The latest ideas about SIDS prevention: How to reduce the risk of SIDS© 2009 Gwen Dewar, Ph.D., all rights reservedSIDS prevention: Changing practices that increase the risk of SIDS Researchers have identified a number of practices that increase the risk of sudden infant death syndrome. These practices to AVOID include: • Prone sleeping (i.e., sleeping on the stomach) • Sleeping on a soft surface (including a soft mattress, pillow, or duvet) • Use of pillows or other soft objects that could cover the face • Maternal smoking and smoking by other household members • Maternal alcohol consumption during pregnancy • Overheating the baby (by overdressing or turning up the thermostat) Why are these practices risky? In some cases, it’s because they create an asphyxiation hazard. In other cases, it’s because they may interfere with the baby’s ability to arouse from sleep. That’s important, because many researchers believe that SIDS caused by a failure to arouse during a potentially life-threatening event, like a severe episode of sleep apnea. (For more information, see this evidence-based article on the causes of SIDS.) Is there anything else we can do?Practices that might have a protective effect against SIDSHere are some other practices that might contribute to the prevention of SIDS.BreastfeedingAnalyses of SIDS cases suggest that breastfeeding has a protective effect against SIDS. Compared to controls, breastfed babies were less likely to die of SIDS, even after controlling for maternal socioeconomic status, baby’s sleeping position, smoking, and bed sharing (Vennemen et al 2009).Why? It’s possible that safety-conscious moms are more likely to breastfeed, in which case breastfeeding isn’t the cause of lower SIDS rates, but merely a marker of a lifestyle associated with SIDS prevention practices. But there are reasons to suspect that much more is going on. Experiments show that breastfeeding babies are more easily aroused from sleep (Horne 2006; Horne et al 2004; Franco et al 2000). And breastfeeding benefits a baby’s immune system. As a result, babies may be less likely to succumb to infections that could trigger a SIDS event (Vennemen 2009). CosleepingCase studies have never yet demonstrated that bed sharing reduces the risk of SIDS. However, some researchers suspect that it might. That’s because experiments show that babies who share their mothers’ beds experience more arousals from sleep (Mosko et al 1997; Mao et al 2004).If there is a protective effect, why doesn’t it translate into fewer SIDS cases? It might be because bed sharing is often accompanied by other practices that actually increase the risk of SIDS. But bed sharing isn’t the only form of cosleeping. And one form, at least, seems to be uncontroversial. In a large study of European SIDS cases, researchers found that the SIDS risk was lowest for babies who slept in the same room as their parents did, albeit in a separate crib (Carpenter et al 2004). Use of a fanBoth overheating and high CO2 levels put babies at greater risk. Does this mean that we can lower the SIDS risk if we improve the ventilation of the bedroom? Perhaps yes. A recent study of SIDS cases in California found that a baby was less likely to die of SIDS in a warm room if there was a fan in use (Coleman-Phox et al 2009).PacifiersMany people don’t like pacifiers. That’s because prolonged pacifier use can interfere with the normal growth of a baby’s palate. In addition, surveys suggest that pacifier use may reduce the duration of breastfeeding, and a recent questionnaire uncovered a link between pacifier and acute otitis media (Mitchell et al 2006; Rovers et al 2008).However, there may be a bright side. Case studies of SIDS victims consistently reveal that babies who use pacifiers are less likely to die of SIDS (Hauck et al 2005). Why? It’s unclear. The apparently protective effect has been linked with both breastfed and bottle fed babies. And, although one experimental study found that babies who frequently use pacifiers were aroused more easily (Franco et al 2000), another did not (Hanzer et al 2008). SwaddlingSwaddled babies experience fewer startles while they sleep. In addition, they experience shorter arousals during active sleep, which reduces the chance that they’ll wake all the way up. They also have fewer arousals during quiet sleep (Gerard et al 2002).You might think this would put swaddled babies at greater risk of SIDS, and this is indeed the case when swaddled babies are placed on their stomachs. But when babies placed on their backs—and babies are too young to change position--swaddled babies might be better off. Studies show that swaddled babies sleeping on their back are at a lower risk for SIDS than are unswaddled babies sleeping on their stomachs (Ponsonby et al 1993; Wilson et al 1994). If you swaddle your baby, follow safety guidelines. Keep baby’s head and face uncovered and don’t swaddle too tightly. The baby should be able to move his hips and knees freely, and his chest shouldn’t be constricted. Some hospitals have abandoned swaddling with loose blankets and use swaddling sacks instead. These sacks are especially designed to permit babies to move their lower limbs. They also prevent babies from unwrapping themselves. Once your baby is old enough to turn himself over, don’t leave him alone in his swaddling clothes. ImmunizationsSome people worry that immunizations cause SIDS. But the scientific evidence suggests otherwise. In a recent analysis of published SIDS studies, researchers found that SIDS rates were almost 50% lower among babies who’d been immunized (Vennemann et al 2007).It makes sense that immunizations could reduce the risk of SIDS. Immunized babies are less likely to contract infections that might trigger a SIDS event. But, because physicians often delay immunizations when babies are ill, it’s also possible that the immunized babies were healthier to begin with. More research is needed to distinguish between these explanations. The bottom line:Steps we can take to reduce the risk of SIDS• Put baby on her back when it's time to sleep• Make sure baby's sleep surface is firm • Keep baby’s face and head uncovered • Avoid overheating the baby • Remove pillows, soft toys, and loose bedding from the baby’s sleep environment In addition, • Pregnant women shouldn’t smoke and babies shouldn’t be exposed to second-hand smoke. • Breastfeeding may help babies arouse from sleep and avoid potentially dangerous infections. • Most researchers recommend that babies sleep in same room where their parents sleep.
• If parents want to bed share, they should review these cosleeping safety guidelines for SIDS prevention.
• Pacifier use, which is undesirable in some respects, might contribute to SIDS prevention. However, nobody knows why. • Swaddling—-when practiced safely-—might reduce the risk of SIDS. But only when babies are placed on their backs and are too young to turn themselves over. The safest way to swaddle may be by using an especially-designed swaddling sack. • Although the causation is unclear, babies who are immunized are less likely to die of SIDS. References: SIDS prevention practicesCarpenter RG, Irgens LM, Blair PS, England PD, Fleming P, Huber J, Jorch G, and Schreuder P. 2004. Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet 363(9404): 185-191.Coleman-Phox K, Odouli R, and Li DK. 2008. Use of a fan during sleep and the risk of sudden infant death syndrome. Arch Pediatr Adolesc Med. 162(10):963-8. Franco P, Seret N, Van Hees JN, Scaillet S, Groswasser J, Kahn A. 2005. Influence of swaddling on sleep and arousal characteristics of healthy infants. Pediatrics. 115(5):1307-11. Franco P, Scaillet S, Groswasser J, and Kahn A. 2001. Pacifiers during sleep and sudden infant death. Eur J Pediatr. 160(7):448. Gerard CM, Harris KA, and Bradley BT. 2002. Spontaneous arousals in supine infants while swaddled and unswaddled during rapid eye movement and quiet sleep. Pediatrics 110(6): e70-76. Hanzer M, Zotter H, Sauseng W, Pfurtscheller K, Müller W, Kerbl R. 2008. Pacifier use does not alter the frequency or duration of spontaneous arousals in sleeping infants. Sleep Med. 2008 Aug 4. [Epub ahead of print] Hauck FR, Omojokun OO, Siadaty MS. Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics. 2005 Nov;116(5):e716-23. Horne RSC, Parslow PM, Ferens D, Watts AM, and Adamson TM. 2004. Comparison of evoked arousability in breast and formula fed infants. Arch Dis Child 89: 22-25. Mao A, Burnham MM, Goodlin-Jones BL, Gaylor EE, and Anders TF. 2004. A comparison of the sleep-wake patterns of co-sleeping and solitary infants. Child Psychiatry and Human Development 32(2): 95-105. Mosko S, Richard C, McKenna J. 1997. Infant arousals during mother-infant bed sharing: implications for infant sleep and sudden infant death syndrome research. Pediatrics. 100(5):841-9. Mitchell EA, Blair PS, L'Hoir MP. 2006. Should pacifiers be recommended to prevent sudden infant death syndrome? Pediatrics. 117(5):1755-8. Ponsonby A, Dwyer T, Gibbons LE, Cochrane JA, and Wang Y. 1993. Factors potentiating the risk of sudden infant death syndrome associated with the prone position. New England Journal of Medicine 329: 377-382. Poyak J. 2006. Effects of pacifiers on early oral development. Int J Orthod Milwaukee. 17(4):13-6 Rovers MM, Numans ME, Langenbach E, Grobbee DE, Verheij TJ, Schilder AG. 2008. Is pacifier use a risk factor for acute otitis media? A dynamic cohort study. Fam Pract. 25(4):233-6. Vennemann MM, Höffgen M, Bajanowski T, Hense HW, Mitchell EA. 2007. Do immunisations reduce the risk for SIDS? A meta-analysis. Vaccine. 21;25(26):4875-9. Wilson CA, Taylor BJ, Laing RM, Williams SM and Mitchell EA. 1993. Clothing and bedding and its relevance to sudden infant death syndrome: Further results from the New Zealand cot death study. J Pediatric Child Health 30: 506-512. Content last modified 4/9
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