A first instinct of parents of newborns worried about heating bills this winter might be to turn down the heat and load up on the blankets in baby's crib.

		Related articles Understanding why some infants don't gasp SIDS risk factors, prevention tips

That might save some money, but it's also putting the baby at a markedly higher risk of sudden infant death syndrome.

The National Institute of Child Health and Human Development last week released advice on how to lower what it calls a seasonal increase in SIDS risk.

No matter the season, though, overdoing the pillows and blankets can cut off an infant's oxygen, said Dr. Raymond Pitetti, associate director of emergency medicine for Children's Hospital. In certain infants who do not have a well-developed gasp reflex, that could be fatal.

SIDS, in which a sleeping, seemingly healthy infant under 1 year of age dies for no apparent reason, has baffled doctors, parents and researchers for years.

"Is it associated with all the infections that infants get? Is it associated with genetic mutations that haven't turned on certain brain functions? Or is it some developmental problem? There are a number of theories, but none of them have been proven," said Dr. Kay Tomashek, co-chair for the Sudden Unexplained Infant Death Initiative at the Centers for Disease Control and Prevention.

Though much about SIDS remains a mystery, risk factors are well-known. Sleeping on the stomach tops the list. In the United States, the SIDS rate has dropped 50 percent since the 1994 advent of the "Back to Sleep" campaign, which urges parents to put babies to sleep on their backs.

One of the biggest risk factors is being African-American or American Indian. Children in those minorities die from SIDS at a rate two to three times higher than the national average.

Death rates in Allegheny County mirror those numbers. In 2002, 3.07 black infants per 1,000 births died from SIDS, compared to 0.20 per 1,000 births for white infants. In 2003, the rates were 1.97 for black infants and 0.10 for white infants.

A second risk factor is maternal smoking.

"In infants who die from SIDS, if you look at their brains afterwards, they have a high proportion of neural injury in areas of the brain that are responsible for changing blood pressure when you change body position," said Dr. Ronald Harper, a distinguished professor of neurobiology at the University of California at Los Angeles.

In Dr. Harper's mind, it's not hard to figure out what's behind the injury.

"The No. 1 cause -- and you don't need much to figure this out -- is cigarette smoking. There's a four-fold increase in the risk for SIDS if the mother smokes during pregnancy," he said. "That just screams what the nature of the injury is."

That puts infants born in Allegheny County at an especially high risk.

According to 2002 state data, Pittsburgh's maternal smoking rate was 22.7 percent and Pennsylvania's was 15.8 percent. The national average was 12 percent.

Because of the risk of SIDS, to name one specific issue, and, more broadly, because of the high rate of black infant mortality in Allegheny County, a number of initiatives work year round to help children born to African-American women get a better start in life.

The Infant Mortality Working Group of the Center for Minority Health, part of the University of Pittsburgh Graduate School of Public Health, last April sponsored its third annual Community Walk and Baby Fair at Hosanna House in Wilkinsburg. The event is scheduled this year for April 29, said project director Ray Howard.

Healthy Start, a 15-year-old federally funded program operated through the Allegheny County Health Department provides education on SIDS and the "Back to Sleep" campaign. Its educational materials include specific cultural competence components geared to its target population, which, in Allegheny County, is 85 percent black, said executive director Cheryl Squire-Flint.

There are many more, including Magee-Womens Hospital's classes for expecting and new parents. West Penn Hospital's Infant Apnea Center counsels expectant parents who have already lost a child to SIDS.

And last year, a panel that grew out of an effort to reduce infant mortality in Allegheny County, compiled recommendations for safe sleep environments to be distributed to health care providers and the community, said Dr. Nilima Karamchandani, medical director of West Penn's neonatal intensive care unit.

Mr. Howard is part of the panel's Safe Sleep Committee, which is tasked with making those recommendations accessible to expectant parents, grandparents and anyone who might be involved in caring for a child.

The recommendations closely mirror those found in November's revised policy statement on SIDS from the American Academy of Pediatrics.

But they will depart slightly from the AAP's recommendation against co-sleeping, Dr. Karamchandani said, in recognition of the common use of that practice among African-American moms. Women who bed-share with their babies often see it as a means of bonding or to ease breast-feeding.

"If it's a tired mom, a smoking mom, a mom on alcohol or drugs, those are clear times when you must avoid bed-sharing," Dr. Karamchandani said.

"But if a mom wants to bed share for breast-feeding reasons or for cultural reasons," then the committee's guidelines will help her do that safely.

The recommendations also include resources for parents, like SIDS of Pennsylvania's Cribs for Kids program, which helps needy parents obtain safe.

Despite all this effort and attention, the high death rate from SIDS among minorities perists.

That's as much a mystery as SIDS itself.

"When we look at the disparity, there is no panacea here," said Mr. Howard of the Center for Minority Health. "We're working with a number of forces and one of those is that there are different views about what's safe for babies," he added, co-sleeping being one of them.

With the work of the Safe Sleep Committee, the April fair at Hosanna House and other collaborative efforts, Mr. Howard said, "We're trying to establish a new decision-making structure in young women and young men so that good prenatal care occurs."

"We've reduced SIDS by over 50 percent," added Dr. Karamchandani, "but our hope is that someday it will be gone."