Prevention of SIDS

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In most cases of sudden infant death syndrome, the baby has no risk factors and the sudden, unexpected infant death could not have been prevented. SIDS usually does not occur as a result of anything that a parent did or didn't do wrong.

Although SIDS cannot always be prevented, there are a number of precautions parents and caregivers can take to help reduce the risk. Most of these precautions are easy to implement.

Always put a baby to sleep on his or her back. It is important to do this every time a baby sleeps—at bedtime and nap time. Babies who are sometimes placed on their stomachs have a higher risk than babies who are always placed on their backs. In fact, studies have shown that when babies are placed on their backs to sleep and then are placed on their stomachs the next sleep time, the risk for SIDS increases 7 to 8 times. Side sleeping is not recommended since a baby can roll over to his or her stomach.

Some infants develop flattening of the head (called positional plagiocephaly) from lying on their backs too much. To help reduce this misshaping, change the baby's position in the crib every week or so. For example, place the baby's head at the opposite end of the crib so that he or she is facing the other direction. Never place the baby on his or her side or stomach to sleep without supervision.

Doctors often recommend "tummy time" during which the infant is placed on his or her stomach while a responsible person is watching closely and the baby is wide awake. Tummy time also helps a baby develop muscles in the neck, shoulder, and back that will help with crawling and sitting up later on. Parents also are advised to hold the baby upright at different intervals during the day and to avoid placing the baby in car seats, bouncers, and carriers too often.

Some parents are concerned that a baby sleeping on its back is more likely to choke on vomit or spit-up. According to the American Academy of Pediatrics (AAP), lying on the back does not increase this risk. Babies normally cough up or swallow fluids on their own with no choking problems. Note: Parents of babies who have been diagnosed with gastroesophageal reflux disease (GERD) or certain upper airway problems should consult their doctors about back sleeping. In some cases, stomach sleeping is recommended, but this should always be at the recommendation of the child's physician.

Make sure the infant's sleep surface is firm with no extra bedding or pillows. The crib, which should be approved by the Consumer Product Safety Commission, should have a firm mattress that fits snugly in the frame. The crib sheet should fit tightly and all other items, including pillows, bumpers, blankets, and plush toys should be removed.

Under no circumstances should a baby sleep on an adult bed, couch, pillow, waterbed, or sheepskin. Soft surfaces can cause suffocation, as exhaled air can become trapped in the space between the sleep surface and the baby's mouth. If the baby is unable to move, he or she will breathe in exhaled air, causing oxygen levels to drop and carbon dioxide levels to rise to a dangerous range.

Do not co-sleep with a baby. Co-sleeping with a baby is dangerous for the baby. A baby should sleep in his or her own space. Cribs, cradles, bassinets, or co-sleepers (which attach to an adult bed) are all acceptable, but the baby should not sleep in an adult bed. It is fine for the baby to sleep in the same room as the parents; in fact, this can reduce the risk of SIDS.

In many cases, infant death associated with co-sleeping is not the result of SIDS but of accidental asphyxiation. Babies can suffocate if a parent changes sleep position and blocks the airway. Infants who sleep face to face with a parent can breathe in carbon dioxide that the parent exhales. Soft, fluffy bedding can suffocate an infant as well.

Watch for overheating. The baby's room temperature should be comfortable for an adult in a short-sleeved shirt. Excessive clothing and blankets are not necessary. If a blanket is used, the infant should be placed in the crib with toes touching the foot of the crib frame and the blanket should be placed around the baby, no higher than the waist, with the sides firmly tucked beneath the mattress. It is safer to dress the infant in an appropriate-weight sleeper and forego the blanket entirely.

Do not smoke, drink, or use drugs during pregnancy and do not allow secondhand smoke near a baby. All of these activities can cause problems, before and after delivery. Smoking during pregnancy triples the SIDS risk and exposure to secondhand smoke doubles the risk. Studies have shown that secondhand smoke emits chemicals that affect the way the brain controls breathing.

See the doctor regularly. Women who are pregnant should seek proper prenatal care throughout the pregnancy. Follow a healthy diet and take steps to prevent a premature birth or low birth weight. After the birth, the baby should be examined by his or pediatrician regularly.

Breastfeed exclusively until the infant is at least 6 months old. Some studies have shown that breast milk provides extra protection from certain respiratory and gastrointestinal infections that increase the risk for SIDS.

Be wary of products that claim to reduce the risk of SIDS. Some products, such as mattresses with ventilation systems that control the level of carbon dioxide, have not been properly tested or approved by the medical community. Also, a baby monitor is not a safeguard against SIDS.

Avoid teenage pregnancy and space pregnancies at least 1 year apart. Babies born to teenage mothers are at a higher risk for SIDS than babies born to older women. The risk increases with the number of children a teenage mother bears. At least a 1 year interval between births reduces the risk for SIDS.

Take steps to reduce other health risks. Properly clean all items that the baby comes into contact with. Anyone that holds the baby should wash his or her hands first. Family members and friends who have a respiratory or gastrointestinal infection or other communicable illness should stay away from the baby until the infection or illness is better.

Contact a doctor immediately if the baby has episodes of stopped breathing, turning blue, going limp, or increased gagging after spitting up.

Communicate with family, friends, and caregivers. Make sure they know strategies to prevent SIDS, such as back sleeping.

For more information, please go to the Safe to Sleep Public Education Campaign.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 27 Aug 2008

Last Modified: 06 Oct 2015