SUDDEN INFANT DEATH SYNDROME (SIDS)
- Since 1992 when the American Academy of Pediatrics (AAP) began recommending that infants be placed on their backs for sleeping, the annual SIDS rate has declined more than 50 percent.
- SIDS is the leading cause of death for infants between 1 month and 12 months of age.
- SIDS is most common among infants that are 2-4 months old. Since we don’t know what causes SIDS, safe sleep practices should be used to reduce the risk of SIDS in every infant under the age of 1 year.
SIDS PREVENTION TIPS (Create a safe sleep environment for your baby):
1. Place infants to sleep on their backs. Infants should be placed for sleep on their backs every time they sleep-even for short naps. Sleeping on the tummy or side is not safe and not advised.
2. Use a firm, tight-fitting mattress covered with a tight fitting crib sheet. Soft materials or objects, such as pillows, quilts, comforters, or sheepskins, should not be placed under a sleeping infant or in the crib with them. Don’t place babies to sleep on chairs, sofas, waterbeds, or cushions. Adult beds are NOT safe places for babies to sleep.
3. NEVER use extra padding, blankets or pillows under baby. Keep soft objects and loose bedding out of the crib. Soft objects including stuffed toys should be kept out of the crib. It is recommended to avoid using bumper pads altogether, if used; they should be thin, firm, well secured and not “pillow-like.”
4. Do not smoke during pregnancy. Maternal smoking during pregnancy has emerged as a major risk factor in almost every epidemiologic study of SIDS.
5. Prevent exposure to second-hand smoke. Smoke in the infant’s environment after birth is a separate risk factor. Do not let a baby be in an environment where people are currently smoking or have been smoking. Smoke travels from room to room in homes and buildings. Smoke particles stay in cars long after a person has stopped smoking in the car.
6. Avoid commercial devices marketed to reduce the risk of SIDS. Although various devices have been developed to maintain sleep position or to reduce the risk of SIDS, none have been proven to work or be safe. They are not necessary and can even be deadly.
7. Do not use home monitors to reduce the risk of SIDS. There is no evidence that use of home monitors decreases the incidence of SIDS. If you choose to use a home monitor for other reasons, place baby monitor cords away from cribs or playpens to avoid strangulation.
8. Avoid overheating. The infant should be lightly clothed for sleep and the bedroom temperature should be kept comfortable for a lightly clothed adult. Overbundling should be avoided, and the infant should not feel hot or sweat. Sleep clothing such as sleepers, infant sleep sacks and wearable blankets that are designed to keep the baby warm without the possible hazard of covering the infant’s head are an excellent alternative to blankets. If you must use a blanket, place the child’s feet close to the foot of the crib and tuck in a light blanket along the sides and foot of the mattress. The blanket should not come up higher than the infant’s chest.
9. Regularly check cribs for loose, missing or broken parts or slats. Do not try to fix a broken crib. Crib recall information from the Consumer Product Safety Commission (CPSC) can be found at www.cpsc.gov.
10. The risk of SIDS is reduced when the infant sleeps in the same room as the mother. A crib, bassinet, or cradle that conforms to the safety standards of the Consumer Product Safety Commission (CPSC) and ASTM (formerly the American Society for Testing and Materials) is recommended. If cradles or bassinets are used, choose those that are also JPMA (Juvenile Products Manufacturers Association) certified for safety. Safety standards for “Co-sleepers” (infant beds that attach to the mother’s bed) have not yet been established by the Consumer Product Safety Commission.
11. Bedsharing /Co-sleeping: Although bedsharing rates are increasing in the United States for a number of reasons, including breastfeeding and cultural reasons, the evidence is that bedsharing is more hazardous than the infant sleeping on a separate sleep surface. Infants should not bedshare during sleep. Infants may be brought into bed for nursing or comforting but should be returned to their own crib or bassinet before the parent gets sleepy. The baby should not be brought into bed when the parent is sleepy or tired or using medications, alcohol or other substances that could impair his or her alertness. The baby’s crib or bassinet should be placed in the parent’s bedroom close to their bed. Infants should not bedshare with other children. Never sleep with an infant on a couch or an armchair.
12. Offer a pacifier at nap time and bedtime. Although the mechanism is not known, the reduced risk of SIDS associated with pacifier use during sleep is strong. It is unlikely that pacifier use will limit breastfeeding if the pacifier use is started after 1 month of age. It is unlikely that dental complications will occur if the pacifier use is stopped by one year of age. The pacifier should be used when putting the infant down for sleep and should not be put back in after the baby falls asleep. If the baby refuses the pacifier, do not force your baby to take it.
13. Avoid development of a flat head, called positional plagiocephaly. The infant should be placed on the tummy when the infant is awake and being supervised. “Tummy Time” should occur at least 3 times a day for 10-20 minutes at a time. This will also help strengthen muscles (“baby push-ups”). Too much time spent in car seats, carriers, bouncers, swings etc, can lead to the development of a flat head. Carrying and holding the baby is also helpful. Change your baby’s head position during sleep: place the infant to sleep with the head to one side at times and then change to the other. Also, routinely change which side of the crib the baby’s head is placed. If you notice flattening of your baby’s head or your baby only prefers to turn his/her head to one side, contact your pediatrician.
14. All caregivers including child care providers, grandparents, foster parents and babysitters should be taught about these SIDS prevention guidelines. About one in five SIDS deaths occur while an infant is being cared for by someone other than a parent. Many of these deaths occur when infants who are used to sleeping on their backs at home are then placed to sleep on their tummies by another caregiver. Babies who are used to sleeping on their backs and placed to sleep on their tummies are 18 times more likely to die from SIDS.