Currently there is no way to predict which newborns will die from SIDS and no way to prevent it in all cases. However, there are lifesaving steps parents and caregivers can take to help protect their baby from SIDS, suffocation and accidents during sleep:
- Back Sleeping. Placing babies on their backs to sleep is the single most important step that parents and caregivers can take to reduce the risk of SIDS. Since the Back to Sleep campaign started in 1994, SIDS deaths have declined by more than 50 percent. This means that more than 25,000 babies’ lives have been saved during the last decade alone with this simple step. It is important to note that placing babies to sleep on their sides is not safe. Babies that roll from their side to their tummy are 18 times more likely to die of SIDS.
- Bedding. Babies should sleep in a crib that meets current safety standards. The mattress should be firm, fit snuggly in the crib and be covered with only a tight-fitting crib sheet. Play yard style cribs are also a good choice. There should be no soft, fluffy or loose bedding or other objects in the crib, including blankets, pillows, quilts and stuffed animals. Bumpers are not necessary – soft or pillow-like bumpers should not be used. Use a wearable blanket or other sleep clothing instead of blankets to keep babies warm. Infants under one year of age should not be placed to sleep on an adult bed, waterbed, sofa, cushion, pillow or sheep-skin.
Never use wedges or positioners to prop your sleeping baby up or keep him on his back. These devices have not been tested for safety and have not been shown to be effective at keeping babies on their backs. These devices are particularly dangerous when your baby starts wiggling around during sleep.
- Head Covering. Make sure your baby’s head remains uncovered during sleep. Babies are at an increased risk for SIDS if their head becomes covered during sleep. Avoid using a blanket or other covering over your baby’s face as a sun or weather screen, or to block out distractions or sounds while your baby is sleeping. The blanket will cause a build-up of exhaled air around the baby’s face. This exhaled air does not have enough oxygen, which can lead to a SIDS or suffocation death.
- Bed Sharing/Sofa Sharing. Do not share a sleep surface with your baby. Sharing a sleep surface is especially dangerous for babies less than 12 weeks old and premature or low birth weight babies. It’s okay to bring your baby into bed to feed and cuddle, but when it’s time to go to sleep, place the baby alongside your bed in a separate, safe sleep space. In addition to the known hazards caused by pillows and comforters in the family bed, there is also increased risk for accidental suffocation or overly. Never bring your baby into bed with you if you or your partner is exhausted, smoke or impaired by drugs or alcohol. Sofas and chairs are particularly dangerous places to fall sleep with your baby.
It is important to note that bed sharing has not been found to be protective against SIDS, in fact current research indicates that bed sharing increases a baby’s risk to die by as much as 40 times. Research does, however, suggest that room sharing is protective against SIDS. Keep your baby next to where you sleep in her own separate space for at least the first six months. This provides greater safety for the baby and makes it easier to breastfeed and share closeness with your baby.
- Pacifiers. Recent research shows that pacifiers can greatly reduce a baby’s risk for SIDS. Experts recommend giving your baby a pacifier EVERY time he or she is placed down to sleep. If you are breastfeeding, wait until nursing is going well (usually one month) before offering a pacifier.
While the exact safety mechanism is not yet known, there are many possibilities for this finding. One is that the presence of a pacifier in the mouth may discourage babies from turning over onto their stomach during sleep. Because moving or turning may dislodge the pacifier, it may encourage babies to stay on their backs. Another is that the pacifier and/or sucking reflex helps keep the tongue positioned forward, keeping the airways open. Pacifier use can also help quiet a restless infant who might otherwise move more aggressively around the crib. Because pacifiers stimulate the upper airway muscles and saliva production, it is felt that pacifier use may keep babies from falling into a deep sleep, which is protective against SIDS. Regular pacifier use is protective against SIDS even if the pacifier falls out of the baby’s mouth when he or she falls asleep.
- Smoking. Babies whose mothers smoke during pregnancy are three times more likely to die from SIDS. Exposure to second-hand smoke by mothers, fathers, grandparents and others after the baby is born also greatly increases the risk of SIDS. Studies have found that the risk of SIDS increases with each additional smoker in the home, the numbers of cigarettes smoked a day, and the length of the infant’s exposure to cigarette smoke. New research now warns of the dangers of third-hand smoke – the chemicals left behind on clothing and in homes and cars. Babies should always be kept in a smoke-free environment to protect against SIDS and other respiratory illness.
- Room Temperature. Babies should be kept warm, but they should not be allowed to get too warm. An overheated baby is more likely to go into a deep sleep from which it may be hard to wake up. Keep the temperature in the baby’s room at a level that feels comfortable to a lightly clothed adult and avoid overdressing the baby.
- Prenatal Care. Good prenatal care, including proper nutrition, abstinence from alcohol, drugs, and smoking, and frequent medical checkups beginning early in pregnancy, is critical to your baby’s overall health and well-being. Early and good prenatal care can also help prevent a baby from developing an abnormality that could put him or her at risk for sudden death.
- Breast Feeding. Breast feeding has been shown to be good for babies by building their immunity against illness and infections, in addition to other benefits. Recent research provides the strongest evidence to date that breastfeeding may also reduce the risk of SIDS. Mothers should be encouraged to breastfeed for the first 12 months and exclusively for at least the first six months if possible.
Data analyzed by scientists at the National Institute of Environmental Health Sciences suggest that breastfeeding can reduce the risk of death for infants in their first year of life. Looking at infants between 28 days and one year of age, researchers concluded that promoting breastfeeding could potentially prevent up to 720 post-neonatal deaths in the U.S. each year. Researchers compared CDC records of 1,204 children who died between 28 days and one year of causes other than congenital anomalies or cancer with those of 7,740 children still alive at one year.
- Proper Health Care. Take your baby to the doctor for all regular well-baby checkups and make sure that your baby receives his or her immunizations on schedule.
- Childcare. Babies who usually sleep on their back are at a significantly increased risk of SIDS when placed to sleep on their stomach by a well intentioned but ill-informed relative or caregiver. Be sure to share your safe sleep rules with baby sitters, child care providers, grandparents and anyone who cares for your baby. Since childcare practices have changed a lot since you were a baby, do not assume that everyone knows about important safe sleep practices in preventing SIDS, suffocation and accidents during sleep.
What is the Back to Sleep campaign? This campaign is aptly named for its main recommendation to place healthy infants on their backs to sleep to reduce the risk of SIDS. The lead partners in this campaign include the National Institute of Child Health and Human Development (NICHD), American Academy of Pediatrics (AAP), First Candle/SIDS Alliance and the Association of SIDS and Infant Mortality Programs. Based on a recommendation made by the AAP in 1992, the campaign was launched in 1994 with an effort to reach every parent and caregiver in the country.
Has the campaign been successful? The campaign has been very successful in reaching parents and other caregivers with the Back to Sleep message. We have seen a change from 70 percent of babies placed on their stomachs to sleep in 1992 to 15 percent in 2005. Rates of SIDS have declined by more than 50 percent during that time, resulting in the most significant impact on our nation’s high rates of infant mortality in history. However, we have not reached all families and all populations. Of the more than 2,200 SIDS deaths each year, more than 70 percent were placed on their stomach to sleep. Thousands of other SUID occur as a result of bed sharing, soft bedding use and other unsafe sleep practices. As a result, experts are recommending expanding the campaign beyond Back to Sleep to Safe Sleep to save as many lives as possible and continue have an impact on our nation’s high rates of infant mortality.
Are some babies more at risk for SIDS than others? Yes, babies in the following categories are at a higher risk for SIDS:
- Babies born to mothers who smoke during or after pregnancy
- Babies placed to sleep on their stomach or side
- Babies who share a sleep surface
- Babies who are premature or low birth weight
- Babies born to mothers who are less than 20 years old at the time of their first pregnancy
- Babies born to mothers who had no or late prenatal care
- Babies born to mothers with too short an interval between pregnancies