Protecting your newborn from the risk of SIDS

SIDS causes up to 3,000 deaths a year in the US and is one of the leading causes of the deaths of babies under one year old. The single best way to decrease the probability of SIDS is to put babies to sleep on their backs, for both night time sleep and day time naps.

How common is SIDS?

Approximately one in two thousand infants will die of SIDS before the age of twelve months. This constitutes about 7% of all infant deaths. It has to be remembered though that neonatal mortality (deaths of newborns younger than 28 days) accounts for over 60% of the infant deaths, while the peak incidence of SIDS is at 8-10 weeks old.  Outside the neonatal period, SIDS is even more significant cause of death of babies.

What is SIDS?

SIDS (Sudden Infant Death Syndrome), also known as cot death or crib death, is not a specific medical condition or disease, but rather a catch-all umbrella label which is applied to infant deaths which are sudden and unexpected. The SIDS label is normally used for a death of an otherwise healthy infant, whose medical history as well as forensic autopsy do not give explanation for the possible causes of death. It is not known what causes SIDS as, by definition, SIDS is a death brought by undetermined causes.

What causes SIDS?

Although the causes of SIDS are by definition unknown (any death with a known cause will not be counted as a SIDS death), there are several theories as to what might cause it, the most popular one at the time of writing in 2011 being one attributing SIDS to brain immaturity leading to problems with breathing control.

Although it’s not known what causes SIDS, there are known risk factors for the infant dying of SIDS. SIDS is more common in male infants, African-American and Native-American ones, babies born to a young mother of lower socio-economic and educational status (education rather than social status appear to be the main factor in the US). The differences between ethnic groups are likely to do with education and social status rather than ethnicity per se. In addition to these factors that are beyond individual’s control, there are also several others, entirely or largely under parents control. Although carers can not prevent SIDS, they can significantly lower the risk of it.

How to prevent SIDS before birth

Premature birth is a major risk factor for SIDS, so good medical care (checkups either from a doctor or a midwife) during pregnancy is the first step to decreasing the risk of premature delivery and lowering the risk of SIDS.

Nicotine and hard drug (heroine and cocaine) use during pregnancy are risk factors. Give up or reduce smoking and try not to use or limit nicotine replacement products if possible. Don’t use hard drugs while pregnant.

Avoid underage and frequent pregnancy. SIDS is most common among teenage mothers and when one pregnancy follows another within a year or less.

Low birth weight is a significant risk factor for SIDS, so good nutrition and non-smoking during pregnancy is likely to lower the risk of crib death.

How to prevent SIDS after birth

Put the baby to sleep in their back, at night, for day time naps and in day-care.  The one most significant and effective step to lowering the risk of SIDS is the supine sleeping position, or putting the baby to sleep on their back rather than on their front. This has been shown to decrease the risk of SIDS by as much as a factor of 12 and is the best way to prevent cot death. This applies to daytime naps as well as night sleeping and to sleeping at daycare as well as at home. Side sleeping is safer than sleeping prone, but it still increases the risk of SIDS. Infants who sleep on their stomachs sleep deeper sleep and are harder to rouse. Although that means less disturbance in the sleep for parents and babies, there significantly higher risk of SIDS is not worth it.

Avoid overheating or overcooling the baby. Winter is the period when the incidence of SIDS is higher which might be connected to overdressing and overheating the infants but there is some evidence that being too cold is a risk factor too. Keep the room in which the baby sleeps at around 18C-21C. As far as clothing and covers go, American SIDS Institute recommends nothing but enough clothing to keep the baby warm. In the UK, light clothing depending on temperature and one cot sized sheet and light (cellular) blanket are advised.

Use a firm mattress and no or light covering (see point above). No pillows, cuddly toys, cot bumper pads or anything else should be in the crib.

Avoid exposing the baby to people who are ill as well as crowded, enclosed spaces. Ask people to wash their hands before handling the baby and don’t let people who are ill touch the infant. Respiratory or gastro-intestinal infections a week to ten days before are a risk factor for SIDS.

Don’t smoke – ideally not at all, but never in the room or the car where the baby is present and never in the bedroom. Apply the same rule to your partner or any visitors. Exposure to tobacco smoke is a risk factor for SIDS as well as respiratory infections.

Breastfeeding is associated with lower risks of SIDS, although it’s not clear whether it’s because it protects against some infections or via association only (in the US, breastfeeding is associated with higher education levels).

Keep the infant’s crib in the carer’s bedroom for the first six months. Possibly because babies sleep a lighter sleep when in the same room as adults, this reduces SIDS risks.

There is mixed evidence as to the effect co-sleeping has on SIDS risks. Normal adult beds are not suitable for infants and co-sleeping in those poses some risk of suffocation and entrapment. American SIDS Institute recommends that babies never sleep in adult beds. If considering co-sleeping, don’t put an infant between adults, remove pillows, heavy duvets and blankets, consider also sleeping on a firm, low level mattress (e.g. a Japanese style futon). Ideally, though, use a drop-side cot/crib adjacent to and level with or slightly lower than an adult bed. Never sleep with a baby if you have been drinking alcohol, taking drugs or are extremely tired. Don’t sleep with a baby if you or your partner sharing the bed smokes.

There is no evidence that special devices marketed for keeping babies on their back reduce the risk of SIDS. Special, ventilated or covered mattresses have not been shown to make difference. Immunization or chemicals used in fire retardants don’t cause SIDS and there is some evidence that having the DTP shots is associated with lower risks.

Although crib death cannot be prevented with certainty, taking the steps described above should go a long way towards reducing the risks. If in doubt, talk to the medical professional taking care of you and the infant. Contact the doctor or health visitor immediately if the infant has episodes of not breathing, going limp or turning blue.