The latest ideas about SIDS prevention: How to reduce the risk of SIDS
© 2009 - 2013 Gwen Dewar, Ph.D., all rights reserved
Talk "SIDS prevention" is like talk about "cancer prevention." Researchers don't claim they know how to prevent SIDS in any given individual. But they've identified a number of practices that appear to 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?
Here are some other practices that might contribute to risk of SIDS.
Analyses 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 (Hauck et al
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
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
Sleeping in the same room with your baby
Experiments show that babies who share their mothers’ beds experience
more arousals from sleep, which could conceivably reduce an infant's
risk of SIDS (Mosko et al 1997; Mao et al 2004). In fact, some
researchers have speculated that the low rate of SIDS reported in Japan
is attributable, in part, to traditional Japanese practice of
But studies of Western populations have failed to show any such
protective effect. On the contrary, a recent case study of SIDS rates in
Europe found that bed-sharing increased the risk of SIDS for infants
under 20 weeks of age (Carpenter et al 2013). As Edwin Mitchell and Peter Blair (2012) have argued, some deaths would be prevented if parents were better informed about this risk.
What's the going on? That's not entirely clear, but it seems
likely that bed-sharing, as it is typically practiced in Western
countries, exposes babies to a number of hazards.
You can read about these hazards -- and the general question of bed-sharing safety -- here.
But bed-sharing isn't the only way to co-sleep, and one thing
seems to be uncontroversial:
Sleeping near parents, but on a separate,
infant-appropriate surface, is an excellent way to minimize risk.
large study of European SIDS cases, researchers found that SIDS rates
were lowest for babies who slept in the same room as their parents did,
albeit in a separate crib or cot (Carpenter et al 2004).
Use of a fan
Both 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? The jury is still out, but it seems possible. A 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).
Many 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; Moon et al 2012). 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).
Swaddled 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 case-control studies suggest that swaddled babies
sleeping on their backs are not at higher risk, not as long as
the babies are too young to reposition themselves on their stomachs
(Ponsonby et al 1993; Wilson et al 1994). In fact, babies might be
better off because they can't pull bedding over their faces (Thach
So if you swaddle your baby, follow safety guidelines. Keep
the 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.
And once your baby is old enough to turn himself over, don’t leave him alone in his swaddling clothes.
Some people worry that immunizations cause SIDS. But the scientific
evidence suggests otherwise. When researchers examined the period shortly after infants were vaccinated, they found no evidence of any increase in sudden infant death (Kunhert et al 2012). And in a meta-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
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
• 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 reducing risks.
• On warm days, the use of a fan might help reduce the risk of SIDS.
• 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 practices
Carpenter 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
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. 2005. Do pacifiers reduce the
risk of sudden infant death syndrome? A meta-analysis. Pediatrics.
Hauck FR, Thompson JM, Tanabe KO, Moon RY, and Vennemann MM.
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Horne RSC, Parslow PM, Ferens D, Watts AM, and Adamson TM. 2004.
Comparison of evoked arousability in breast and formula fed infants.
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Kuhnert R, Schlaud M, Poethko-Müller C, Vennemann M, Fleming P, Blair PS, Mitchell E, Thompson J, and Hecker H. 2012. Reanalyses of case-control studies examining the temporal association between sudden infant death syndrome and vaccination. Vaccine. 16;30(13):2349-56.
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solitary infants. Child Psychiatry and Human Development 32(2): 95-105.
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Poyak J. 2006. Effects of pacifiers on early oral development. Int J Orthod Milwaukee. 17(4):13-6
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Thach BT. 2009. Does Swaddling Decrease or Increase the Risk for Sudden Infant Death Syndrome? J Pediatr. 155(4): 461–462.
Vennemann MM, Höffgen M, Bajanowski T, Hense HW, Mitchell EA.
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Content of "The latest ideas about SIDS prevention" last modified 10/13