Despite a reduction in the incidence of sudden infant death syndrome (SIDS) over the past two decades—largely due to a campaign to place infants on their backs when they sleep—SIDS remains the leading cause of death among healthy infants between the ages of two weeks and one year. (Arias E, et al. Annual summary of vital statistics-2002. Pediatrics 2003;112:1215-30)
In spite of recommendations promulgated in the early 1990s by the American Academy of Pediatrics (AAP) and the National Institutes of Health (NIH), prone sleeping (i.e., infants placed face down) is still a common presumptive cause of SIDS. Therefore, in October 2005, AAP updated its recommendations for reducing the risk of SIDS and once again disseminated this information to physicians and the public.
However, in order to more fully comprehend and adhere to the AAP’s guidelines, it helps to review the factors that place infants at risk for SIDS. Although its underlying cause remains elusive, multiple behavioral and socioeconomic factors have been associated with SIDS.
Risk Factors for Sudden Infant Death Syndrome (SIDS)
- Bed sharing with a smoking parent
- Bed sharing with a non-smoking parent
- Birth before 37 weeks gestation
- Low birth weight
- Low Apgar scores
- Recent viral illness
- Native American or African American ancestry
- Infant of male gender
- Young maternal age
- Low socioeconomic status
- Illicit drug use in household
- Single parent status
- Soft bedding material within the infant’s crib or bassinet
- Prone sleeping position (versus back)
- Side sleeping position (versus back)
- Cigarette smoking during pregnancy
- Parental unemployment
- Postnatal exposure to cigarette smoke (possibly including tertiary smoke—that is, residual smoke on clothing or furniture)
Reducing the Risk of Sudden Infant Death Syndrome (SIDS)
Since infant sleeping position and situation are among the most easily modifiable risk factors for SIDS, and since cultural practices surrounding sleep position mirror differences in SIDS rates between different ethnic groups, the AAP’s recommendations remain focused on the “Back to Sleep” concept:
- Place infant on his or her back to sleep. Side sleeping is not advised.
- Use a firm sleep surface (e.g., a firm crib mattress); keep soft objects (stuffed animals, etc.) and loose bedding out of the crib.
- Avoid overheating infants during sleep. Keep the room temperature comfortable, do not overdress the infant, and use a light blanket or sleep sack.
- Do not smoke during pregnancy, and keep the infant's environment smoke-free.
- Use a separate but nearby sleeping environment, ideally with the infant in a bassinet or crib near the mother's bed. Do not sleep with an infant on a couch or armchair, and do not allow the infant to sleep with other children.
- Consider offering a pacifier at naptime and bedtime, but delay pacifier use until one month of age in breastfed infants. (Pacifiers may reduce SIDS risk, but their use prior to one month of age might shorten the duration of breastfeeding).
- The use of apnea monitors has not been shown to reduce the risk of SIDS.
- Once risk factors have been addressed within a household, having one child die from SIDS does not increase the risk for future children.
(From American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics 2005;116:1245-55)
SIDS is a devastating, life-changing event: Not only do families suffer the loss of a child; they must face the emotionally draining investigation and self-examination that surround every SIDS case. Eliminating risk factors may help parents to avoid this tragedy.
