornall asks whether it is time to stop classifying unexplained infant deaths as SIDS and instead focus on reducing the risks that we now know account for most sudden infant deaths.
In October, Britain's leading SIDS research team concluded that maternal smoking during pregnancy - already a recognised factor in 90% of cot death cases - was directly responsible for 60% of such deaths. The Foundation for the Study of Infant Death endorsed this, saying: "If no women smoked in pregnancy, about 60% of cot deaths could be avoided, reducing the number of deaths in the UK from around 300 to 120 a year."
Heeding advice on sleeping position has also had an impact. Since the 1991 Back to Sleep campaign, the number of cases in the UK has fallen by 75%. However, a 2006 study found that the proportion of SIDS babies who died while co-sleeping with their parents had risen from 12% in 1984 to 50% in 2003.
However many SIDS cases there are, the fact that by the foundation's own estimation most are now attributable to modifiable parental behaviour suggests the need for a fundamental rethink, writes Gornall. Can the foundation continue to justify funding the hunt for the elusive "cause" of SIDS when even scientists can't agree on where to look for an answer, he asks?
Attitudes must change, he says. Efforts must focus on educating women who smoke throughout their pregnancies and those parents who continue to endanger their infants with other unsafe parenting practices, whether through ignorance or carelessness.
SIDS campaigners, many of them cot death parents whose children died before key risk factors were as well understood as they are today, have worked hard to ensure that parents do not suffer the additional burdens of suspicion and stigma, he writes.
Yet the flip side of this coin is the need to confront the hard truths about cot death if the "reduce the risk" message is to be brought home to those parents who remain the hardest to reach and whose children are most at risk.