Baby Behavior in the News: Safety of Infant Sleep Machines

If you’ve been a long time reader or have had the chance to browse through our previous posts, you know that we've posted a lot on infant sleep over the years. We know from experience that one of the hardest parts of being a new parent is adjusting to the lack of sleep that comes with caring for such a tiny baby. In the past, we've explained why babies don’t sleep through the night (see Baby Behavior Basics Part 1), how babies sleep at different ages and the difference between falling asleep and staying asleep  (see The Science of Infant Sleep Part 1, Part 2, and Part 3), and we’ve provided tips for sleep deprived parents (see Dealing Realistically with Postpartum Sleep Deprivation Part I and Part 2.

As we’ve discussed infant sleep and parental fatigue, both in person at speaking engagements and with readers of this blog,  we’ve gotten a lot of questions about the use of noise machines to help babies sleep better.  While we understand the concept (white noise is repetitive stimulation, which we know calms babies), there are a few reasons we’ve been careful not to recommend use of these machines for babies. First, we know that babies, especially young babies, need to wake often (see Baby Behavior Basics Part 1) and second, we didn’t know much about the safety of these machines for use with babies.  So, when a recently published study about the safety of infant sleep machines showed up in the news, it caught our eye.

The authors evaluated 14 machines that are widely available in the US and Canada. Each machine played a range of 1 to 10 different sounds, including nature noises (for example, wind, water, birds, etc) white noise, mechanical sounds (traffic, trains, etc) and heartbeat sounds. During the measurements, the authors tried to recreate the experience of using these machines in real life. They used a microphone set-up to mimic an infant’s ear and measured the sound level at 3 different distances,  30 cm (~11.8 inches) similar to crib rail placement), 100 cm (~ 3 feet) to replicate placement on a table near the crib, and 200 cm (~6.5 feet) to represent a machine placed across the room.

Not surprisingly, the closer the machine was to the microphone, the louder the measurement. At the crib rail and bedside table positions, all 14 machines exceeded the recommended levels for hospital nurseries. Three of the machines were so loud that they would be considered dangerous for adults when exposed for 8 hours (like overnight, for example). Even when placed across the room, 13 of the 14 measured louder than recommended.

Like usual, the authors state that more research is needed. They did not collect information about how these machines are usually used in real life, so this study does not provide information about where parents usually place the machines, how long they typically stay on, or which volume setting is used most (they measured at the loudest setting).  However, they point out that all of these machines are easily available for purchase with very little instruction for use or safety information and that there is clear evidence that inappropriate noise exposure can change infants’ heart rates, disrupt sleep quality and duration, and even lead to hearing loss.

The authors suggest that policy makers require more oversight for these machines, including limits on volume levels, better labeling and instructions for use, and requiring automatic timers to shut the machines off and prevent overuse.  For parents who are using these machines, they recommend placing the machine as far away from the baby as possible, setting the volume as low as possible, and limiting use by using automatic time shut-off or turning the machine off once the baby falls asleep. 

Reference: Hugh, Sarah C et al. Infant Sleep Machines and Hazardous Sleep Pressure Levels. Pediatrics Volume 133, Number 4, April 2014. 

Good news! Preschoolers are less likely to be overweight!

Earlier this week,  a paper was published in the Journal of the American Medical Association (JAMA) reporting the prevelence of obesity in the United States from 2011-2012. The Centers for Disease Control and Prevention (CDC) collects information from people all over the country and reports their findings every other year. These data are widely used in everything from news stories to policy documents to grant proposals. If you've ever heard someone say "In the United States, one-third of all adults are overweight or obese" chances are she was referring to these data.

In this most recent report, there was some exciting news! Although obesity rates didn't change much in most of the age groups, there was a significant decrease in the number of preschool-aged children who were classifed as overweight, from nearly 14% in 2003-2004 to 8.4% in 2011-2012.

There is so much work going into the prevention of childhood obesity at local, state, and national levels and this report shows that these efforts are having an impact. While nearly 10% obesity  among preschool children is far from desirable, it is good news that we are finally reversing course on such a challenging and devastating public health issue.

Reference: Ogden CL et al. Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. JAMA. 2014; 311: 806-814.

In the News: Early Solid Foods and Obesity Risk

A few weeks ago, we talked about findings from a large study about increased obesity risk with putting babies to sleep with a bottle. This time, we’ll share another outcome from that same study related to early solid food introduction. They found that introducing solid foods before four months of age increased obesity risk by 40 percent, and this was not the only study with this finding. (Gibbs 2013) In a past post, we shared a 2011 study indicating  that there was a 6-fold higher risk of obesity at 3 years when infants were started on solid foods before 4- months of age. This risk, however, was only seen in infants that were formula fed or fed breast milk for less than 4-months.

The American Academy of Pediatrics and World Health Organization continue to recommend that parents wait until 6-months of age to start solid foods with their infants. However, many parents start solid foods earlier than this. In the Gibbs study, 29% of formula fed infants and 9% of breastfed infants started solids before 4-months of age.

There are many reasons parents start solid foods earlier than the recommended 6-months of age. According to a study reported on in a past post, top reasons for starting solid foods included:

• Thinking that the baby seemed hungry
• Wanting to feed something other than formula or breast milk
• Wanting the child to sleep longer
• Having a healthcare professional tell the parent to start solids earlier
• The baby wants the food that the parent was eating

If you're feeling tempted or confused, please read this past post for tools to help you deal with each of these common reasons for starting solids early.

The Gibbs study explores some common feeding practices and we know that their findings and recommendations may challenge your current practices. For more information about why it’s important to wait until about 6-months to start solid foods and how to know when your baby is ready, click here. When did you start solid foods with your baby and why?

Reference
Gibbs BG, Forste R. Socioeconomic status, infant feeding practices and early childhood obesity. Pediatr Obes. 2013 Apr 2. [Epub ahead of print]

Baby Behavior in the News: Autism and Vaccines

New Institute of Medicine (IOM) report released shows autism is not linked to the MMR vaccine.

Who is the IOM?
The IOM is an independent, nonprofit organization that works outside of the government to provide unbiased and evidence-based information about health and healthcare topics. Their goal is to provide the information necessary for people to make informed decisions about their health. The IOM reviews studies applying a rigorous research process involving leading scientists and extensive peer review. In other words, they know what they’re talking about and provide sound evidence-based advice.

The New Report: Adverse Effects of Vaccines
A new report published by the IOM reviewed adverse effects from 8 common childhood vaccines: chickenpox (varicella zoster), influenza or flu (except 2009 H1N1), hepatitis B, human papillomavirus (HPV), Measles-Mumps-Rubella (MMR), hepatitis A, meningococcal, and those that contain tetanus (like Diptheria-Tetanus-acellular Pertussis or DTaP). A panel of medical experts reviewed a mountain of evidence, including both studies of whole populations and case reports of adverse events related to vaccines reported by individuals.

Vaccines and Autism

After reviewing a number of large, rigorous studies, the committee determined that the evidence does not support a causal relationship between the MMR vaccine and autism. Although there were not enough studies to accept or reject a link between autism and the DTaP vaccine, experts did say that they were “not finding a strong signal" that there was any link.

For a list of all of the findings of the IOM report, please see the link provided below. Please note that there the committee’s findings are presented in a variety of ways, including a 2-page Research Brief that provides a short summary of the committee’s review process and general findings and the full report, which includes extremely detailed information about the studies included in the evaluation.

A Final Word

According to this report, in general, few adverse effects were caused by the 8 common childhood vaccines, though there were some adverse events linked to some of the vaccines. We encourage all of our readers to take a look at the findings of this report. The protection that vaccines provide significantly improves the quality of life in our communities. We hope this post and the links to the full IOM report we provided will help you make an informed decision about vaccinating your children.

Full IOM Report: Adverse Effects and Vaccines: Evidence and Causality