Sudden infant death syndrome (SIDS) causes newborn babies to die in their sleep—often without warning. It’s so unpredictable, in fact, that many pathologists and healthcare providers now refer to it as Sudden Unexplained Infant Death Syndrome (SUIDS), according to Steven A. Shapiro, D.O., chair of the Pediatrics Department at Abington–Jefferson Health.
The incidence of SIDS has dropped tremendously since the launch of the Safe to Sleep (formerly Back to Sleep) campaign in 1994. Yet the Centers for Disease Control and Prevention (CDC) reports about 3,500 sudden and unexpected infant deaths each year.
The unpredictability and finality of SIDS scares new parents who desperately want to keep Baby safe, but you can take some actions to help reduce his risk. Here are the top SIDS prevention strategies and facts that parents need to know.
SIDS Risk Factors
The causes of SIDS aren’t really understood. "Most babies who die of SIDS appear perfectly normal," says Rachel Moon, M.D., a pediatrician at Children's National Medical Center, in Washington, D.C., and a member of the American Academy of Pediatrics's SIDS Task Force.
But experts believe SIDS victims have an immature arousal center in the brain. Put simply, they can't wake themselves up when they're having trouble breathing. Infants who sleep on their stomach are particularly vulnerable to SIDS—possibly because this position increases the likelihood that they will re-inhale oxygen-depleted air.
"We do know that there are demographic and environmental risks," Dr. Moon adds, noting that African American and Native American babies die of SIDS at two to three times the national average, and three out of five SIDS victims are boys. Other groups at increased risk include premature babies, low-birthweight babies, and infants who are exposed to cigarette smoke.
In terms of age, "the peak danger is between 2 and 4 months old," says Marian Willinger, Ph.D., special assistant for SIDS at the National Institute of Child Health and Human Development, in Bethesda, Maryland. However, you should continue to safeguard your child from SIDS until he turns one.
How to Prevent SIDS
Although taking the right precautions doesn't always guarantee that your child will be protected from SIDS, recent research is revealing more ways than ever to reduce his risk. Here are expert-approved methods to prevent SIDS in your baby.
Never let your baby sleep on his stomach.
Back-sleeping increases a baby's access to fresh air and makes her less likely to get overheated (another factor linked to SIDS). But not all new parents are getting the message: Eighteen percent of Parents readers say they usually put their infants to sleep on their stomach, and another 13 percent do so some of the time.
"Some exhausted new parents may do it out of desperation, because infants tend to sleep better and more deeply on their stomach," says Parents advisor Jodi Mindell, Ph.D., author of Sleeping Through the Night: How Infants, Toddlers, and Their Parents Can Get a Good Night's Sleep. "But having your baby sleep on her tummy is a no-no."
You shouldn’t even risk putting Baby on his stomach for a short nap. That's because infants who normally sleep on their back are 18 times more likely to die of SIDS when placed down on their tummy for a snooze. "Infants seem to have difficulty adjusting to the change," says Dr. Moon.
Despite the dangers of stomach sleeping, though, you shouldn’t worry if your little one begins to flip over on his own. "Once a baby can roll over by herself, her brain is mature enough to alert her to breathing dangers," says Dr. Moon. "And by the time she's 6 months old, her improved motor skills will help her to rescue herself, so the SIDS risk is greatly reduced."
Keep in mind, however, that your baby should still have several supervised "tummy time" sessions every day. This helps the baby's development, and it also prevents flat spots on his head from sleeping on his back. “Babies need tummy time when mom and dad are awake, alert, and observing carefully,” advises Dr. Shapiro. “Tummy time is not sleep time—it’s development time.”
- RELATED: Does Your Baby Need a SIDS Monitor?
Side-sleeping isn’t safe, either.
Studies show that putting a baby down on her side rather than on her back doubles the SIDS risk. "It's easier for an infant to roll onto her tummy from her side than from her back," says Dr. Moon, who is also a member of the American Academy of Pediatrics (AAP) Task Force on SIDS. "And she may not yet have the skills to roll back in the other direction."
Don’t put anything in the crib except a fitted sheet.
Wait until your baby’s first birthday to put a pillow and blanket in the crib. Blankets, pillows, comforters, and stuffed toys can hinder your child's breathing; even soft or improperly fitting mattresses can be dangerous. If you're worried that your little one may get chilly, swaddle her in a receiving blanket or use a sleep sack. According to a Belgian study, swaddling helps fussy infants sleep better on their back and may protect them from SIDS by causing them to startle more easily. But always practice proper swaddling techniques, and don’t swaddle too tight. “Baby needs to be able to move around and have the ability to kick and squirm,” says Dr. Shapiro.
Maintain a comfortable temperature in the nursery.
Make sure you don't overheat your baby with swaddling or high room temperature. "A nursery that's too warm substantially increases an infant's SIDS risk," says Warren Guntheroth, M.D., professor of pediatrics at the University of Washington, in Seattle. That might be because the warm baby falls into such a deep sleep that it is difficult for him to awaken if he is in trouble. Set the thermostat at 68 degrees, don't put the crib near a radiator, and dress your child in light layers that you can remove easily if she gets hot.
Be careful with co-sleeping.
While co-sleeping in bed, your infant could be suffocated by a pillow or a loose blanket. His air supply may be cut off if you or your spouse inadvertently rolls over onto him. And he could be strangled if his head gets trapped between the headboard and mattress. The same dangers occur with co-sleeping on a couch or an armchair.
Despite numerous studies that confirm the heightened SIDS risk caused by co-sleeping, many moms continue to do it. According to a parents.com poll, 52 percent of readers do it all or some of the time, citing the added convenience for nighttime feedings and the security of having their infants next to them.
If you decide to co sleep, don't put your baby right in the bed. And think twice about a co-sleeping crib that clamps onto the frame of your bed, since “parents could still suffocate Baby with an arm or leg,” warns Dr. Shapiro. The best bet might be simply moving your baby's crib into your room.
Make sure your baby has enough room.
Your little one should be able to move around and squirm while sleeping. “A baby that can't move very well can get into dangerous positions that become compromising,” says Dr. Shapiro. He advises parents to avoid super-narrow bassinets and other small beds. “Position your baby with their hands out above their heads so they are freely movable, and don't wrap hips tight if swaddling,” he says.
Give your baby a pacifier.
Binkies actually reduce the risk of SIDS. "We don't know why yet," Dr. Moon says, "but it may be that sucking on a pacifier brings a baby's tongue forward, which opens the airway a little bit more." Or it could be that babies who use pacifiers don't fall into as deep a sleep as babies who don't. The AAP now recommends that you consider giving your child a pacifier at night and for naps during his first year. Note: If you're breastfeeding, don't introduce a Binky until your infant is 1 month old and nursing well.
Breastfeed, if possible.
Babies who are breastfed are more easily roused from sleep than formula-fed babies, which may be a reason breastfed babies are less likely to die from SIDS. Mothers who breastfeed are also less likely to smoke, and a baby's exposure to smoke—both in the womb and secondhand—increases the risk for SIDS, says Dr. Shapiro.
"If you are feeding your baby and think that there's even the slightest possibility that you may fall asleep, feed your baby on your bed, rather than a sofa or cushioned chair," said Lori Feldman-Winter, M.D., FAAP, member of the American Academy of Pediatrics (AAP) Task Force on SIDS. "If you do fall asleep, as soon as you wake up be sure to move the baby to his or her own bed," she said.
Talk with your childcare providers.
Just because you're up-to-date on SIDS safety doesn't mean your childcare provider is. Consider these frightening statistics: One out of five SIDS deaths occurs when a baby is in day care or being watched by someone other than a parent, according to research in the journal Pediatrics. And more than 20 percent of babies in day-care centers are put down for naps on their tummy. "Most states don't have safe-sleep guidelines for licensed providers," says Dr. Moon.
Review SIDS precautions with everyone who watches your child, whether it's a day-care worker, a babysitter, a relative, or a friend. They must know how to keep your infant safe while he sleeps, so you can rest easy.
Skip anti-SIDS gadgets.
Unless your baby has a diagnosed cardiac or respiratory illness, using an electronic breathing monitor doesn't help, studies show—and it may actually give parents a misguided sense of security. Devices marketed to reduce carbon dioxide rebreathing, such as crib mattresses with built-in fans, are also not proven to be effective. And avoid wedge-shaped sleep positioners that claim to keep your baby on her back: An infant can slide off and suffocate against it.
Summary of SIDS Prevention Strategies
In order to prevent SIDS, do these following things:
- Always put your baby to sleep on his back—never on his stomach or side.
- Have her sleep in a crib in your room. Never share your bed with your baby.
- Make sure the crib mattress is firm.
- Don’t put anything in the crib except a tight-fitting sheet. Avoid crib bumpers, blankets, pillows, and soft toys.
- Use a pacifier at sleep time.
- Try swaddling your child.
- Don’t smoke while pregnant, and don't allow anyone to smoke around your infant. Also, never expose your baby to other illicit drugs.
- Don’t overdress your child or put his crib near a heat source.
SIDS and Age: When is My Baby No Longer at Risk?
Although the causes of SIDS (sudden infant death syndrome) are still largely unknown, doctors do know that the risk of SIDS appears to peak between 2 and 4 months. SIDS risk also decreases after 6 months, and it’s extremely rare after one year of age.