G.I.V.E. for Kids: Healthy Mind, Healthy Body

Back To Sleep
Protect Your Baby from Sudden Infant Death Syndrome

by National Institute of Child Health and Human Development, Parents' Source, July 20, 2004

Many new parents spend those first few weeks anxiously checking their babies throughout the night, listening for breath, feeling their chests rise and making sure they are safely in dreamland. Their worries are not unfounded: Sudden Infant Death Syndrome (SIDS) is the leading cause of death in infants 1 month to 1 year old.

SIDS is the diagnosis given for the sudden death of an infant under 1 that remains unexplained after a complete investigation. Although there is no way to guarantee your baby will not succumb to SIDS, also called crib death, you can reduce that chance by understanding the risk factors, having baby sleep on her back unless a doctor advises otherwise, and learning about the safest bedding environment.

Risk Factors

Babies who sleep on their stomachs are more likely to die of SIDS than those who sleep on their backs. Mothers who smoke during pregnancy are three times more likely to have a SIDS baby, and exposure to passive household smoke doubles a baby's risk of SIDS. Other risk factors include mothers who are less than 20 at their first pregnancy, mothers with no or late prenatal care, and premature or low birth weight babies.

Evidence suggests that some babies have brain abnormalities making them vulnerable to SIDS. Studies reveal that many SIDS infants have abnormalities in a portion of the brain likely involved in controlling breathing and waking during sleep. Babies born with defects in other portions of the brain or body may also be more prone to sudden death. These abnormalities may stem from prenatal exposure to a toxic substance, or lack of a vital compound in the prenatal environment, such as sufficient oxygen. Cigarette smoking during pregnancy, for example, reduces oxygen the fetus receives.

Scientists believe congenital abnormalities may not be sufficient to cause death. Other possibly important events occur after birth such as lack of oxygen, excessive carbon dioxide intake, overheating or infections. For example, many babies experience a lack of oxygen and excessive carbon dioxide levels when they have respiratory infections that hamper breathing, or they re-breathe exhaled air trapped in underlying bedding when they're on their stomachs. Normally, infants sense such inadequate air intake and awake and cry, thereby changing their heartbeat or breathing patterns to compensate. A baby with a certain brain abnormality, however, might lack this protective mechanism. Infections as a SIDS trigger may explain why more cases occur in winter, when some infections are more common.

Some babies who die suddenly may be born with a metabolic disorder preventing them from properly processing fatty acids. A build-up of these acid metabolites could eventually lead to a rapid and fatal disruption in breathing and heart functioning. Genetic screening determines if parents are carriers of this disorder and babies can be tested after birth.

What Parents Can Do

Good prenatal care, proper nutrition and no smoking or drug/alcohol use by the mother might help prevent babies from developing an abnormality that could put them at risk for SIDS. These measures may also reduce the chance of having a premature or low birth weight baby, also linked to SIDS. And babies need a smoke-free environment.

Most babies should sleep on their backs. Studies show that placing babies on their backs has reduced the number of SIDS cases by as much as a half in countries where infants had traditionally slept on their stomachs. Many parents think placing babies on their stomachs prevents choking on spit-up during sleep. But studies in countries where there has been a switch from babies sleeping predominantly on their stomachs to their backs have not found increased risk of choking or other problems.

In some instances, doctors may recommend that babies be placed on their stomachs to sleep if they have disorders such as gastro-esophageal reflux or certain upper airway disorders which predispose them to choking or breathing problems while on their backs. Parents should talk to the baby's pediatrician about sleep positions.

Parents should make sure baby sleeps on a firm surface. Avoid fluffy blankets or covering as well as pillows, sheepskins, blankets or comforters. Infants should not be placed to sleep on a waterbed or with soft stuffed toys.

Should mothers sleep with their babies? Studies are mixed. Some demonstrate bed-sharing, or co-sleeping, can alter mother's and baby's sleep patterns, suggesting this may reduce the SIDS risk. Co-sleeping may also encourage breast-feeding, which has been linked to a reduction in SIDS, perhaps because breast milk protects babies from some infections that can trigger SIDS. Other studies, however, suggest that co-sleeping, under certain conditions, may increase the risk of SIDS. If mothers choose to sleep with their baby, quilts, blankets, pillows, comforters, or other similar soft materials should not be placed under the baby. The bed-sharer should not smoke or use alcohol/drugs that may impair her ability to awake for baby's needs. Also be aware that, unlike cribs, which are designed to meet safety standards for infants, adult beds are not so designed and may cause accidental entrapment and suffocation.

Babies should be kept warm but not too warm, because an overheated baby is more likely to go into a deep sleep from which it is difficult to arouse. The temperature in the baby's room should feel comfortable to an adult, and baby should not be overdressed.

Finally, infants need regular well-baby check-ups and routine immunizations. Claims that immunizations increase the risk of SIDS are not supported by data, and babies who receive scheduled immunizations are less likely to die of SIDS. Moreover, if an infant ever has an incident where he stops breathing and turns blue or limp, he should be medically evaluated for the cause.

For more information go to the National Institute of Child Health and Human Development at
http://www.nichd.nih.gov/publications/pubs/sidsfact.htm

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