The overall decline in infant mortality during the first half of the twentieth century reflected improvements in the postneonatal mortality rate, which resulted largely from better nutrition and sanitation.

Some postneonatal deaths are due to complications of low birthweight and congenital defects, but most are caused by infection, injury, and sudden infant death syndrome (SIDS, discussed in the next section). Since some of these conditions can be treated, the babies who die of them are usually from poor families that have little or no access to medical care.

This is especially poignant in the case of Native American babies, since there is a low rate of neonatal death among Native Americans. Their babies leave the hospital healthy but during the first year of life die at twice the rate of white babies. The causes are often preventable accidents and treatable conditions like pneumonia and gastroenteritis (Honigfeld & Kaplan, 1987).

Our present rates of infant death are chilling to any concerned person. The American Academy of Pediatrics Task Force on Infant Mortality (1986) asks several questions. First, why—in a wealthy country like the United States—is infant mortality not declining at a faster rate, and why is there an apparent increase in postneonatal mortality? Second, why is there such a large disparitv

INFANCY AND TODDLERHOOD
PUTTING RESEARCH TO WORK
If you are a parent, or are about to become a parent, or if you have occasion to care for infants or toddlers, you can put into practice some of the most important findings to emerge from recent research into child development. The following recommenda-jns are just a sampling:*
Respond to babies' signals. This is probably the single most important thing that caregivers can do. Meeting an infant's needs—whether it's for food, cuddling, or comforting—establishes a sense of trust that the world is a friendly place. Answering cries or requests for help gives a baby a sense of having a measure of control over his or her life, an important awareness for emotional and intellectual development. Adults often worry about spoiling children by reacting too quickly to meet their needs, but the children who have the most problems in life are those whose needs go unmet.

As one old saying goes, "Baby a baby when he's a baby, and you won't have to baby him the rest of his life" (Chapters 6 and 7).

Provide interesting things tor babies to look at and do. By first watching a mobile hanging over a crib and then handling brightly colored toys and simple household objects, babies learn about shapes, sizes, and textures. Playing helps them develop their senses and  motorskills. And handling objects helps them distinguish between themselves and things that are not themselves (Chapters 5 and 6).

Talk to babies and read to them. By hearing and being able to respond to speech directed especially to them, babies learn how to express themselves. You'll be most effective if you pitch your voice high and speak slowly, use short words and simple sentences, leave off word endings (saying "go" instead of "going," for example), ask questions, repeat words and phrases, and talk about things in the baby's world. You'll probably do most of these things intuitively as you talk in "baby talk," or "motherese" (Chapter 6). Give babies freedom to explore. It's better to "baby-proof" an environment

(by taking away breakables, small things that can be swallowed, and sharp objects that can injure and by jamming books into a bookcase so tightly that a baby can't pull them out) than it is to confine a baby in a playpen. Babies need to have opportunities to crawl and eventually walk, and they need opportunities to exercise their large muscles. They also need to learn about their environment in order to feel in control of it. And they need the freedom to go off on their own in order to develop a sense of independence (Chapters 5, 6, and 7).

t'HMR h rinding ter or di.ipterv referenced at the end otbetween black and white babies? And, third, what effects do budget cuts in health care have on babies?

The knowledge and the technology needed to diagnose and treat high-risk pregnancies and to help vulnerable infants are at our fingertips. It has been clearly shown that babies' survival rate improves with good prenatal and postnatal care for mothers and babies. Education and availability of contraceptives can also help, by enabling women to space their pregnancies better and thus reduce the number of high-risk births. Unfortunately, much of this know-how has not benefited poor and minority-group mothers and babies.

Babies from disadvantaged groups weigh on average Vi pound less at birth than middle-class babies. Yet, as one pediatric nutritionist has pointed out, "Pound for pound, the poor baby does as well as the rich baby; black babies do as well as white babies" (Winick, 1981, p. 80). Therefore, a major advance in saving the lives of babies would be to raise the average birthweight by even half a pound. This can be done if society and government are committed to make good prenatal care and general health care available and affordable to all prospective mothers.

SUDDEN INFANT DEATH SYNDROME (SIDS)
One kind of death among infants follows a typical, tragic sequence: a baby goe-to sleep normally at the usual time, but a parent later finds the baby dead Sudden infant death syndrome (SIDS), the sudden and unexpected death of ar. apparently healthy infant, is a medical condition that takes the lives of sonu 7000 babies a year, or 2 out of every 1000 born. In 1985 it accounted for 12 percen: of all infant mortality, affecting black babies more than white babies (Wegman 1987). It is the leading cause of death among infants aged 1 month to 1 year and is most likely to strike babies between

2 and 6 months old (Arnon, Midura Damus, Wood, & Chin, 1978; Hunt & Brouillette, 1987).

Despite the fact that SIDS, also known as crib death, has been observed sina biblical times and was as common in the eighteenth and nineteenth centuries a> it is today, we know very little about it.

It is as mystifying as it is sad: the death i-not caused by suffocation, vomiting, or choking, it is not due to a contagiou-condition, and there is no known way to predict or prevent it. It is most common

in winter.

According to some observers, one reason for the mystery surrounding SID^ is that it is being overdiagnosed—that some deaths from other causes, including accidents, are attributed to SIDS (Bass, Kravath, & Glass, 1986; Hunt & Brouillette, 1987).

SIDS is particularly confusing and dismaying to parents because they do no: know what has caused it and because it is so sudden. One woman described i; as follows:

This is the most painful time I have ever had to accept. It is hard to be a mother om day and not the next. The first months my arms actually ached to hold her again, i kept thinking I could hear her in bed playing, but it was just the furnace kicking on (DeFrain, Taylor, & Ernst, 1982, p. 19)
A bereaved family as a whole also suffers greatly, seeing SIDS as the most severe family crisis it has ever experienced (DeFrain & Ernst, 1978; DeFrain et al., 1982). Parents feel guilty and under criticism from society, and siblings react with such emotional problems as nightmares and difficulty in school. It usuallv takes almost 18 months for a family to regain happiness. Recovery often seen impossible to the parents, but it does eventually come about. One mother recalled:

So many people tell you when your child dies that things will someday be okay. A; that time you seriously doubt that you can ever feel happy and normal again. But i; does happen; and it is a blessing and a relief that it does. (DeFrain et al., 1982, p. 69

A number of risk factors do seem to be important in SIDS. Babies most likelv to succumb are black males whose birthweight was low. Their mothers tend to be young, unmarried, and poor; to have received little or no prenatal care; to have been ill during pregnancy; to smoke, abuse drugs, or both; and to have had another baby less than a year before the baby that has died of SIDS. Their

fathers are also likely to be young (Babson & Clarke, 1983; Kleinberg, 1984; Shannon & Kelly, 1982a, 1982b; Valdes-Dapena, 1980; Wegman, 1987). Apparently, whatever these babies' problems are, they are worsened by living in a poor environment. Yet poverty is not the whole story. The picture is similar to that of birth sudden infant death syndrome (SIDS)    Sudden and unexpected death of an apparently healthy infant; also known as crib death.