Infants should sleep alone in their own cribs or approved beds in the first year of life, without blankets and stuffed animals, according to new national guidelines likely to have an impact on millions of U.S. households and child care providers.

The guidelines, released today by an American Academy of Pediatrics task force, are an attempt to reduce hundreds of preventable deaths of infants in adult beds and other unsafe sleep environments.

The guidelines will impact generations of future caregivers, as well as gift-givers at baby showers. The better gift now is a portable mesh crib or a sleeper or sleep sack, not a stuffed animal or blanket and never the crib bumpers that have been associated with infant deaths.

In another change likely to stir discussion, the academy recommends that babies should be put to bed with pacifiers, because their use is associated with fewer SIDS deaths, and they don't impair the development of teeth or ability to breast-feed.

Michigan is one of the states well ahead of the guidelines. The state adopted infant safe sleep guidelines in April 2004 and recommended that babies sleep in their own beds.

Proposals before the state Legislature would require day care providers to place infants to sleep on their backs, in individual beds.

Training also is under way across the state to teach these concepts to nurses, church nursery personnel and home day care providers. Study has shown that many deaths thought to be caused by sudden infant death syndrome are cases where babies suffocated in too much bedding.

Blankets are a factor

Sometimes, the causes of a baby's death are unclear, leaving parents like Heather Hilden of Edmore to live with uncertainty. Her 18-month-old son, Riley, died April 14 after she placed him in his crib, on his back, with his favorite blanket and Tigger stuffed animal.

"He had spiked a fever the night before and I gave him some Motrin," recalled Hilden, who has two other children, ages 12 and 8. "I have to wonder what would have happened if I hadn't put him to bed with his blanket."

She found him the next morning facedown on his blanket. An autopsy said Riley had a respiratory virus and bacterial sepsis. Still, there was the issue of his blanket.

"If I could have done anything differently, I wouldn't have put that blanket in there," she said.

She goes to see her son's grave site nearly every day, and the family has posted stories about him on a Web site, www.babiesonline.com/babies/o/ourangelriley.

Tomorrow's Child is a Lansing-based nonprofit group formed to unite parents who have lost babies to SIDS. The Hildens joined the group for its walk Oct. 2 at Hawk Island Park. "This is the first thing I've looked forward to all year," Heather Hilden said. "I feel I can do something besides sit at home and cry."

Another Michigan death was clearly caused by unsafe bedding. Ten-month-old Emilee Peterson of Portage died Feb. 3, 2004, in a Kalamazoo-area day care home.

Emilee stayed at the home one day a week, so she could learn to socialize with other children, said her mother, Lorie Peterson. Peterson's mother and mother-in-law watched her daughter the other weekdays while she worked as director of Kalamazoo's Senior Services.

Emilee was the only child of Lorie and her husband, Keith.

The day Emilee died, Lorie Peterson carried her into the home wrapped in a thick quilt because of a snowstorm. An emergency crew found Emilee not breathing under the quilt.

The home reopened for business after the caregiver was cleared of wrongdoing by a judge and the state, Lorie Peterson said.

She and her husband, who adopted a 1-year-old girl from China last month, now give talks to child care providers for Tomorrow's Child, which has received a $250,000 state grant to implement safe sleep programs.

Danger in bed

Dr. John Kattwinkel, chair of the SIDS Task Force for the American Academy of Pediatrics, said mounting evidence from 10 well-documented studies show that bed sharing increases the risk of accidental deaths. "We came to this conclusion because of the evidence," said Kattwinkel, professor of pediatrics at the University of Virginia.

Though some of the deaths involved parents who drank or used drugs and then rolled over on a baby while they slept, others involved breast-feeding, he said.

"There's no evidence to support that parents who don't drink and use drugs can safely sleep" with babies, he said.

Child death review teams established by the Wayne County Medical Examiner's Office have concluded that many cases that appeared to be SIDS are deaths of babies smothered, or asphyxiated by adults or bedding, said Dr. Melissa Pasquales-Styles.

An analysis she conducted determined that 17 of 21 infant deaths last year in Wayne County that were labeled accidental were caused by positional asphyxia -- pressure on the body causing a lack of oxygen.

Though 20% to 25% of accidental infant deaths are associated with parents' drug and alcohol use, many more involve babies buried under heavy bedding, caught in bumper pads, or wedged between adult beds and walls. Several cases have involved babies and breast-feeding mothers in the same bed, she said.

Pat Tackitt, a child fatality investigator with the office, credits parents who let her photograph death scenes of their infants to use for educational programs about safe sleep. "The courage they have shown is a great gift to helping others understand," she said.

"This is about giving parents tools to make them safe."

Safe sleep guidelines need not inhibit breast-feeding, said Dr. Sophie Womack, director of neonatology at Detroit's Sinai-Grace Hospital and chair of the board of Tomorrow's Child.

"Breast-feed your baby, and when you're finished, put the baby in its crib," she said.

Not everyone agrees. The La Leche League International, which promotes breast-feeding, advises parents to evaluate the risks and benefits of sharing a bed and decide for themselves. "There is no right answer that fits every family situation," the statement says.

Maria Munoz, 34, of Detroit says she believes she can sleep safely in a queen-sized bed with her daughter, Helena, now 2, whom she breast-feeds. Her husband, Jim, sleeps in an upstairs bedroom.

"I've developed a sixth sense about where my baby is when we sleep together," she said.

"I don't think I'd be able to sleep at all if Helena were in a crib in another room; I'd worry too much about her."

Michigan takes action

Throughout Michigan, safe sleep programs are under way.

In Berrien County, a program called Baby's Own Bed (269-983-8528 anytime) provides free cribs and portable cribs to low-income mothers. Sandra Hayes, a nurse with the Lakeland Regional Health System in St. Joseph is distributing rubber stamps to pediatricians' offices with two questions they add to all paperwork given to parents. The questions are: Where does your baby sleep? and How do you put your baby down to sleep at night?

"It allows doctors to try to come at safe sleep from as many directions as we can," she said.

In Highland Park and Detroit, the Infant Mortality Project (313-868-8420 anytime) offers several programs that teach mothers about safe sleep, money management, parenting and discipline. One of them, the Jubilee Parents support group, meets over lunch in the St. Raymond church rectory on Detroit's east side. Child care and transportation are provided to those who need it. The women receive coupons, food and other items.

"This is a job for life," said Pat Hollins, a facilitator with the program. "You can divorce your husband but you can't divorce your kids."

Contact PATRICIA ANSTETT at 313-222-5021 or anstett@freepress.com

SOME GUIDELINES
Infant safe sleep recommendations include:

•No bed sharing. Infants in the first year of life should sleep in a crib or playpen.

•Infants always should sleep on their backs.

•Use a firm crib mattress, covered by a sheet.

•Keep soft objects and loose bedding such as pillows, comforters and stuffed toys, out of the crib.

•Keep infants away from smoke.

•Offer a pacifier when the infant is laid down for a nap or at bedtime. Don't reinsert it once the infant falls asleep.

•Avoid letting the baby get too hot. The infant should be lightly clothed for sleep, and the bedroom temperature should be warm enough for a lightly clothed adult.

•Avoid devices marketed to reduce the risk of SIDS, for instance, by maintaining a healthy sleep position. None has been tested sufficiently for safety. There is no evidence that use of home monitors decreases the risk of SIDS.

•Have others caring for the infant follow these recommendations.

Source: American Academy of Pediatrics at www.aap.org.

SUPPORTING SAFE SLEEP
•Tomorrow's Child, a nonprofit, state-funded organization, offers safe sleep resources and bereavement services for families after the death of a child. 800-331-7437. www.tomorrowschildmi.org

•www.2virtues.com has infant products to promote safe sleep, including Swaddleaze, a sleep sack that also is a swaddler. $24.95.

•La Leche League has breast-feeding resources. 800-523-3243. www.lalecheleague.org.