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How to Reduce the Risk for SIDS

For more than a decade, pediatricians have urged parents to put babies to sleep on their back. The goal: Reducing sudden infant death syndrome (SIDS).

That strategy seems to be working--but millions of parents still haven't gotten the message, according to the American Academy of Pediatrics (AAP).

The AAP first recommended that infants sleep on their back in 1992. That year, seven out of 10 parents were letting babies sleep on their stomach, according to the National Institute of Child Health and Human Development (NICHD). The National Center for Health Statistics says 120 out of every 100,000 babies were falling victim to SIDS--the unforeseen death of an otherwise healthy infant, usually while sleeping.

By 1997, those agencies reported a dramatic shift. Fewer than two out of 10 parents were putting infants to sleep on their stomach--and the death rate from SIDS had fallen 36 percent, to 77 out of 100,000 births. By 2005 only about 15 percent of parents were putting infants to sleep on their stomach. Since the Back to Sleep Campaign began in 1992, the rate of SIDS has dropped more than 50 percent.

Why don't all parents heed the advice that the AAP considers so sound?

  • Some parents fear children will choke on their vomit. However, research has found that babies who sleep on their back have no additional risk of choking on vomit. There may actually be a greater risk for choking on vomit when babies are placed on their stomach.

  • Some workers at child-care centers aren't getting the message.

  • Grandparents who care for an infant believe the old way is best.

  • Parents believe SIDS is very rare.

What is known about SIDS?

The cause of SIDS remains a mystery. But the following is known about SIDS, according to the NICHD:

  • Babies who sleep on their stomach are much more likely to die from SIDS than babies who sleep on their back.

  • Babies who sleep on or under soft bedding are more likely to die from SIDS.

  • Babies who usually sleep on their back but who are then placed on their stomach, such as for a nap, are at very high risk for SIDS. So it's important for everyone who cares for your baby to use the back sleep position for naps and at night.

The AAP says SIDS occurs most often during a baby's first 6 months of life, particularly between 2 and 3 months of age.

African-American babies are more than two times as likely to die from SIDS as white babies, and American Indian/Alaskan Native babies are nearly three times as likely, according to the NICHD.

What can be done to decrease the risk of SIDS?

Doctors currently have no way of predicting which babies will die from SIDS. But parents can take several measures to lower the risk.

  • Get prenatal care. Early and regular prenatal care can help reduce the risk for SIDS. Mothers-to-be should follow a healthy diet, avoid smoking or using drugs or alcohol, and get frequent medical checkups. These steps might help prevent a baby from developing an abnormality that could put him or her at risk for sudden death. These measures may also reduce the chance of having a premature or low birth weight baby, which also increases the risk for SIDS.

  • Put your baby on his or her back for sleep, even at naptime. Parents and other caregivers should put babies to sleep on their back instead of on their stomach or side. Studies have shown that placing babies on their back to sleep has reduced the number of SIDS cases by as much as a half in countries where babies had traditionally slept on their stomach. The back sleep position is the best sleep and nap position for babies from 1 month to 1 year of age. Although many parents are afraid babies will choke on spit-up or vomit if placed on their back, studies have not found any evidence of increased risk of choking or other problems. Always talk with your child’s doctor before raising the head of the crib if your baby has been diagnosed with gastroesophageal reflux.

  • Place baby on his or her stomach while awake and under supervision. For motor development of the shoulders, your baby should get a certain amount of tummy time while he or she is awake and being observed by you or another caregiver. In addition, tummy time may help prevent flat spots from developing on the back of your baby's head. Such physical signs are almost always temporary and will disappear soon after your child begins to sit up.

  • Avoid using car seats, strollers, infant carriers, and infant swings for routine sleep and daily naps. These devices may lead to possible obstruction of an infant’s airway or suffocation. Always place cribs, bassinets, or play yards in hazard-free areas, with no dangling cords or wires to reduce the risk for strangulation.

  • Use proper bedding. Make sure that your baby sleeps on a firm mattress or other firm surface covered by a fitted sheet. Don’t use fluffy blankets or comforters under your baby. Don’t let your baby sleep on a waterbed, sofa, sheepskin, a pillow, or other soft materials. When your baby is very young, don’t place soft stuffed toys or pillows in the crib. Some babies have smothered with these soft materials in the crib. 

  • Control temperatures and avoid overheating. Avoid overbundling, overdressing, or covering your infant’s face or head to prevent him or her from getting overheated. Babies should be kept warm, but not too warm. An overheated baby is more likely to fall into a deep sleep from which it is difficult to arouse him or her. Keep the temperature in your baby's room at a level that feels comfortable to you.

  • Share your room. Place your baby's crib or bassinet in your bedroom for first six months. The risk for SIDS is reduced when a baby sleeps in the same room as the mother.

  • Avoid sharing your bed. Recent scientific studies have shown that bed sharing can alter sleep patterns of both mother and baby. Although sharing a bed may have certain benefits, such as encouraging breastfeeding, no scientific studies have shown that this arrangement reduces the risk for SIDS. And some studies suggest that under certain conditions, bed sharing may actually increase the risk. Also avoid putting your baby to sleep in a bed with other children or on a sofa with another person, because these situations have also been found to increase the risk for SIDS. You can bring your infant to your bed for feedings and comforting, but you should return your child to his or her crib for sleep. Bed-sharing is also not recommended for twins or other multiples.

  • Keep a smoke-free environment. Don’t smoke when you are pregnant and don’t let anyone smoke around your baby. Smoking in pregnancy is a major risk factor for SIDS. Babies and young children exposed to secondhand smoke have more colds and other diseases, as well as an increased risk for SIDS.

  • Take your child for regular checkups and Immunizations. If your baby seems sick, call your doctor right away. Parents should take their babies for regular well baby checkups and routine immunizations. Claims that immunizations increase the risk for SIDS are not supported by research. If a baby ever has an incident in which he or she stops breathing and turns blue or limp, the baby should be medically evaluated for the cause of such an incident.

  • Breastfeed your baby. Breastfeeding is strongly recommended for at least six months due to its association with the reduced risks of SIDS and its protective effects.             If possible, you should breastfeed your baby because breast milk can provide protection from some infections that can trigger sudden death in babies.

  • Beware of home monitors for babies at risk. Avoid using home cardiorespiratory monitors or other devices like wedges, positioners and special mattresses that are marketed to decrease the risk for SIDS and sleep-related infant death. Although some electronic home monitors can detect and sound an alarm when a baby stops breathing, there is no evidence that such monitors can prevent SIDS. In 1986, the National Institutes of Health recommended that home monitors not be used for babies who do not have an increased risk for sudden unexpected death. The monitors may be recommended, however, for babies who have experienced one or more severe episodes during which they stopped breathing and required resuscitation or stimulation. They can also be used for premature babies with apnea (stopping breathing), and for siblings of two or more SIDS babies. If an incident has occurred, or if a baby is on a monitor, parents need to know how to properly use and maintain the device, as well as how to resuscitate their baby if the alarm sounds.

  • Offer pacifiers during sleep time. The American Academy of Pediatrics recommends that parents offer a pacifier for the first year of life during routine sleep and nap time. The pacifier should not be sugarcoated. Clean and replace pacifiers often. Don’t offer a breastfed infant a pacifier until one month after breastfeeding has been firmly established.