Back to Sleep and Sudden Infant Death Syndrome

October is Safe Sleep and SIDS Awareness Month. One of First Chance for Children’s Board Member, Dr. Andrew Quint, wrote about his experiences with Sudden Infant Death Syndrome (SIDS) as a pediatrician. It’s important to understand what SIDS is, and how to prevent it to best protect our loved ones. Warning: this article discusses child death.

Read what Dr. Quint has to share below:

When I was in training as a pediatric resident in the early 1990s I was often called to the emergency room to try to resuscitate a baby who had been found unresponsive in their crib. Most often the baby was less than 4 months of age and most often the baby could not be saved and died. At that time we didn’t have a very good idea what caused these deaths and we couldn’t offer parents any good advice for how they could prevent these tragedies. The cause of these deaths was named Sudden Infant Death Syndrome (SIDS) because the deaths were sudden, with no warning signs, and they occurred almost exclusively in infants. SIDS has also been called “crib death.”

Most SIDS deaths happen in babies between 1 month and 4 months of age, and the majority (90%) of SIDS deaths happen before a baby reaches 6 months of age. However, SIDS deaths can happen anytime during a baby’s first year. SIDS always occurs while babies are sleeping. SIDS is the leading cause of death for infants between 1 month and 1 year of age.

When I was training to be a pediatrician we routinely recommended to parents that they place their babies on their stomachs to sleep. The common thinking at that time was that this was a safer position than on their backs because there was a concern that if the baby vomited during sleep they might choke and die. Research, however, found that if infants were placed to sleep on their stomachs, their risk of dying from SIDS increased by at least two-fold.

As a result of such research, the “Back-to-Sleep” Campaign was initiated in 1994 by a collaboration between several organizations including the American Academy of Pediatrics (AAP) and SIDS groups. This campaign encouraged parents to put their babies to sleep on their backs in order to reduce the risk of SIDS.

Subsequent research found that between 1993 and 2010, as a result of this campaign, the percent of infants placed to sleep on their backs increased from 17% to 73% and the number of infants dying from SIDS decreased by 70%. Still, in 2017, 1360 babies died of SIDS so the problem has not gone away.

AAP Safe Sleep Environment Recommendations 

  • Until their first birthday, babies should sleep on their backs for all sleep times—for naps and at night. We know babies who sleep on their backs are much less likely to die of SIDS than babies who sleep on their stomachs or sides. Some babies will roll onto their stomachs. You should always place your baby to sleep on the back, but if your baby is comfortable rolling both ways (back to tummy, tummy to back), then you do not have to return your baby to the back. However, be sure that there are no blankets, pillows, stuffed toys, or bumper pads around your baby, so that your baby does not roll into any of those items, which could cause blockage of air flow.
  • Use a firm sleep surface. crib, bassinet, portable crib, or play is recommended along with a tight-fitting, firm mattress and fitted sheet designed for that particular product. Nothing else should be in the crib except for the baby. A firm surface is a hard surface; it should not indent when the baby is lying on it.
  • Never place your baby to sleep on a couch, sofa, or armchair. This is an extremely dangerous place for your baby to sleep.
  • Room share without bed sharing—keep baby’s sleep area in the same room where you sleep for the first 6 months or, ideally, for the first year. Place your baby’s crib, bassinet, portable crib, or play yard in your bedroom, close to your bed. The AAP recommends room sharing because it can decrease the risk of SIDS by as much as 50%. In addition, room sharing will make it easier for you to feed, comfort, and watch your baby.
  • Bed-sharing is not recommended for any babies-bed-sharing in an adult bed not designed for infant safety exposes the infant to additional risks for accidental injury and death, such as suffocation, asphyxia, entrapment, falls and strangulation.
  • Only bring your baby into your bed to feed or comfort. Place your baby back in his or her own sleep space when you are ready to go to sleep. If there is any possibility that you might fall asleep, make sure there are no pillows, sheets, blankets, or any other items that could cover your baby’s face, head, and neck, or overheat your baby. As soon as you wake up, be sure to move the baby to his or her own bed.
  • Keep soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation out of the baby’s sleep area. These include pillows, quilts, comforters, sheepskins, blankets, toys, bumper pads or similar products that attach to crib slats or sides. These can obstruct an infant’s nose and mouth. A large percentage of infants who die of SIDS are found with their head covered by bedding. Therefore, no items that could obstruct infant breathing or cause overheating should be in the bed. If you are worried about your baby getting cold, you can use infant sleep clothing, such as a wearable blanket. In general, your baby should be dressed with only one layer more than you are wearing.
  • Avoid overheating and head covering in infants
  • Try giving a pacifier at nap time and bedtime. This helps reduce the risk of SIDS, even if it falls out after the baby is asleep. If you are breastfeeding, wait until breastfeeding is going well before offering a pacifier. This usually takes 2-3 weeks. If you are not breastfeeding your baby, you can start the pacifier whenever you like. It’s OK if your baby doesn’t want a pacifier. You can try offering again later, but some babies simply don’t like them. If the pacifier falls out after your baby falls asleep, you don’t have to put it back in. Pacifiers that attach to infant clothing, stuffed toys, or other objects should not be used with sleeping infants.  
  • Do not smoke during pregnancy or after your baby is born. Keep your baby away from smokers and places where people smoke. Infants are at greater risk for SIDS from exposure to tobacco smoke because some of the chemicals in tobacco smoke and nicotine impair the brain and lung development of infants.
  • Breastfed babies have a lower risk of SIDS. Breastfeed or feed your baby expressed breast milk. The AAP recommends breastfeeding as the sole source of nutrition for your baby for about 6 months. Even after you add solid foods to your baby’s diet, continue breastfeeding for at least 12 months, or longer if you and your baby desire.
  • Make sure your baby has tummy time every day. Awake tummy time should be supervised by an awake adult. This helps with baby’s motor development and prevents flat head syndrome

Looking for more information?

  • For more information about SIDS click here.
  • Learn about our CRIBS program here.
  • Watch the ABC’s of safe sleep below.