By THOMAS HARGROVE and LEE BOWMAN
Scripps Howard News Service

PITTSBURGH -- America grossly undercounts the number of babies who suffocate in avoidable sleeping accidents, top medical authorities and child safety advocates agreed in a first-of-its-kind gathering to combat sudden infant death.

But they sharply, sometimes emotionally, differed this weekend over whether they have enough proof to urge parents to stop sleeping with their infants, a sensitive issue that stirred political controversy in recent years.

"We know that 80 percent of sudden infant deaths are related to their sleep environment. We need to focus on the preventability of these deaths, no matter what they're called in the statistics,'' said Dr. James Kemp, a researcher on infant sleep safety at Washington University School of Medicine in St. Louis.

Only one-seventh of the nearly 5,000 infants who die without obvious cause each year are attributed to accidental asphyxiation. Most are blamed on Sudden Infant Death Syndrome.

John Kattwinkel, chairman of the American Academy of Pediatrics' Sudden Infant Death Task Force, cautioned that more statistical evidence is needed before a national campaign against adult bed-sharing with infants should be mounted.

"When we have the data, then we will do that," Kattwinkel said.

The academy's latest guidelines, published in 2005, said bed sharing is not recommended and "may" be dangerous, but avoided stronger language in deference to breastfeeding advocates.

It was a different story for many of the 200 infant death investigators and advocates attending the conference entitled "Breaking the Cycle: A Safe Sleep Summit." The conference was convened in reaction to a series of stories last year by Scripps Howard News Service detailing wildly erratic diagnoses of infant death.

"How many more babies are going to have to die while we wait," said Deborah Robinson, an infant death investigator from Seattle. "They will err on the side of the data. The problem is, the data are no good."

Others believe its time to come to a new consensus about infant death.

"I have a hard time using the word 'SIDS' any longer," said Major Connie Shingledecker, a chief child death investigator for the Manatee County, Fla., Sheriff's Department. "How can I use that word and talk about suffocation. Suffocation is preventable, but true SIDS is not."

In 1992, about 80 percent of 4,895 unexpected infant deaths reported to the federal Centers for Disease Control and Prevention each year were considered SIDS deaths -- a determination that's supposed to be reached only after a thorough death scene investigation, autopsy and medical history review of the baby rule out any other possible cause.

By 2005, of 4,857 deaths reported, just under 48 percent were considered SIDS deaths, but almost 30 percent were attributed to "unknown causes" and the rest to accidental suffocation or homicide.

Much of the recent decline in reported SIDS cases stems from a growing reluctance by local health and law enforcement authorities to use the diagnoses in cases that, they believe, actually resulted from avoidable accidents.

"We've shifted from SIDS to positional asphyxia for many of these cases. That's not what people want to hear, but it's our job to report it," said Peggy Regensburg, a public health program manager from New York City.

The state of New York has reduced the number of reported SIDS cases by 90 percent in recent years, opting instead for the more vague diagnosis of death by "undetermined" causes.

Regensburg and many others at the conference sponsored by the Cribs For Kids, a non-profit group based in Pittsburgh, argue that unsafe sleep practices are being found in so many instances that it's irresponsible not to take a stronger stand against bed sharing and other practices.

"First, we need to improve how these deaths are recorded," Kattwinkel said. His colleague, University of Virginia medical researcher Fern Hauck, echoed a message that wasn't always well received by many others in the gathering.

"We are at a crossroads right now," Hauck said. "But we need more precise data that would require more time and money."

Kattwinkel pointed to political pressure mounted against the Consumer Product Safety Commission following its 1999 announcement that adult bed sharing with infants is a significant threat and its 2002 campaign warning of the dangers of the adult bed for infants.

"There was considerable push-back against that," Kattwinkel said. "That's why we need to do all of the necessary epidemiology first."

Also attending the meeting was product safety researcher Saud Wanna-Nakamura, who became a target after she convinced the federal commission to warn adults to stop taking their babies to bed.

"I didn't then know how afraid I should have been when releasing the bed data, but I was beaten up for it," Wanna-Nakamura said. "It was vicious sometimes."

But that didn't stop the researcher from presenting new data at the conference, a study of 484 infant smothering deaths that resulted from pillows and cushions. Of these, 213 infants died from suffocation because of adult pillows and 128 perished while sleeping on sofa cushions.

"So far, we haven't been beaten up over these pillow data," she said. "We're still working to protect the American people."