Despite years of research, sudden infant death syndrome [SIDS] is still a devastating challenge for both families and the medical world. SIDS is part of a phenomenon known as sudden unexplained infant death syndrome [SUIDS], according to Steven A. Shapiro, D.O., chair of the Pediatrics Department at Abington-Jefferson Health.
The good news is that the incidence of SIDS has dropped tremendously since the launch of the Safe to Sleep [formerly Back to Sleep] campaign in 1994. Yet the Centers for Disease Control and Prevention [CDC] reports about 3,400 sudden and unexpected infant deaths occur each year in the U.S.
The unpredictable nature of SIDS justifiably scares many new parents who desperately want to keep their baby safe, but you can take some actions to help reduce your baby's risk. Here are the top SIDS prevention strategies and facts that parents need to know.
SIDS Risk Factors
The causes of SIDS aren't really understood. "Most babies who die of SIDS appear perfectly normal," says Rachel Moon, M.D., a pediatrician at Children's National Medical Center in Washington, D.C., and chair of the American Academy of Pediatrics's SIDS Task Force.
But experts believe that babies with SIDS have an immature arousal center in the brain. Put simply, they can't wake themselves up when they're having trouble breathing. Infants who sleep on their stomachs are particularly vulnerable to SIDS—possibly because this position increases the likelihood that they will re-inhale oxygen-depleted air.
"We do know that there are demographic and environmental risks," Dr. Moon adds, noting that African American and Native American babies die of SIDS at a rate two to three times the national average, and three out of five SIDS deaths are males. Other groups at increased risk include premature babies, low-birthweight babies, and infants who are exposed to cigarette smoke.
In terms of age, "the peak danger is between 2 and 4 months old," says Marian Willinger, Ph.D., special assistant for SIDS at the National Institute of Child Health and Human Development in Bethesda, Maryland. However, you should continue to take steps to safeguard your child from SIDS until they turn 1.
Ways to Reduce the Risk of SIDS
Unfortunately, not all cases of SIDS can be prevented, and research like a May 2022 study published in The Lancet suggests there may be a biological component involved in SIDS as well. However, there are steps you can take to help reduce the risk of SIDS in your baby.
Never let your baby sleep on their stomach
Back-sleeping increases a baby's access to fresh air and makes them less likely to get overheated [another factor linked to SIDS]. But some parents still practice stomach-sleeping: 18% of Parents readers say they usually put their infants to sleep on their stomachs, and another 13% do so some of the time.
"Some exhausted new parents may do it out of desperation because infants tend to sleep better and more deeply on their stomachs," says Jodi Mindell, Ph.D., author of Sleeping Through the Night: How Infants, Toddlers, and Their Parents Can Get a Good Night's Sleep.
But the truth is, stomach sleeping really is correlated with higher risks of SIDS: Infants who normally sleep on their back are actually 18 times more likely to die of SIDS when placed down on their tummy for a snooze. "Infants seem to have difficulty adjusting to the change," says Dr. Moon.
Despite the dangers of stomach sleeping, though, you shouldn't worry if your little one begins to flip over on their own. "Once a baby can roll over by themselves, their brain is mature enough to alert them to breathing dangers," says Dr. Moon. "And by the time they are 6 months old, their improved motor skills will help them to rescue themselves, so the SIDS risk is greatly reduced."
Keep in mind, however, that awake tummy time is still an important part of your baby's development. Your baby should still have several supervised "tummy time" sessions every day. This helps your baby's development, and it also prevents flat spots on their head from sleeping on their back. "Babies need tummy time when parents are awake, alert, and observing carefully," advises Dr. Shapiro. "Tummy time is not sleep time—it's development time."
Skip side-sleeping, too
Studies show that putting a baby down on their side rather than on their back increases the risk of SIDS. "It's easier for an infant to roll onto their tummy from their side than from their back," says Dr. Moon. "And they may not yet have the skills to roll back in the other direction."
Don't put anything in the crib except a fitted sheet
Wait until your baby's first birthday to put a pillow and blanket in the crib. Blankets, pillows, comforters, and stuffed toys can hinder your child's breathing; even soft or improperly fitting mattresses can be dangerous.
If you're worried that your little one may get chilly, swaddle them in a receiving blanket or use a sleep sack. According to a 2017 study, swaddling helps fussy infants sleep better on their back and may protect them from SIDS by causing them to startle more easily. But always practice proper swaddling techniques, and don't swaddle too tight. "Your baby needs to be able to move around and have the ability to kick and squirm," says Dr. Shapiro.
Don't use positioners or other baby gadgets for sleep
While things like breastfeeding pillows or "lounge" pillows can be helpful during your baby's awake time, they should never be used for sleeping. Additionally, you should never let your baby sleep in anything other than an approved crib or bassinet with a flat sleeping surface. Car seats, baby swings, baby seats, and things like the recalled "Rock 'n Play" should never be used for sleep either.
Maintain a comfortable temperature in the nursery
Make sure you don't overheat your baby with swaddling or a high room temperature. "A nursery that's too warm substantially increases an infant's SIDS risk," says Warren Guntheroth, M.D., professor of pediatrics at the University of Washington, in Seattle.
The link between higher temperatures and SIDS might be because the warm baby falls into such a deep sleep that it is difficult for them to awaken if they are in trouble. Set the thermostat at 68 degrees, don't put the crib near a radiator, and dress your child in light layers that you can remove easily if they get hot.
Be careful with co-sleeping
While co-sleeping in bed, your infant could be suffocated by a pillow or a loose blanket. Their air supply may be cut off if you or your partner inadvertently rolls over onto them. And they could be strangled if their head gets trapped between the headboard and mattress. The same dangers occur with co-sleeping on a couch or an armchair.
Despite numerous studies that confirm the heightened SIDS risk caused by co-sleeping, many parents continue to do it. According to a Parents poll, 52% of readers do it all or some of the time, citing the added convenience for nighttime feedings and the security of having their infants next to them.
It's important to be aware of the risks of co-sleeping and SIDS. If you decide to co-sleep, don't put your baby right in the bed. And think twice about a co-sleeping crib that clamps onto the frame of your bed, since "parents could still suffocate their baby with an arm or leg," warns Dr. Shapiro. The best bet might be room-sharing by moving your baby's crib into your room, which is what the AAP recommends in its safe sleeping guidelines that were updated in 2022.
Make sure your baby has enough room
Your little one should be able to move around and squirm while sleeping. "A baby that can't move very well can get into dangerous positions that become compromising," says Dr. Shapiro. He advises parents to avoid super-narrow bassinets and other small beds. "Position your baby with their hands out above their heads so they are freely movable, and don't wrap hips tight if swaddling," he says.
Give your baby a pacifier
Pacifiers can actually reduce the risk of SIDS. "We don't know why yet," Dr. Moon says, "but it may be that sucking on a pacifier brings a baby's tongue forward, which opens the airway a little bit more." Or it could be that babies who use pacifiers don't fall into as deep a sleep as babies who don't.
The AAP now recommends that you consider giving your child a pacifier at night and for naps during their first year. Note: If you're breastfeeding, you may want to hold off on introducing a pacifier until your infant is 1 month old and nursing well.
Breastfeed, if possible
Babies who are breastfed are more easily roused from sleep than formula-fed babies, which may be a reason breastfed babies are less likely to die from SIDS. Parents who breastfeed are also less likely to smoke, and a baby's exposure to smoke—both in the womb and secondhand—increases the risk for SIDS, says Dr. Shapiro.
However, all those late-night nursing sessions may also pose a risk too, so be proactive in making sure you lay your baby down in their crib. [And don't be afraid to enlist your partner if you need help!]
"If you are feeding your baby and think that there's even the slightest possibility that you may fall asleep, feed your baby on your bed, rather than a sofa or cushioned chair," said Lori Feldman-Winter, M.D., FAAP, a member of the American Academy of Pediatrics [AAP] Task Force on SIDS. "If you do fall asleep, as soon as you wake up be sure to move the baby to their own bed," she said.
Talk with your child care providers
It's always a good idea to confirm your child care provider's guidelines and practices for SIDS prevention. One out of five SIDS deaths occurs when a baby is in daycare or being watched by someone other than a parent, according to research published in the journal Pediatrics. There are no national safe sleep guidelines daycares must follow and it's up to states to set their own rules, so it's always best to check your daycare's policies for yourself.
That's not to scare you out of daycare, but rather to reinforce the importance of reviewing SIDS precautions with everyone who watches your child, whether it's a daycare worker, a babysitter, a relative, or a friend. They must know how to keep your infant safe while they sleep, so you can rest easy too.
Skip anti-SIDS gadgets
Unless your baby has a diagnosed cardiac or respiratory illness, using an electronic breathing monitor doesn't help, says the AAP—and it may actually give parents a misguided sense of security. Devices marketed to reduce carbon dioxide rebreathing, such as crib mattresses with built-in fans, are also not proven to be effective. And avoid wedge-shaped sleep positioners that claim to keep your baby on her back: An infant can slide off and suffocate against it.
Summary of SIDS Prevention Strategies
In order to prevent SIDS, do the following things:
- Always put your baby to sleep on their back—never on their stomach or side.
- Have your baby sleep in a crib in your room; never share your bed with your baby.
- Make sure your baby's crib mattress is firm.
- Don't put anything in the crib except a tight-fitting sheet; avoid crib bumpers, blankets, pillows, and soft toys.
- Use a pacifier at sleep time.
- Try swaddling your child.
- Don't smoke or use illicit drugs while pregnant, and don't allow anyone to smoke around your infant.
- Don't overdress your child or put their crib near a heat source.
SIDS and Age: When Is My Baby No Longer at Risk?
SIDS can occur anytime during a baby's first year of life [it's extremely rare after 1 year of age], but the risk over those 12 months decreases with time. Although the causes of SIDS are still largely unknown, doctors do know that the risk of SIDS appears to peak between 2 and 4 months of age and decreases after 6 months.