How To Prevent SIDS

Every parent has heard of SIDS and has an appropriate fear of SIDS. The only way to mitigate the fear is to ensure that as a parent, you’ve done everything you can to prevent it.

What is SIDS?

SIDS is an acronym for Sudden Infant Death Syndrome. By definition, the death of an infant less than 1 year old can only be classified as SIDS if there is no explainable reason for the death (including a thorough investigation into the details surrounding the death and an autopsy performed). SIDS is the third leading cause of death in infants (first is congenital anomalies and second is prematurity with the associated problems).

When does SIDS happen?

Typically SIDS occurs between 1-6 months of life and will peak between 3-4 months. Interestingly, developmentally, babies start to roll around 4 months (when SIDS is peaking). Again, by definition, we don’t have the answer as to why the child died, but many experts think that the timing may have something to do with a child rolling, not being able to move the head/clear the airway, and suffocating. Technically speaking, SIDS can happen when a child is awake, but most cases happen when a child is asleep (between the hours of midnight and 8 am). Interestingly, there are more cases of SIDS in the winter months (which leads one to conjecture if overheating or extra blankets plays into that fact).

How do I prevent SIDS?

1. Sleep your baby on his/her back. The single most effective intervention in the prevention of SIDS came with the “Back to Sleep” campaign (now known as the “Safe to Sleep” campaign). When doctors started telling parents to sleep their babies on their back (instead of the side or stomach), the rates of SIDS dropped dramatically.
2. Reduce/modify risk factors. See the list of risk factors below. Anything that is modifiable (e.g., stop smoking) should be done. Clearly, some risk factors can’t be adjusted (e.g., age, race).
3. Breastfeed. If you have the option and are able, breastfeed. I know that there are extenuating circumstances that prevent breastfeeding, but if it is something you are toying with, but not certain of, consider the decreased risk of SIDS as another potential benefit.
4. Vaccinate your child. Children who have been vaccinated have a lower incidence of SIDS than those who have not been vaccinated.
5. Use a pacifier during nap time and bedtime. Studies show that pacifiers decrease SIDS. While pacifier use goes in and out of fashion, they are very much in fashion now due to the reduced SIDS risk. You may want to delay introducing the pacifier if breastfeeding is initially going poorly. Also, don’t force it if the baby isn’t interested. Don’t stress about replacing the pacifier if it falls out once the infant falls asleep. Don’t use pacifiers that are attached to things (e.g., stuffed animals or pacifier clips) as they are a strangulation risk.
6. Create the optimal sleep environment.

Risk factors for SIDS

1. Prematurity
2. Infants with IUGR (intrauterine growth retardation)—the infant who didn’t grow well in utero.
3. Native American and African American ethnicity
4. Young moms (younger than 20 years old)
5. Mothers who have had lots of children (the term is grand multiparity)
6. No or little/late prenatal care
7. Moms who smoked during pregnancy
8. Secondhand smoke exposure after birth
9. Pregnancies that are really close together
10. Moms who used cocaine or opiates (e.g., heroin) during pregnancy
11. Low socioeconomic status
12. Maternal infections (especially urinary tract infections or sexual transmitted infections)

(Note: This list is based on scientific evidence, not just my opinion or personal experience.)

How do I create the optimal sleep environment?

The best sleep environment is/has:

1. A roomy crib/bassinet with a well-fitting (no gaps between the mattress and the crib bars), firm mattress. A basinet by mom’s bed is completely acceptable in the beginning. Just move your baby to the bigger sleep environment by the time your child is starting to move (e.g., rolling side to side).
2. No soft bumpers (the net style is ok).
3. No big, fluffy, soft blankets. Whether a thin, receiving style blanket (like the ones they use at the hospitals) is acceptable is arguable. If I’m to be honest, I wrapped my newborns in a thin blanket until about 3-4 months (as they started to roll); I then transitioned out (due to risks of SIDS). Just make sure a swaddled baby is on his/her back (not side or belly). A “sleep sack” would be an acceptable alternative.
4. No pillows.
5. No stuffed animals.
6. The right temperature. (Think a comfortable temp for an adult, typically between 68-74 degrees is optimal). Overheating is known to increase risk SIDS.
7. No sleeping on a couch, sofa, chair, water bed, or other soft surface.
8. Avoid wedges or sleep positioners in the crib (they are suffocation risks).
9. Keep the infant close (new evidence supports even room sharing in the beginning), but NOT in your bed.
10. Smoke free.

Should I buy a “sleep monitor” to prevent SIDS?

This is tricky business. Parents are completely justified in being concerned and worried about whether they are doing everything they can to help keep their baby safe. The problem is that most of these products don’t actually have scientific evidence to support that they really prevent SIDS. In the defense of these monitors, they don’t actually “claim” to reduce SIDS, (but they certainly are creating a perfect path for parents to jump to their own conclusion that they do). They prey on parental fear.

Officially, the American Academy of Pediatrics (AAP) does NOT endorse them. Be careful not to be lulled into thinking that the monitor will save the day or compensate for poor sleep conditions (like tummy sleeping).

Of note, these sorts of monitors can be helpful for infants who have heart or lung issues. However, generally, if infants have these sorts of problems, they will be given medical/hospital grade equipment to help monitor at home.

Doesn’t back sleeping cause flat heads?

Yes, back sleeping does increase the risk of flat heads. However, I’d rather have an alive child with a flat head, than the alternative. Make sure your child gets lots of tummy time while awake to help prevent it. Also, don’t allow your infant to sleep in things like the car seat (that is, once you get back home). Move the child out of the seat. The seats are hard and can contribute to flat heads.

Does having one child die of SIDS mean others will also?

There is a slightly higher risk of SIDS in future siblings after an infant dies of SIDS. Whether this is due to an unmodified/unrecognized risk factor, some genetic component, or otherwise, we are uncertain, but the slightly higher risk exists nevertheless.

My most sincere sympathy and love extends to anyone who has ever had to deal with SIDS in any fashion. Death by SIDS is a tragedy. Hopefully, together we prevent more from happening.