6 Key Recommendations You NEED to Know to Reduce the Risk of SIDS

SIDS: Sudden Infant Death Syndrome is an unexpected death of a seemingly healthy baby younger than one year usually during sleep that cannot be explained. Some researchers think that young babies who develop SIDS have a defect in the part of the brain that drives breathing and arousal from sleep. (1)

SUID: Sudden Unexpected Infant Death includes SIDS, unknown cause, and accidental suffocation and strangulation in bed (2).

The Purpose of This Post
Many mom blogs, facebook groups, and forums attempt to address SIDS with varying levels of facts and opinions. Some companies and marketers have capitalized on this fear to push products that promise to “monitor” for and “prevent” SIDS altogether. The goal of my post today is to provide you with the most up to date evidence-based recommendations protect your little one from something so tragic and to give you some reassurance and peace of mind around the topic.

SIDS is the leading cause of death among babies between 1 month and 1 year of age (4). Fortunately, however, SIDS and SUID have both seen a large decline since 1990 when the CDC and the American Academy of Pediatrics pushed new safe sleep recommendations.

How Common is SIDS?
CDC report for 2017 reported 3600 cases of SIDS which is roughly 1 in 2824.86 births or 35.4 deaths per 100,000. This is not zero, but this is also nearly the same chance you will be struck by lightning in your lifetime.

What Babies Are at the Highest Risk of Sids?
Male infants, infants between 1 and four months of age, and premature infants (or infants with a low birth weight).

What Are the Official Recommendations to Reduce the Risk of SIDS?
1. Place your newborn on their back to sleep: Infants under the age of 12 months should be placed on their backs to sleep every time. This means no belly or side sleeping. You may be thinking, “but what if my baby vomits during the night… won’t they choke?”. I heard this many times from patients after delivery and honestly, I wondered the same thing for some time. Per the 2016 report by the American Academy of Pediatrics, ” Infants have airway anatomy and mechanisms to protect against aspiration (3).” The CDC follows the AAP recommendations for back sleeping up to 12 months or until the infant can roll over and back without help.

2. Have baby sleep in your room: Per their report, sleeping in the same room as your newborn can help reduce the risk of SIDS! This is best when the infant is close enough to the bed that the infant is within view and reach to comfort and monitor. The ADA reports that this can decrease the risk of SIDS by as much as 50%.

3. Have baby sleep on their own surface: Co-sleeping/co-bedding/bed-sharing is a hot topic widely debated in mom-blogs across the internet. There are many products now that market “safe” bed-sharing but the evidence (at least up until 2016) was insufficient to show any association between these products and the incidence of SIDS. *More on the Dock-a-tot below. A few highlights from their recommendations include:
– Avoid placing infants on couches/armchairs to sleep
– Be mindful of falling asleep while feeding baby on a couch or recliner where the risk of suffocation is very high
– Many women fall asleep while feeding in bed, just ensure that there are no sheets/covers/pillows that may block the baby’s airway
– SIDS risk is very high with co-sleeping in infants less than four months old and even higher if the baby was born prematurely or at low birth weight.

4. Keep soft objects and loose bedding away from baby’s sleep area: You want your baby to have it all, but 10 stuffed animals in their bed are going to do more harm than good for the first 8-12 months of life. It seems strange to put a perfect new baby into an empty crib, but the CDC and AAP have shown an increased risk of SIDS with soft comforters, pillows, sheets, and soft mattresses. Babies are born with disproportionately large heads and little to no muscle tone to support it. Because they cannot hold their head, they are more likely to be strangulated, suffocated, or entrapped by loose materials. Use the stuffed animals during playtime and tummy time to keep them engaged and stimulated, but keep them out of the crib when the baby is sleeping.

5. Avoid overheating: Simply put, a baby only needs maybe one layer more than an adult to help them stay warm. The AAP mentions using a sleep sack, swaddling, and environment appropriate clothing. As a continuation of the previous point on loose bedding and soft objects, avoid additional covers and covering the head.

6. Feeding and pacifiers: Breastfeeding until 6 months old has been associated with a lower rate of SIDS. Pacifiers without strap or strings at naptime and bedtime MAY reduce SIDS, but the evidence hasn’t been completely associated. If you are breastfeeding and want to introduce a pacifier for naps and for comfort, you may consider waiting 3-4 weeks old to avoid nipple confusion.

*No Products Prevent SIDS: The AAP discourages products claiming to reduce the risk of SIDS. This is because to date, the FDA has not cleared or approved any baby products to prevent or reduce the risk of SIDS. One product, in particular, I will address below is the Dock-A-Tot.

A Note on The Dock-A-Tot:
Their safety page claims that the cover’s material is 100% breathable. On their website, they acknowledge the AAP recommendations that the best location for an infant to sleep is in a crib, bassinet or play yard in the parents’ bedroom. They acknowledge that co-sleeping is not recommended, but also discuss that many parents find it beneficial. They have removed claims that it is “safe for bed sharing arrangements” and list safety recommendation that should be followed in concert with a discussion between parents and their pediatrician. They recommend:

  • No co-sleeping with an adult with sleep disorders, obese, or those under the influence of drugs/alcohol/medications
  • Firm mattresses only – no sheets/comforters/blankets above or below the dock *This includes burp cloths/covers between the baby and the dock*
  • Place baby in the dock on their back only
  • No cords or strings around the dock/baby
  • Never leave a baby alone in an adult bed
  • Ensure all components of the dock are fully assembled and zipped during use.

While the exact cause of SIDS is unknown, there are several known causes of SUID causes that can be avoided. The risk of SIDS, while small, is real and can be reduced by implementing the recommendations above. No FDA products have been approved to reduce the risk of SIDS. Co-sleeper products like the Dock-A-Tot have not been evaluated to assess the association between its use and SIDS. This product, if used, should follow the manufacturer recommendations at the parent’s discretion after discussion with a pediatrician for individual evaluation of risks and benefits.

1. https://www.mayoclinic.org/diseases-conditions/sudden-infant-death-syndrome/symptoms-causes/syc-20352800
2. https://www.cdc.gov/sids/data.htm
3. SIDS and Other Sleep-Related Infant Deaths: Updated 2016 4. Recommendations for a Safe Infant Sleeping Environment
Pediatrics Nov 2016, 138 (5) e20162938; DOI: 10.1542/peds.2016-2938

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