How to Reduce the Risk of SIDS

One of the hardest things a pediatrician ever has to deal with is losing a baby we have cared for to SIDS (sudden infant death syndrome). Yes, the parents are devastated, but we are greatly affected too. To do everything we can to prevent SIDS, we offer these guidelines for reducing the risks of this happening to any baby, even yours.

What is SIDS and why does it happen?

Lauren Adler_02R WEB72

Lauren Adler, MD, FAAP

Sudden infant death syndrome (SIDS) is the unexplained death, usually during sleep, of a seemingly healthy baby less than a year old. SIDS is sometimes called “crib death” because the infants often die in their cribs.What makes SIDS such a frightening occurrence is that it strikes typically without warning, in babies who seem to have nothing wrong with them.

Most deaths due to SIDS occur between 2 and 4 months of age, and the incidence increases during cold weather. African-American infants are twice as likely and Native American infants are three times more likely to die of SIDS than Caucasian infants. Also, more boys than girls are victims of SIDS.

In trying to find a cause for SIDS, many experts point to stomach sleeping.

Numerous studies have found a higher incidence of SIDS among babies placed on their stomachs to sleep than among those sleeping on their backs or sides. This has caused some researchers to hypothesize that stomach sleeping puts pressure on a baby’s jaw, thereby narrowing the airway and impeding breathing.

Another theory is that stomach sleeping can increase an infant’s risk of “rebreathing” his/her own exhaled air, particularly if the infant is sleeping on a soft mattress or with bedding, stuffed toys or a pillow near the face. The theory is that the soft surface creates a small enclosure around the baby’s mouth to traps exhaled air. As the baby breathes this, the oxygen level in his/her body drops and carbon dioxide accumulates. Eventually, this lack of oxygen could contribute to SIDS.

And yet another hypothesis is that infants who succumb to SIDS may have an abnormality in a part of their brains that helps control breathing and awakening during sleep. If a baby is breathing stale air and not getting enough oxygen, the brain usually triggers the baby to wake up and cry. That movement changes the breathing and heart rate, making up for the lack of oxygen. But a problem with the arcuate nucleus in the brain could deprive the baby of this involuntary reaction and put him/her at greater risk for SIDS.

How to know if your baby is at risk of SIDS

The frustrating thing that we tell parents who are concerned about SIDS is that there is no single risk factor sufficient to cause a SIDS death. Instead, a combination of several risk factors may cause an at-risk infant to die of SIDS.

Physical factors that can make an infant more vulnerable to SIDS (and these may vary from child to child):

  • Brain abnormalities.Some infants are born with problems that make them more likely to die of SIDS. It is believed that the portion of the brain that controls breathing and arousal from sleep does not work properly.
  • Low birth weight.Premature birth or being part of a multiple birth increases the likelihood that a baby’s brain doesn’t mature completely, resulting in less control over such automatic processes as breathing and heart rate.
  • Respiratory infection.Many infants who died of SIDS had recently had a cold, which may contribute to breathing problems.
  • Boys are more likely to die of SIDS.
  • Infants are most vulnerable during the second and third months of life.
  • For reasons that aren’t well-understood, African-American, American Indian or Alaska Native infants are more likely to develop SIDS.
  • Family history.Babies who’ve had siblings or cousins die of SIDS are at higher risk themselves.
  • Secondhand smoke.Babies who live with smokers have a higher risk of SIDS.

Environmental factors that can increase an infant’s risk of SIDS:

  • Sleeping on the stomach or side.Babies who are placed on their stomachs or sides to sleep may have more difficulty breathing than those placed on their backs.
  • Sleeping on a soft surface.Lying face down on a fluffy comforter or a waterbed can block an infant’s airway. Draping a blanket over a baby’s head also is risky.
  • Sleeping with parents.While the risk of SIDS is lowered if an infant sleeps in the same room as his or her parents, the risk increases if the baby sleeps in the same bed, partly because there are more soft surfaces to impair breathing.

Maternal risk factors that can increase an infant’s risk of SIDS:

During pregnancy, the risk of SIDS is also affected by the mother, especially if she:

  • Is younger than 20
  • Smokes cigarettes
  • Uses drugs or alcohol
  • Has inadequate prenatal care

What you can do to reduce the likelihood of your baby falling victim to SIDS

  • Place your baby to sleep on his/her back, every time. Babies up to 1 year of age should always be placed on their backs to sleep during naps and at night. However, if your baby has rolled from his back to his side or stomach on his own, he can be left in that position if he is already able to roll from tummy to back and back to tummy. If your baby falls asleep in a car safety seat, stroller, swing, infant carrier or infant sling he/she should be moved to a firm sleep surface as soon as possible.
  • Place your baby to sleep on a firm sleep surface. The crib, bassinet, portable crib or play yard should meet current safety standards. Check to make sure the product has not been recalled. Do not use a crib that is broken or missing parts, or has drop-side rails. Cover the mattress that comes with the product with a fitted sheet. Do not put blankets or pillows between the mattress and the fitted sheet. Most important: Never put your baby to sleep on a chair, sofa, water bed, cushion or sheepskin. For more information about crib safety standards, visit the Consumer Product Safety Commission website at
  • Keep soft objects, loose bedding or any objects that could increase the risk of entrapment, suffocation or strangulation out of the crib. Pillows, quilts, comforters, sheepskins, bumper pads and stuffed toys can cause your baby to suffocate. Best to keep them out of the crib.
  • Place your baby to sleep in the same room where you sleep but not the same bed. Babies who sleep in the same bed as their parents are at risk of SIDS, suffocation or strangulation. Parents can roll onto babies during sleep or babies can get tangled in the sheets or blankets.
  • Breastfeed as much and for as long as you can. Studies show that breastfeeding your baby can help reduce the risk of SIDS.
  • Schedule and go to all well-baby visits. Your baby will receive important immunizations at regularly scheduled well-baby visits with us.
  • Keep your baby away from smokers and places where people smoke. If you smoke, quit. Don’t let anyone smoke near your baby, even if you are outside.
  • Do not let your baby get too hot. Keep the room where your baby sleeps at a comfortable temperature. In general, dress your baby in no more than one extra layer than you would wear. If you are worried that your baby is cold, dress him/her in sleep clothing designed to keep babies warm without the risk of covering their heads.
  • Offer a pacifier at nap time and bedtime. Studies show that this helps reduce the risk of SIDS.
  • Do not use products that claim to reduce the risk of SIDS. Products such as wedges, positioners, special mattresses and specialized sleep surfaces have not been shown to reduce the risk of SIDS. In addition, some infants have suffocated while using these products.

Remember “Tummy Time”

We tell all our parents to give their babies plenty of tummy time when they’re awake. This helps strengthen the neck muscles and avoids flat spots on the head. However, always stay with your baby during tummy time and make sure he/she is awake. If your baby sleeps asleep on his/her tummy, gently roll him/her over onto his/her back.

If you are worried about SIDS, please come see us.

At Westchester Health Pediatrics, we want to do everything we can to prevent SIDS and give you peace of mind during the first crucial months of your baby’s life. If you’re concerned about the possibility of SIDS, please come in and meet with us. We’re ready with advice, guidance and support from our years of experience with all kinds of babies. We look forward to seeing you and your baby! Our #1 goal is to help you raise a happy, healthy baby and for you to feel confident as a parent. Whenever, wherever you need us, we’re here for you.

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By Lauren Adler, MD, FAAP, Lead Pediatric Physician with Westchester Health Pediatrics, member of Northwell Health Physician Partners

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