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Newborn Issues
: SIDS: Sudden Infant Death Syndrome


About Sudden Infant Death Syndrome (SIDS)

Tragically, SIDS, sometimes referred to as crib death is a leading cause of death in babies. In the USA there are about 3,000 SIDS deaths per year. 90% of SIDS deaths occur during the first 6 months of life, most between 2 and 4 months. SIDS occurs more often in male babies. Also, African-American and Native American infants have a higher rate of SIDS as compared to Caucasian, Asian, or Hispanic babies.

It is also known that SIDS victims are more likely to be born to a young mother with a lower educational level. SIDS tends to occur more in colder geographic areas and during the winter. Recent illness, such as upper respiratory infection or gastroenteritis, is commonly reported.

What causes SIDS?

SIDS is technically defined as the sudden death of a previously healthy baby younger than 1 year of age. An infant's death is attributed to SIDS only if no other cause of that death is found after a thorough investigation. There are many misconceptions about what causes SIDS, and although the exact cause is not understood, it is known that SIDS is not caused by infections or immunization.

SIDS is not thought to be caused by suffocation, vomiting and choking, or child abuse. The current thinking seems to focus on 3 main factors: age of a child, combined with a problem in the control of breathing as well as the presence of certain risk factors. These risk factors include:

  • *Prone sleeping position(sleeping on the stomach),
  • Soft bedding
  • Cigarette smoke exposure(even during pregnancy)
  • Overheating
  • Prematurity

    *Prone sleeping(sleeping on the stomach), the most important risk factor within a parent's control, increases the risk of SIDS by 10 to 15 times.

    Prevention of SIDS:

    The only approach to SIDS is prevention, aiming to eliminate some of the risks that are within our control:

    Sleep position



    Sleeping on the back is the most effective way to reduce the risk of SIDS. This applies to night-time as well as day-time naps at home, at the babysitters and even in daycare; SIDS can occur during the day and 20% of SIDS deaths occur in child care setting(baby sitter or day care).
    Remember that a baby can be in the prone(on stomach) while awake. Since experts began promoting the "baby-on-back" sleep position in 1992, the number of SIDS deaths in the US has declined by 40% from 1.2 to 0.7 deaths per 1,000 births.

    IMPORTANT:Babies who sleep on their side are at twice the risk of SIDS as a babies who sleep on their backs. The side position is not very stable, so a baby can easily roll onto the prone(on stomach) position.

    Avoid soft bedding and over-heating:

  • In baby's crib: Avoid soft bedding, including blankets and comforters, quilts, pillows, stuffed toys, sheepskins, and crib bumpers
  • If blankets are necessary, only one thin blanket should be used, and it should be tucked in so that it cannot cover baby's head(In cold weather, a blanket sleeper is an alternative to a blanket)
  • Select a crib that conforms to Consumer Product Safety Commission recommendations and that has a firm and snug-fitting mattress
  • Never put a baby to sleep on a waterbed, sofa or couch, soft mattress, pillow, adult beds or other soft surface
  • Avoid overheating; use light clothes for sleep and keep the room at a temperature of about 70 F

    No Smoking:

    Cigarette smoke exposure during pregnancy and secondhand smoke exposure after birth are important risk factors for SIDS. The more a baby is exposed to smoke, the higher the risk. This is one risk factor that parents can definitely control.

    Breastfeeding protects against SIDS

    For reasons not well understood, breastfeeding may have a protective effect against SIDS. Yet another good reason to breastfeed your baby.

    It's important to realize that removing risk factors decreases but does not completely eliminate the risk of SIDS.

    Practical issues:

    Are there adverse effects if babies sleep on their back all the time?

    Very few. Studies have shown that supine sleepers had a slightly higher incidence of diaper rash and cradle cap as compared to babies who sleep on their stomachs(prone). Positional occipital plagiocephaly(flattened back part of the head)tends to be more common in babies who sleep on their backs.

    Can baby choke or aspirate when back sleeping?

    Multiple studies in countries that have had more experience with back sleeping than the US, have not shown any increase in the rate of choking or aspiration related to sleeping on the back.

    Can baby ever be put on his/her stomach?

    Yes, the " baby on back position" reccomendation applies only for sleep time. As a matter of fact, the American Academy of Pediatrics recommends that infants spend time in the prone position every day while awake. This decreases the incidence of positional plagiocephaly and promotes motor development.

    What about special devices or matresses?

    Devices marketed as being able to keep babies on their back or side are not recommended. Also, several manufacturers have marketed ventilated mattresses and wedges designed to keep babies on their back or in the side position. There is no evidence that these products prevent SIDS; wedges have not even been studied. Most mattresses that are advertised as protecting against SIDS have been shown not to help the breathing control problem related to SIDS. In addition,the use of such products may make parents too relaxed about maintaining the other measures that do reduce the risk of SIDS.

    Is sleeping with baby dangerous?

    Sleeping with baby in the same bed as the parents occurs in many cultures outside of North America. However, there is much controversy about the benefits and risks of co-sleeping. In fact, tragically, babies have died while co-sleeping with their parents. The fear is that although co-sleeping may facilitate breastfeeding, and promote bonding, it may also result in overheating and exposure to passive cigarette smoke. Experts also fear that baby may be sleeping on a soft mattress with pillows and quilts and may be at risk of getting caught or trapped between the bed and wall or headboard. According to The American Academy of Pediatrics, co-sleeping does not protect against SIDS and in fact, may increase the risk of accidental suffocation.

    Still, many parents strongly promote "co-sleeping". If parents choose to share their bed with baby, they need to realize that it is not the crib that causes crib death and need to take the following precautions:

  • Place baby on his/her back
  • Be aware of the risk of entrapment, as adult beds do not meet child safety standards
  • To prevent accidental suffocation, avoid soft sleep surfaces, quilts, and pillows
  • Do not from smoke or use substances that may make you drowsy or not easily arousable(drugs, alcohol)

    REMEMBER THOUGH: The safest place for your baby to sleep is in a crib close to your bed.
    Other Newborn Issues Topics

    The information provided in this site is designed to be an educational aid only. It is not intended to replace the advice and care of your child's physician, nor is it intended to be used for medical diagnosis or treatment. If you suspect that your child has a medical condition, always consult a physician.

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