Safe-Sleeping Guide for Parents and Childcare Providers

In order for your infant to develop healthily, you need to provide a safe sleep environment. A safe and healthy environment reduces the risk of Sudden infant death syndrome (SIDS).

In order for your infant to develop healthily, you need to provide a safe sleep environment for him or her, as well as for yourself as parents or guardians. A safe and healthy environment reduces the risk of Sudden infant death syndrome (SIDS). In this article, you will find out everything about SIDS, starting from risk factors to tips for creating a safe sleeping environment for your child.


Sudden infant death syndrome (SIDS)

Sudden infant death syndrome (SIDS) is the term used for the abrupt and unexplained death of an infant of less than one year old. The cause of death is unknown, and it usually occurs during sleep. It is also known as cot death or crib death. The diagnosis is made when no other cause of death can be found from the autopsy or medical investigation. Most common cases have happened between the hours of 00:00 and 09:00, but without any evidence of noise or struggle.

Almost ninety percent of deaths caused by SIDS are for infants younger than six months, and it is the leading cause of death for infants between one and twelve months old. Approximately 1,600 American infants each year die from Sudden infant death syndrome.

Additionally, SIDS can be called SUID. However, the SUID or Sudden Unexpected Infant Death includes all sudden infant deaths, including accidental infant deaths like strangulation or suffocation, homicides and natural causes like neurological conditions, infections, and cardiac disorders. Around 3500 infants a year die from SUID in the United States. While SUID deaths include SIDS, it does not go the other way around.


The cause of SIDS is still unknown. The dominant theory is that the infant has brain defects in the area that controls breathing and arousal from sleep. Other factors, especially physical and environmental can contribute to SIDS.

Risk factors

Research has shown many environmental and physical factors can impact your infant and increase their risk for SIDS. Among those factors are low birth weight, premature birth, respiratory infections, exposure to passive smoke, brain abnormalities, sleeping on the stomach or side, sleeping with parents or other babies and sleeping on a soft surface.

Physical risk factors

Factors like low birth weight, brain abnormalities, and respiratory infections are physical factors that can lead to Sudden infant death syndrome. These circumstances expose your infant to the risk of not being able to breathe correctly. Low birth weight is common if the mother had multiple babies at once or if the babies were prematurely born. However, twins do not have a higher risk of SIDS than singleton births – both twins dying from SIDS is rare, and both twins dying from SIDS on the same day is extremely rare. Premature infants have a more significant risk of SIDS because their brain has not developed yet, and they might have some brain abnormalities.

Brain abnormalities can destabilize the undeveloped infant’s brain or they may even limit the infant’s capability of arousal and breathing. While the cause of SIDS is unknown, your baby can get these abnormalities from a decrease in oxygen or exposure to a toxic substance like smoking cigarettes during pregnancy. Researchers have found that many babies with SIDS had abnormalities in the arcuate nucleus, which is responsible for breathing and waking during sleep. Babies that have other defects of the brain and body can also be at risk.

The chemical in your brain called serotonin is possibly involved in SIDS. Serotonin is in charge of breathing regulation during sleep. Almost 70% of infants with SIDS had low levels of serotonin before they died. In normal circumstances, a baby’s brain will trigger the infant to wake up and cry if it is not getting enough air. However, babies with an abnormality might not have this protective mechanism.

A respiratory infection also puts your baby at risk, because the infection can cause breathing problems for your infant. This situation might explain the increase of SIDS during colder months when respiratory infections are more common. Many cases with SIDS babies showed that the infants had a respiratory infection before death. And infants that sleep on their stomachs have a higher risk of SIDS as well.

Environmental risk factors

The environment can also be a risk factor for SIDS. Exposing a child to passive smoking at home is a major environmental risk factor for SIDS. Apart from postnatal smoking, exposure to prenatal smoking has a more significant impact on your infant.

The sleeping position of your infant can also make it vulnerable to SIDS. Sleeping on the stomach or side can make it more difficult for the infant to breathe. And if the sleep surface is soft, then it can make it even worse. The same goes for a waterbed, blanket, and soft comforter. All of these cause your infant to sink into the sleep surface and block their airway.

Rebreathing may also occur, which develops when a child breathes back in their own exhaled air because a soft mattress, pillow, toys or bedding are near their face. Rebreathing reduces the oxygen level in the baby’s body, while at the same time, raises the carbon dioxide level. Infants that sleep on their side will probably roll onto their stomachs, and because of that, many different authorities and medical institutions recommend that the child sleeps on the back.

Sleeping in the same room as the infant decreases the risk of SIDS because you are able to oversee your baby. But, putting the baby in the same bed as the parents have the opposite effect. Sharing a sleep surface with anyone (parents, siblings or other babies) increases the risk of suffocation, overheating or overlaying. Of course, the risk is much higher if there is a history of low birth weight, premature birth, cigarette smoking or obesity.

Demographic risk factors

Studies have also found that there are certain demographic factors among children that died from SIDS, but it is not sure if the risks are causative or correlative. If there is a family history of SIDS, infants have a higher risk. Male babies have a more significant chance of dying from SIDS than female infants, and American Indian, Black, and Alaska Native infants are at 2 to 3 times increased risk of dying from SIDS than Caucasian babies. Infants that are 2 to 3 months old have a higher chance, and babies that get colds are at considerable risk of SIDS. That’s why winter months are especially dangerous. Additionally, if the birth mother is younger than 20 years old, uses alcohol, tobacco, drugs or smoke, or if she had poor or late prenatal care, the child would be at a more significant risk of developing SIDS.


Guidelines for Reducing the Risk of SIDS

With the rising awareness of SIDS, according to a CDC study, the rates for SIDS have dropped more than 60% over the past 25 years. The latest data from 2015 says that there are 39.4 SIDS deaths per 100,000 live births, while in 1990 it was 154.5 SIDS deaths. The cause of this syndrome is still unknown, but many prevention practices have been beneficial in lowering an infant’s risk of SIDS. Below are the SIDS prevention guidelines you need to follow.

1. Always place your infant on their back to sleep.

As you have previously read, sleeping on the side or stomach can increase the risk of SIDS. These positions allow the mattress to smother and block the child’s airway. You need to place your infant on the back wherever the baby goes to sleep and make sure nothing will interfere with their breathing. If the child falls asleep outside of the bed, for example, in a car seat, baby seat or stroller, you need to get him or her out and put on a flat surface. If you are worried about your child choking when placed on the back, don’t worry because choking is extremely rare in healthy sleeping infants. When children have more than six months, they can turn and roll over by themselves, which is completely fine, but you still need to continue putting them on their backs as their initial position until they are one year old.

2. Don’t use soft bedding and materials in the infant’s sleep environment.

As discussed above, you need to use a firm mattress for the baby’s crib to prevent the smothering and suffocation. You need to avoid memory foam mattresses and mattress toppers, extra blankets, crib bumper pads or toys in the child’s bed. Also, ensure your child has proper and comfortable pajamas.

3. Don’t sleep in the same bed as your infant.

You need to keep your baby close in order to monitor it, but babies must sleep in a separate bed or crib. As you have probably read above, if the baby sleeps in the bed with someone, it increases the chance of suffocation. Sleeping with someone likely includes the use of more pillows and bedding which pose a threat to the baby. Any object or person in the bed can block the child’s airway, so anything you place in the bed is an additional suffocation risk to infants. Not to mention the fact that adults smoke, drink or use medication – all of which interfere with the child’s health in some way.

4. Avoid alcohol, drugs, and tobacco use during pregnancy and after birth.

Mothers who use tobacco, alcohol, drugs, or smoke during pregnancy can have premature births and expose their babies to a higher risk of Sudden infant death syndrome. After birth, exposure of the child to secondhand smoke is linked to higher SIDS risk. Additionally, alcohol and drugs can reduce inhibitions and diminish mental capacity, which can cause parents not to have the best judgment around their child and increase their SIDS risk.

5. Immunize your infant.

Infants who have acted per the recommendations for infant immunizations have a fifty percent less chance for developing SIDS compared to those who have not been immunized.

6. Prevent your infant from overheating.

Overheating during sleep also increases the infant’s risk of SIDS. Put your child in comfortable pajamas and make sure that their bedroom has a comfortably cool temperature. If the temperature suits you, it will very likely suit the child as well. Watch your child in order to see if he or she is sweating, and is hot to the touch or possibly cold. However, do not put any extra blankets in the crib, but instead, put the baby in a wearable blanket sleep sack or dress the baby in warmer onesie pajamas.

7. Receive early and regular prenatal and postnatal care.

Getting proper prenatal will aid the prevention of premature births and SIDS along with it. After the baby is born, you need to get regular postnatal care that keeps your baby safe and raises your awareness of any conditions that can expose the baby to the risk of SIDS.

8. Breastfeed your infant.

Breastfeeding reduces the risk of SIDS by fifty percent, but it is still not clear why. However, be careful to avoid breastfeeding while sitting down if you are tired, to avoid falling asleep and potentially harming the baby.

9. Avoid products that are claimed to reduce SIDS.

Many manufacturers sell their products with claims that they reduce SIDS. They use this as a marketing ploy to earn money. You should avoid companies that make the claim of keeping your baby safe just to make profits.

10. Use a pacifier to help your infant fall asleep.

The use of a pacifier for sleep can lower the risk of SIDS. When putting your infants to bed, put the pacifier in their mouth and wait once they fall asleep to remove it. However, do not force your baby to use the pacifier if they do not want to use it. You should start using it after your infant has been breastfeeding for at least one month. This way you will avoid nipple confusion or even the preference for the pacifier over the mother. Keep the pacifier clean, without putting any substance over it, and replace it if it gets damaged.


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