11 Things You Should Do To Prevent Sudden Infant Death Syndrome (SIDS)

October is Pregnancy and Infant Loss Awareness Month, when we look to raising awareness globally about the very real devastations of pregnancy and infant loss. According to the World Health Organization (WHO), approximately one in four pregnancies end in miscarriage and 2.6 million babies are stillborn.

These numbers translate into as many (if not more) broken hearts. If anyone you know and love has experienced the loss of a child to miscarriage, stillbirth, Sudden Infant Death Syndrome (SIDS), or any other foetal or infant fatality cause, you can easily understand why we need to be more vigilant in preventing such loss — however we can. Here are some evidence-based strategies to reduce the risk of SIDS.

What Is SIDS?

SIDS is a diagnosis of exclusion, meaning that no other identifiable cause of death can be made even after a thorough investigation. It usually happens without warning to seemingly healthy infants aged under one year, with the highest incidence occurring between two and four months of age. SIDS usually happens in their sleep without explanation. Research has however identified several risk factors and proposed a variety of prevention strategies, which we have listed here. 

1. Put your baby on their back to sleep

The most significant and widely recognized preventive measure is placing your baby on their back to sleep. This practice, known as the "Back to Sleep" campaign, has led to a significant reduction in SIDS rates. Ensure that every snooze session, including naps, begins with your baby on their back, even when they can roll over. Don’t put your baby to sleep on their side or tummy, because babies placed in these positions might have trouble breathing in the middle of the night.

2. Use a firm, flat sleep surface

A baby’s sleep environment plays a critical role in reducing SIDS risk. Use a firm and flat mattress designed for infants, and avoid soft bedding, soft mattresses, waterbeds, comforters and pillows. These items pose suffocation risks and can cause obstruction to an infant's airway. Make sure the mattress is not inclined at an angle greater than 10 degrees, because this can also increase the risk of suffocation. 

3. Keep the crib bare

Keep baby’s crib or cot completely bare if possible. Avoid any fluffy padding, soft quilts, bumper pads, pillows or stuffed animals in the crib, since these can cause breathing problems should your baby’s face accidentally press up against them. To eliminate any risk of smothering or suffocation, all your baby needs in their crib is a snug fitted sheet that cannot easily come undone. Car seats, baby swings, sleep positioners or baby nest loungers should never be used for overnight sleep either. 

4. You can share a room, but not a bed

Statistics show that room-sharing with your baby can reduce their risk of SIDS by up to 50%, but that sharing a bed increases the risk by three times compared to an infant sleeping in a crib in their parents’ room. The American Academy of Pediatrics (AAP) thus recommends room sharing with your infant, without bed sharing. This means that your baby should sleep in a crib, bassinet, or portable crib in your room for at least the first six months to a year. 

Co-sleeping is strongly discouraged because it is dangerous for your infant to sleep with an adult or another child in the same bed (even an attached sidecar bassinet). They could easily get trapped between the gaps, be severely hurt or suffocated if accidentally rolled over or covered by a sleeping person’s arm or leg, bedding or pillow. When you're deeply asleep due to exhaustion from night feeds, you won't even know what's happening

Despite the inconvenience, be sure to put your baby back into their own separate bed after feeding or comforting them, especially if you’re very tired or using medicines that cause drowsiness.

5. Try to breastfeed if possible 

Breastfeeding has numerous health benefits, including a reduced risk of SIDS by as much as 50%. Experts are not sure exactly why, but some believe that the essential nutrients and antibodies from breastmilk that help strengthen your baby's immune system may protect them from infections that increase their SIDS risk. This may be related to the fact that a number of infants suffered from SIDS shortly after having a respiratory infection, suggesting that a cold might have led to fatal breathing problems.

The AAP recommends exclusive breastmilk feeding for at least 6 months, ideally continuing beyond a year for as long as mum and baby want.

6. Use a pacifier if possible

Pacifier use has been associated with reducing SIDS risk, because some scientists believe that using a pacifier can open up your baby’s airways more, or prevent your baby from falling into a deeper sleep—both helpful for reducing the threat of SIDS.

However, it's essential not to force the pacifier if your baby doesn't want it, or to replace the pacifier in their mouth should it fall out while they’re sleeping. The pacifier should also not be attached to a string or clip since those pose suffocation risks. You should also not attempt to make the pacifier more attractive by coating it with honey or any other substance — honey can cause botulism in children under one, which may also be linked to SIDS.

7. Avoid overheating the baby

It is important to watch baby’s temperature, because research has shown that becoming too warm while sleeping can cause baby to fall into a deeper sleep, making it more difficult for them to wake when their bodies are telling them to breathe.

Try dressing your baby in light breathable layers, and opt for pyjama onesies or sleep sacks instead of using blankets. Don’t cover your baby’s head and stop swaddling once your baby can roll over. Keep your baby’s sleep environment at a comfortable temperature of around 20-22 degrees Celsius.  

8. Ensure your baby receives regular immunisation shots

Making sure your baby receives all their routine vaccinations on schedule will also help. Vaccinations can help prevent infections that may contribute to SIDS risk, since they help babies develop immunity to pathogens that can cause severe illnesses or respiratory infections. Research suggests that having your baby immunised on time can reduce their risk of SIDS by up to 50%.

9. If you're pregnant, ensure you're getting good prenatal care

Adequate and regular prenatal care is essential, as is avoiding smoking, alcohol, and illicit drug use during pregnancy. Babies whose mothers did not receive good medical care while pregnant, or whose mothers used drugs or alcohol while pregnant, were found to experience higher risk of SIDS.

A healthy pregnancy and proper prenatal care help ensure that your baby is born at a healthy weight and without complications, reducing their vulnerability to SIDS. Overall, prenatal care is a vital step in nurturing a healthy pregnancy and minimizing potential risks, including SIDS.  

10. Don't smoke

Research shows that babies who live with smokers have a higher risk of SIDS, because being exposed to second-hand smoke can cause respiratory issues and inflammation in infants, making it harder for them to breathe normally. Smoke also reduces the oxygen-carrying capacity of baby's blood, potentially depriving their vital organs of oxygen during sleep. 

Babies born to mothers who smoked during pregnancy are also three times more susceptible to SIDS than babies born to non-smokers, since smoking during pregnancy increases the risk of preterm birth and low birth weight, both of which are factors associated with a higher SIDS risk. This is great incentive to quit smoking if you’re pregnant, and to not let anyone smoke around your baby.  

11. Give your baby tummy time

Supervised tummy time while baby is awake aids infant development while simultaneously minimising the occurrence of positional plagiocephaly (flat head or an uneven head shape). Besides strengthening their neck and upper body muscles, tummy time also promotes motor skills and helps babies develop the ability to lift their head and turn it from side to side. Such physical advancements will improve your baby's ability to move and reposition their head during sleep, making them less likely to become trapped in a position where their airway is obstructed. 

You can start placing your infant on their tummy for short supervised periods of time soon after coming home from the hospital (about 1-2 minutes in the beginning), lengthening these periods incrementally to a total of 15-30 minutes daily by the time they are seven weeks old. They should be doing about one hour of cumulative tummy time a day when they are three months old.