To Prevent Sudden Infant Death Syndrome: Think Carefully About Your Baby’s Sleeping Environment

Babies sleep a lot; something that is very important to their brain development.  However, because they spend a lot of time sleeping, have difficulty adjusting their own body position and have immature sleep arousal mechanisms (waking), this puts them at risk for Sudden Infant Death Syndrome (SIDS), or crib death. Almost all SIDS deaths happen without any warning or symptoms. Death occurs when the infant is thought to be sleeping. The most common period for SIDS to occur is between 2 and four months, but this can happen up to one year of age.


This year, two important studies were published that help us better understand the specific risk factors for SIDS related to the baby’s sleeping environment. The first study looked a large database with information on 8,207 SIDS cases during 2004-2012 in the USA. The majority of the victims were less than four months of age. Younger victims were more likely bed-sharing and sleeping in an adult bed/on a person. A higher percentage of older victims had an object (like a stuffed animal) in the sleep environment and had changed position from side/back to prone. The researchers concluded that the risk factors for SIDS may be different for different ages of infants.  The largest risk factor for younger infants is bed-sharing with their caregivers, whereas rolling into objects in the sleep area is the predominant risk factor for older infants.

The second study looked specifically at sleeping on couches (sofas) as a risk factor. About one in every eight cases of SIDS occurs on a couch. The researchers analyzed data from 1,204 infant deaths on sofas. Infants that died on sofas were more likely to be sharing the couch with another person, to be found on their side, or to be found in a new sleep location (having moved off the couch or to a different area of the couch). The study found parents were more likely to lay their infants face down on a sofa than face down in a crib. In addition, many sofas have cushions that slope downward towards the back cushions. It is easy for an infant to roll onto her stomach or become wedged into a large, soft cushion where they cannot breathe, especially if placed on her side to begin with. In the study, most parents shared the sofa with an infant they had placed there. But sleep-deprived parents may be more likely than they think to fall asleep on the couch with their newborns.  The researchers plainly concluded that the sofa is an extremely hazardous sleep surface for infants.

Please don’t think that because you are awake or you are sitting next to your infant, that SIDS can’t happen. Always pay careful attention to your infants’ sleeping environment, during naptime and overnight, and teach others in the family to do the same. The bottom line is that infants need to sleep alone, on their backs and in a crib, and it doesn’t matter if it’s for a nap or overnight, and it doesn’t matter if the parent is awake or asleep. 


The American Academy of Pediatrics recommends the following steps to prevent SIDS:

Always put a baby to sleep on its back. This includes naps. Do NOT put a baby to sleep on its stomach. Also, a baby can roll onto the stomach from its side so this position should be avoided.

Put babies on a firm surface (such as in the crib) to sleep. Never allow the baby to sleep in bed with other children or adults, and do NOT put them to sleep on other surfaces such as a sofa.

Let babies sleep in the same room (but NOT the same bed) as parents. If possible, babies’ cribs should be placed in the parents’ bedroom to allow for nighttime feeding.

Avoid soft bedding materials. Babies should be placed on a firm, tight-fitting crib mattress without loose bedding. Use a light sheet to cover the baby. Do not use pillows or quilts.

Make sure the room temperature is not too hot. The room temperature should be comfortable for a lightly clothed adult. A baby should not be hot to the touch.

Offer the baby a pacifier when going to sleep. Pacifiers at naptime and bedtime can reduce the risk of SIDS. Doctors think that a pacifier might allow the airway to open more, or prevent the baby from falling into a deep sleep. If the baby is breastfeeding, it is best to wait until 1 month before offering a pacifier, so that it doesn’t interfere with breastfeeding.

Keep your baby in a smoke-free environment.

Do not use breathing monitors or products marketed as ways to reduce SIDS. Research has found that these devices do not help prevent SIDS.


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