SIDS: Reducing the Risks

One of the scariest things in caring for our newborns is learning about sudden infant death syndrome (SIDS). SIDS is one aspect of a broader category called Sudden Unexpected Infant Death (SUID). Every year, approximately 3,500 infants die from SUID in the U.S. alone and some of these may have been preventable with safe sleep habits.

It can happen to anyone. Perhaps the most troublesome story for me is that of three-week-old Charlie. Charlie’s father, pediatric cardiologist Dr. Sam Hanke, recently told his story at an American Academy of Pediatrics (AAP) conference when experts released the updated guidelines on preventing SUID and other sleep related infant deaths. Early one morning, Dr. Hanke innocently took a nap with Charlie on his couch. His chilling words stick with me: “I woke up, Charlie didn’t.”

His story resonates because it proves that none of us are immune. I mean this guy is a pediatric cardiologist. I’m a pediatrician and I know the rules; this couldn’t happen to me, right? But, I too get exhausted and I slip. I know many of us have. I see plenty of pictures of unsafe sleep habits posted on social media. And I get it- I am not here to judge, trust me!

So, this New Year, let’s ALL do better and follow these AAP recommended 15 safe sleep habits that aim to lessen the risk of sleep-related infant deaths. 

1.  Babies Should Sleep on Their Backs: Every. Single. Time. Daycare, naps, at night, baby needs to be on their back. My mom and mother-in-law love to tell me “man, you always slept on your stomach!” Well, it’s not 1986 anymore!

2.  Firm Sleep Surface: Your baby should sleep on a firm sleep surface, such as a mattress in a safety-approved crib. The only thing that should be in baby’s crib is a fitted sheet. Not that cute stuffed animal, blanket or the adorable designer bumper pads. Keep those out of the crib for now.

3.  Breast is Best: Studies have shown that the protective factor of breastfeeding in preventing SUID increases with more exclusivity of breastfeeding. But always remember that some is better than none!!

4.  Sleep in Parents’ Room but in Separate Crib/Sleeping Surface: For the first six months, baby should sleep in their crib, play yard, or bassinet in the parents’ room. The AAP says doing this DECREASES THE RISK OF SIDS BY AS MUCH AS 50%. I really want to stress this one. 50%?! If you can’t pass up that sale why pass up this risk reducer? I want to reiterate- in parents’ room but on separate sleeping surface.

  • To note, breastfeeding in bed happens, but you need to return baby after. If you do fall asleep, (which happens to the best of us, ahem, myself included), it’s better to do that in your bed than on a sofa or armchair.

5.  Keep Soft Objects and Loose Bedding Away from Baby: Pillow-like toys, quilts, comforters, and blankets or non-fitted sheets can obstruct baby’s nose and mouth.

  • This includes bumper pads! The original purpose of bumper pads was to prevent injury or death with head entrapment. However, new crib standards have narrower distance between slats to serve this purpose. So, since bumper pads no longer have a purpose, do not use them! Yes, they’re pretty and they keep baby from sticking his/her arm through the slats. But they also “have been implicated as a factor contributing to deaths from suffocating, entrapment, and strangulation.” Yikes.

6.  Pacifier at Nap Time and Bedtime: We don’t really know why, but pacifiers seem to help, even if it falls out of baby’s mouth. Make sure it’s the pacifier only; no fabric clips or stuffed animals attached to the pacifier.

7.  Smoking = Bad: This one, cannot say enough. It hurts both you and your baby. Please, for your entire family’s health, try and quit if you do smoke.

8.  Alcohol/Drugs: Prenatal and postnatal exposure to booze and drugs is bad. No alcohol/drugs if bed-sharing (but we’re not bed-sharing, right?).

9.  Avoid Overheating/Head Covering in Infants: Generally, baby should wear one layer more than what you are comfortable in. If you are wearing long sleeves, dress your baby in footie PJ’s AND a sleep sack. But no blanket, hats, etc.... 

10.  Prenatal Care: You should get it…

11.  Immunizations: For several reasons, baby should be immunized in accordance with AAP and CDC guidelines. Recent evidence suggests that vaccination may have a protective effect against SIDS adding another reason to that list.

12.  Avoid the Easy Fix: People sell all sorts of things that claim to reduce the risk of SIDS. Many, like some wedges and positioners (e.g. Nap Nanny), often do not comply with safety standards. As we discussed above, a simple firm surface is the best. Just look at how they do it in Finland, where they started giving parents a CARDBOARD BOX for babies to sleep in and, since, have seen decreases in infant mortality. The proof is in the numbers.

13.  Do Not Use Home Cardiorespiratory Monitors as a SIDS Reduction Strategy: Currently, there is no data that commercial devices that monitor infant vital signs (e.g Owlet, Angelcare, Mimo) are effective at reducing the risk of SIDS. And often, when they alarm, just cause more anxiety for the parent. I would focus on the known rather than the unknown.

14.  Supervised, Awake Tummy Time: With all the good back sleeping your babies will be doing, let’s make sure they have an opportunity to develop their head and neck strength – this will help them learn to roll over, reducing the risk of SUID by allowing them to get out of compromising positions.

15.  Swaddling? Be Careful: “There is a high risk of death if a swaddled infant is placed in or rolls to [their stomach].” I swaddled both of my children – so I know a good tight swaddle is a miracle worker in those first few weeks. Important points to remember: stop swaddling when they are close to rolling over and make sure your swaddle allows room for the hips and knees to move (should just be snug around the arms/chest).

Safe sleep habits are all about eliminating risk. Unfortunately, you can do all of these things but risks will still be there. I always remind my West Pediatrics patients we are trying to lessen risks. So is a mesh bumper set as bad as padded bumpers? Maybe not, but it is still an increased risk from no bumpers. Less risk is more comfort to me.

Finally, for some perspective, while approximately 3,500 babies may die annually from SUID, remember, roughly 4 million babies are born each year in the U.S. SUID is something to take very seriously but please know the odds are very much in your favor. Follow these habits, and you'll be in good shape!

Well there you have it! This blog post is written in January 2017 based upon an October 2016 AAP report, linked above. Stay in touch and follow West Pediatrics’s blog to stay informed! West Pediatrics’s patients are strongly encouraged to call me 24/7 with any questions about sleep habits or what products are best to buy for your baby. If you’re interested in joining West Pediatrics, please reach out to me today through our contact page! Idea for a blog post? Submit that too!