SIDS Prevention

Sudden Infant Death Syndrome (SIDS) is one of the most devestating events that can ever happen to a parent. Unfortunately, the medical community has not found a direct cause of SIDS, but at least, much research has been done to look into how we can decrease the risk SIDS from occurring. Much has changed since “back in the day” of how grandmothers and great-grandmothers took care of their children. Although we grew up strong and well as parents, we were considered lucky, by all means.

Here is what we do know about SIDS:

SIDS occurs most often between the ages of 1 month to 4 months. The incidence rate significantly tapers off at 6 months of age, but precautions are recommended until 1 year of age as there are still cases of SIDS deaths between 6 months and 1 year.

SIDS probably occurs because of the “convergence” of triggers (e.g. poor air-flow, over-heating, etc.) along with a critical developmental age and the under-developed respiratory and cardiac systems (heart and lungs) that increase the potential risk of SIDS.

How Do We Decrease the Risk of SIDS?

BACK TO SLEEP – placing your infant on his or her back to sleep every time he or she sleeps is one of the major recommendations noted since dating back to even 1994 when SIDS research started becoming more prevalant. Since then we have noticed a 50% drop in SIDS cases, which even more supports this advice. Unfortunately, because babies are being placed on their back to sleep, we are seeing more cases of “flat head” or plagiocephaly. It is very important to have supervised tummy time during playtimes with mom or dad and to vary the different head positions when the baby sleeps.

When the baby learns to roll, then it is fine if he or she chooses to sleep in a different position. The main point is: set them to sleep on their back, and then don’t worry about it if they roll around and you wake up in the morning and they’re on their stomach.

There have been questions of whether “side sleeping” is an appropriate alternative. The recent research has brought about the newest recommendations that “side sleeping” is now NOT an appropriate alternative and that only back sleeping should be advised.

The only time an infant should deviate from this recommendation is if the risk of Gastrointestinal Reflux exceeds that of SIDS. This is a crucial medical decision that willl likely involve the advice of a Pediatric Gastroenterologist.

QUIT SMOKING – research supports the idea that smoking increases the risk of SIDS in-utero (while baby/fetus is still in the womb) as well as when he or she is an infant. Research further concludes that smoking increases the incidence of pre-term or very small babies which is a group also with increased risk of SIDS. Animal studies show that smoking alters the development of receptors in the body that serves to regulate the automatic function of our breathing (if you notice, we don’t think to breathe, we just do it). Smoking and sleeping with your infant in your own bed greatly increases the risk of SIDS.

SAFE SLEEPING SURFACES – Crib safety is one of the key factors in SIDS prevention. Some older cribs passed down through the generations may not meet the newest guidelines for crib safety. Of note, make sure the cribs do not have folding or sliding side rails, that the space between each rail is about a can of pop in width, that it has a sturdy base, that it does not have any protruding hardware, and that it has a firm well-fitting mattress and sheets. Increased risk of suffocation can occur with soft bedding, bumpers, pillows, positioners, stuffed animals and toys. Basically, to you, the crib will look like a most boring, uncomfortable, confined space, but it does reduce the incidence of SIDS. Further recommendations state that loose bedding whether over or under the child (blankets, quilts, sheepskins, comforters, etc.) can increase the risk of SIDS due to suffocation risks.The same rules apply for bassinets, playards or any place a baby will be found sleeping. Most discouraged is a baby falling asleep in a tired parent’s arms on a sofa or in bed or a child left on a sofa or chair to sleep. Also the AAP warns against the use of car seats, slings, bouncers or “other sitting devices” as a routine sleeping place for the baby. Slings in particular are potentially hazardous places and a baby should be routinely monitored for appropriate air flow and sleep position while in a sling.

ROOM-SHARING BUT NOT BED-SHARING – The newest recommendations from AAP states that research shows a lower incidence of SIDS when the baby sleeps in the room with parents,  but not on the same sleep surface. Therefore, a bassinett or crib co-sleeper pulled to the side of the bed is ok, but sleeping with the baby in your bed is not.

BREAST-FEEDING IS GOOD – Breastfeeding has been shown to decrease the risk of SIDS. It is not safe, however, to keep the baby in bed with you after the feeding session is over. Always return the child to his or her sleeping area to prevent suffocation risks. If you can’t breastfeed for whatever reason, do not tear yourself apart over guilt regarding this. Just make sure you do most everything else to prevent SIDS, and you are still a great parent!

BABY MONITORS MAY NOT BE HELPFUL – Studies show that unless the baby has been diagnosed with an ALTE (Apparent life-threatening event) such as true apnea (you should discuss this with your physician), then monitors do not improve the risk and may not be helpful in the prevention of SIDS.

DON’T OVERHEAT – Overheating the baby, whether by over-bundling or keeping the room warm can increase the risk of SIDS. AAP suggests to keep the room well-ventilated and cool. Fans may or may not be helpful, but the study that looked into this was small and biased, so no recommendations can be made of this as yet.

PACIFIERS ARE A GOOD THING (when very young) – Binkies have been noted to be helpful at naptimes and bedtimes to reduce the incidence of SIDS. The recommendation involves offerring the pacifer and if refused or falls out of the mouth, to not replace or force the issue.

REGULAR PRENATAL CARE – Getting good, regular pre-natal check-ups prior to the birth of the baby is very important in having a normal, healthy pregnancy, or catching medical issues early so that they may be addressed. This has been shown to decrease the incidence of SIDS.

IMMUNIZATIONS ARE NOT HARMFUL – Multiple immunizations have not shown to increase the incidence of SIDS. So, please, protect your little one and immunize them from the multitudes of tragedy-inducing infections out there.

DON’T USE BAD STUFF – Illicit drugs (marijuana, cocaine), smoking tobacco, alcohol during and after pregnancy are not recommended and may increase SIDS occurrence. We already know “bad stuff” is “bad” so just stay away from it if you care about your little one, which I hope you do.

In the end, SIDS prevention is a mish-mash of recommendations of being a good, healthy parent so that you may have a good, healthy baby, and to keep the sleeping area firm, open, well-ventilated, cool and… well, boring, and put your baby on his or her back to sleep and offer a pacifer. Instead of monitors, keep the baby in your room, but not on your bed, and don’t do unhealthy bad things.

Source: Moon RY, Darnell RA, Goodstein MH, Hauck FR. American Academy of Pediatrics, Task Force on Sudden Infant Death Syndrome. SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment. Pediatrics. 2011;128(5):1341–1367

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