SIDS Risk Factors

The American Academy of Pediatrics recommends that parents follow safe sleep practices when putting an infant to bed. However, many families do not follow this advice, putting their child at risk of Sudden Infant Death Syndrome (SIDS), accidental suffocation, and other unknown causes of death, according to a new study recently presented at the Pediatric Academic Societies (PAS) annual meeting in Vancouver, Canada.

Each year, about 4,000 infants die unexpectedly and for no apparent reason. SIDS is the leading cause of all deaths in children younger than 1 year old, according to the U.S. Centers for Disease Control and Prevention (CDC). In 2010 alone, more than 2,060 infant deaths were reported as SIDS, more than 910 were reported as "cause unknown," and nearly 630 were reported as accidental suffocation or strangulation in bed.

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Research Reveals High-Risk Behaviors

In the study presented by PAS, researchers determined families’ sleep practices by surveying a nationally represented sample of 1,030 mothers, ages 14 and older, from 32 hospitals across the country. (Of the mothers sampled, 61 percent were white, 13 percent were black, and 25 percent were Hispanic.) When infants were 2 to 6 months old, mothers completed a telephone survey in which they were asked about infant care practices, including bed sharing and infant sleeping position.

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“The safest position for babies is sleeping on their backs,” says pediatrician Danelle Fisher. “Some people ask about side or tummy sleeping, and we don’t advise that unless a parent is awake and watching.”

Researchers found that 18.5 percent of all mothers reported sharing a bed with their infant, and about 10 percent of all mothers put their babies to sleep on the child's stomach. These behaviors were more common among black and Hispanic families, with 28 percent of Hispanic mothers sharing a bed with their infant and about 22 percent of black parents putting their children to sleep on their stomach, according to the press release.

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Safe Infant Sleep Practices

So how do you put your baby to sleep safely? Danelle Fisher, board-certified pediatrician and vice-chair of pediatrics at Providence Saint John's Health Center in Santa Monica, Calif., and Jennifer Gardner, board-certified pediatrician and founder of the Healthy Kids Company, recommend the following safe sleep practices:

1. A safer sleeping position

“The safest position for babies is sleeping on their backs,” Fisher said in an interview with Healthline. “Some people ask about side or tummy sleeping, and we don’t advise that unless a parent is awake and watching.”

When a baby sleeps on his side, there is a possibility that he could roll over onto his tummy, which could result in suffocation, Fisher said.

“Many parents worry that it is a choking hazard to sleep on the back,” Gardner said. “In fact, it is more difficult to aspirate in the 'back to sleep' position (a term coined in 1994, during the American Academy of Pediatrics’ Back to Sleep campaign) than on the tummy or side.”

“Once a baby can roll from the back to the tummy position, parents do not need to constantly reposition the baby onto the back,” Gardner said. “They should, however, always start the baby in the back-to-sleep position.”

2. A safer sleeping environment

“A baby should be placed in a crib with no blankets, pillows, stuffed animals, bumpers, or loose-fitting clothing that could be pulled over the face,” Gardner said. “The mattress should be firm—look for a safety-approved crib mattress—with a tight-fitting fitted sheet. The room should be warm, but not overheated.”

It is also important that your baby have his or her own sleeping space. Sharing a bed with your baby heightens the risk of suffocation because of the softer mattress and the larger covers and pillows you may have. There is also a high risk that you might roll over onto the child while sleeping, Fisher said.

Even if you think you are just going to lie down for a little bit to calm the baby, sharing a sleeping space is not recommended, Fisher said, because you could easily fall asleep.

If you would like to sleep close to your child at night, Fisher recommends getting a co-sleeper or a bassinet that you can push right up to the side of your bed.

And if parents would like to ensure that their child keeps warm at night, Fisher recommends buying blankets that attach with Velcro and swaddle the baby tightly or dressing the baby in a sleep sack to provide an extra layer.

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3. Pacifiers may prevent SIDS

“Babies less than six months of age who sleep with a pacifier have less of a chance for SIDS,” Fisher said.

Gardner recommends that the pacifier be dry and placed before an infant goes to sleep.

“Pacifier use should never be forced,” Gardner said. “If breastfeeding, a mother might want to consider waiting until breast feeding is going well, [when the child is] around 1 month old.”

4. Watch for potential risk factors

“Children whose parents smoke have a higher incidence of SIDS—even if they smoke outside the home,” Fisher said.

But if you can’t resist smoking that cigarette, Gardner recommends taking a shower immediately afterward and placing clothes in a plastic bag until they're washed.

According to KidsHealth.org, other potential risk factors for SIDS include alcohol or drug use during pregnancy, poor prenatal care, prematurity or low birth weight, and a mother who is younger than 20 years old.

“The risk of SIDS is greatest between 1 and 4 months old, but these recommendations remain in effect for the first year of life,” Gardner said. “All caretakers should be educated in the back-to-sleep position, including grandparents, nannies, and daycare providers.”

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