Suffocated prone: The iatrogenic tragedy of SIDS

Epidemiologic research has shown that prone sleeping is a major risk factor for sudden infant death syndrome (SIDS). In a public health review from Sw eden, we explored the historical background of the SIDS epidemic, starting with the view of the Catholic Church that sudden infant deaths were infanti cides and ending with the slowly disseminated recommendation of a prone sle eping 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 adv ice that targets the whole population. False advice, as well as correct adv ice, may have a profound effect on public health because of the many indivi duals concerned. Preventive measures must be based on scientific evidence, and systematic su pervision and evaluations are necessary to identify the benefits or the har m of the measures. The discovery of the link between prone sleeping and SID S 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 sys tem.