Minimizing the risk of SIDS


Dr. Greene, I am terrified of SIDS. What can I do to prevent it and when can I stop worrying?

Dr. Greene`s Answer:

Everything dear to us causes pain. Becoming a parent opens up new landscapes within us: new hopes, fears, delights, and sorrows. There is no magic moment when you will stop worrying. Sometimes, even when we do everything right, babies die, including from SIDS. The fragility and unpredictability of life underscore how precious each life is.

Thankfully, there are specific steps you can take to minimize the risk to your child.

SIDS, or Sudden Infant Death Syndrome, is defined as the sudden, unexpected and unexplained death of any infant or young child. What a horror for any parent! When surveyed about what they would have appreciated in those chilling moments after the death, SIDS parents responded with several concrete requests they were often too stunned to make at the time (Journal of Emergency Medicine, Sep 1997):

  • To hold their baby one last time
  • To have the clothing returned to them
  • To have a print or mold of their baby’s hand
  • To have a lock of hair.

These poignant requests underline the tragedy of SIDS, the most common cause of infant death in developed countries. SIDS accounts for about half of the deaths that occur between one month and one year of age.

Genetics plays a large role. SIDS is more common in boys than in girls, and it is more common in some population groups (Black, Native American, Hawaiian, Filipino, Maori).

Most of the affected infants have damaged or immature brainstems, making it difficult for them to wake up when they are in trouble. A recent series of autopsies has demonstrated visible brain abnormalities in over 70 percent of the SIDS babies examined (Pediatric Neurology, Jul 1998).

While parents often feel horribly responsible after SIDS, sometimes there is nothing they could have done to prevent it. There are many factors outside of our control.

Sometimes infants can even die of SIDS in the hospital. For example, a 5-month -old baby boy was admitted to Rotunda Hospital in Northern Ireland after he had experienced three near-SIDS events. He underwent a sleep study to try to identify what was causing these events. During the study he had no periods of slow heart rate or inadequate breathing. Nevertheless, he died of SIDS while he was still in the hospital. His heart slowed and stopped, and even expert medical care couldn’t prevent it (Archives of Diseases in Children, May 1998).

Infants at risk for SIDS may have abnormalities in heart conduction. Almost 35,000 healthy babies in Italy had EKGs performed in the first week of life. They were then followed for a year. Most of those who ended up dying of SIDS had an abnormality on their original EKGs (a prolonged QTc interval). Those with this abnormality were more than 40 times more likely than their peers to die from SIDS (New England Journal of Medicine, Jun 11, 1998). These findings hold promise for future screening and prevention.

There are already several important preventive measures available. Events that occur even before the baby is born affect the risk of SIDS. Anything that causes less oxygen to get to the baby in the uterus will increase his or her risk. On average, smoking during pregnancy doubles the chances, and the odds increase with each cigarette. Other drugs of abuse such as cocaine or heroine increase the risk by as many as thirty times.

The media often focus on “crack babies,” but tobacco use continues in approximately 25% of all pregnancies in the United States (J Pharmacol Exp Ther, Jun 1998). Nicotine exposure is responsible for many more SIDS deaths than any other drug of abuse, including cocaine. Stopping smoking during pregnancy is the most immediate step we can take to save infants’ lives. Other studies also show that ensuring babies are breathing fresh clean air may be important; for example use of a fan while babies are sleeping was shown in one study to decrease the risk of SIDS. It is not entirely clear why, but rebreathing exhaled air or accumulation of carbon dioxide may be associated with SIDS deaths (Arch Pediatr Adolesc Med, 162(10) Oct 2008).

Minimizing caffeine use during pregnancy is another way to protect your child. Those babies whose mothers drank 4 or more cups of coffee per day could have up to twice the risk of SIDS (Arch Dis Child, Jan 1998).

After birth, many things influence a baby’s susceptibility to SIDS. It is more common in babies who sleep in warm environments, who are over-bundled, who sleep in rooms with space heaters, who are exposed to cigarette smoke, who sleep on soft surfaces, who do not use pacifiers, and those who sleep face down or in a prone position. The rate of SIDS is also higher in those babies who do not receive timely well-child care and immunizations.

Putting children to sleep on their backs lowers the risk of SIDS by about three times. Use firm bedding in a slightly cool room. Avoid cigarette smoke, and even anything that smells like cigarette smoke. Take your baby in for regular well-child visits and immunizations. There is some evidence to support that breastfeeding may help reduce the risk of SIDS.

The SIDS rate has dropped by more than half in the last few years to 0.7 per one thousand live births in the United States. Changes in sleeping positions are being credited for the reductions (AAP News, Jan 98). Even with the change in sleeping habits, about 5 out of 6 babies found dead are found face down (J Pediatr, Feb 1998). SIDS is becoming quite rare in children who sleep on their backs and who are not exposed to tobacco.

Recent studies show that approximately 20% of babies who die from SIDS are discovered with their faces or heads covered, whether by bedding or clothing. While the chain of events in these tragedies is not known, preventing your baby from being able to cover his/her head with bedding or clothing may also be an important part of preventing SIDS deaths (Arch Dis Child, 93(9) 778-783, 2008).

The following safe bedding recommendations are written by sponsors of the “Back to Sleep” campaign:

  1. Place baby on his/her back on a firm tight-fitting mattress in a crib that meets current safety standards.
  2. Remove pillows, quilts, comforters, sheepskins, stuffed toys, and other soft products from the crib, playpen, or portable crib.
  3. Consider using a sleeper or other sleep clothing as an alternative to blankets, with no other covering.
  4. If using a blanket, put baby with feet at the foot of the crib. Tuck a thin blanket around the crib mattress, reaching only as far as the baby’s chest.
  5. Make sure your baby’s head remains uncovered during sleep.
  6. Do not place baby on a waterbed, sofa, soft mattress, pillow, or other soft surface to sleep.
  7. Make sure everyone that cares for your baby knows the above recommendations for safe bedding.

There is no way to completely prevent or even predict SIDS. This uncertainty makes the deep love we have for our children all the more poignant. The peak period for SIDS is between two and four months old. It is very rare before one month of age, and at least 95% of all the cases have occurred before children reach six months old. But this doesn’t mean that when they pass six months all fear will subside. For as long as we live, this marvelous life we share is both strong and fragile, a treasure to be cherished moment by moment.

Last medical review on: November 05, 2008
About the Author
Photo of Alan Greene MD
Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.
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What are your thoughts on co-sleeping? And by co-sleeping I mean in a safe environment free of tobacco/drugs/alcohol, a surface that is not a sofa or waterbed, an infant that is not less than, say, 37 weeks gestational age, and a mother who is breastfeeding and had a healthy course of pregnancy?