Sudden Infant Death Syndrome (SIDS) is a great cause of worry for many parents. This is not surprising. Sudden infant death syndrome is the third most common cause of death for infants, after birth defects and premature birth.
However, it is important not to panic. SIDS as a cause of death has declined sharply in the past 30 years. In the US, the SIDS rate was 130.3 per 100,000 live births in 1990, while it was 38.4 per 100,000 live births in 2020, a 70.5 percent decrease.
There are good reasons for the decline. Although the reason for SIDS is still largely unknown, there are clear risk factors and – more importantly – clear, research-based ways to mitigate your child’s risk.
What is Sudden Infant Death Syndrome?
Sudden Infant Death Syndrome or SIDS – sometimes called crib death or cot death – is the sudden and unexplained death of a seemingly healthy baby younger than a year old. A majority of SIDS cases occurred within the first six months of life, peaking at one month to 4 months old. This usually happens during sleep, hence the name Crib Death; however, it can also occur while awake, although this is rare.
Unfortunately, SIDS has no warning signs or symptoms.
Research can still not explain why a baby stops breathing and dies suddenly like this. Still, there are several theories and observations on variations between countries, seasons, ages, gender, and more that may help you protect your child.
When using these metrics, if it seems that your baby may be at risk for SIDS, you can take several precautionary steps.
Read the article below and watch the video at the bottom of the article to learn about the risk factors and what protective measures you can take. Below the video, you’ll find the link to more information on how to create a safe sleeping environment for your baby.
Sudden Infant Death Syndrome Facts and Risk Factors
Unfortunately, SIDS remains mostly unexplained. Although we know what some of the main risk factors are and what to do to lower their impact or avoid them, for many factors, there is still no clear evidence to explain why exactly they are high risk.
Low birth weight babies and preterm babies are at higher risk for SIDS. They are susceptible to infections since their immune systems are not fully developed. Preterm babies also have immature lung capacities, making them prone to respiratory problems.
Moreover, colder seasons decrease the immune systems of these babies; hence SIDS deaths are more common during these seasons due to respiratory infections.
Additionally, deficient sleep arousal, which is common in infants in the first few weeks of life, increases the risk of SIDS. This is mostly aggravated by environmental factors, such as passive smoking, sleeping in the prone position, or sleeping with many face-blocking objects (e.g., pillows, blankets, loose beddings, and stuffed toys), as these may obstruct or interfere with proper respiration and adequate ventilation.
SIDS happens in families of all social, economic, and ethnic groups. However, it has been shown that the incidence of SIDS varies depending on the country and ethnic groups. A high incidence has been noted in, for example, New Zealand, while Asia, the Netherlands, Sweden, and Finland have particularly few cases of Sudden Infant Death Syndrome.
Within the US, African American babies are twice as likely to die from SIDS than white babies, and American Indian babies are nearly three times more likely to die of SIDS than white babies.
The reasons for these differences are still not clear. However, it is suggested that several factors may play a role, such as behavioral, sociodemographic, and environmental.
It is important to note that the differences between countries have fallen since the general advice to let babies sleep on their backs was issued.
Age and Gender
Sudden Infant Death Syndrome is very uncommon for babies younger than one month. The incidence of SIDS peaks at 1-4 four months old. The risk decreases in babies more than six months old, with only 20% of the cases recorded for this age group.
Additionally, the male gender predisposes a baby to a higher risk of SIDS. Although it was shown in research that there is no significant difference in sleep arousal in both genders, it was still theorized that male babies tend to have interrupted sleep more than female babies. Hence when this happens, mothers tend to put them into a prone position as they can sleep longer in the said position.
Differences in time of the day, day of the week, and season
It has been shown that most babies who die of SIDS die at night and are found in the morning. However, SIDS death can occur during daytime sleep also. According to some research, placing infants on their side to sleep was more observed in daytime deaths.
SIDS is more common during weekends, but it is not clear why. Altered ways of living, such as that the parents consume more alcohol, is a possible explanation.
Somewhat more cases occur during winter. The general belief is that infections are more common during the colder months. In countries without these seasonal variations, Sudden Infant Death Syndrome appears to be higher during the semesters, supporting the theory that infections may cause SIDS.
Another possible explanation is that babies are more likely to be overdressed or put under heavier blankets during winter, which may cause them to overheat or end up with their heads covered by the blanket.
Back to Sleep
A prone sleeping position (on the stomach) is a significant risk factor for SIDS, and it should be avoided.
It is unclear why placing the baby to sleep on their belly puts them at higher risk. However, there are several possible explanations, such as suffocation, the face-down position leading to oxygen deprivation which may result in hypoxia, rebreathing of carbon dioxide, reduced arousal response and increased waking thresholds, airway obstruction, and similar.
Babies who are placed on their side to sleep also have a higher risk of SIDS. One of the possible reasons is that this way of sleeping makes it more likely that the baby will roll over on their belly during sleep.
Since the recommendation to put babies on their backs to sleep for all sleep times was issued, the rates of SIDS have declined by more than 50% in some countries.
Other Sleep Environmental Factors
Many studies showed that bed-sharing increases the risk of SIDS. Therefore, AAP strongly advises against it and emphasizes that the safest sleeping practice is to have the baby sleep in the parents’ bedroom, near the parents’ bed but on a separate surface designed for infants.
However, AAP recently adjusted its sleep guidelines, acknowledging the fact that bed-sharing still happens. Polls indicate that up to 70% of all parents bring their babies and older children into their family bed at least occasionally. If you put your baby in your bed to sleep, make sure to do it in the safest way possible by following safe co-sleeping guidelines.
Babies put to sleep on soft mattresses or couches and similar are at higher risk for SIDS. According to some studies, babies who are placed to sleep on a soft surface have a five times higher risk of SIDS than those babies who sleep on a firm mattress.
Loose bedding also puts the baby at high risk, as it may land on top of the infant and make it difficult for them to breathe. AAP states that a large percentage of babies who die of SIDS are found with their heads covered by bedding.
Overheating is another factor that increases the baby’s risk of SIDS. Research shows that when babies are overheated, they are more likely to go into a deep sleep, from which it is hard for them to arouse.
The research is still unclear when it comes to the effects of swaddling on SIDS. Swaddling the baby may prevent them from rolling on their tummy, which may protect them from SIDS.
On the other hand, swaddling may put the baby at a higher risk for SIDS if the baby is swaddled after they are already able to roll over by themselves because it prevents them from lifting their head and moving if they are at risk of suffocation. Therefore, it is recommended that the parents stop swaddling the baby as soon as the baby shows any signs of trying to roll over.
Also, in the case of bed-sharing, swaddling is not recommended because it can lead to overheating, which is proven to increase the risk of SIDS.
Other Environmental Factors
Exposure to smoke, drugs, alcohol
If the baby is exposed to smoke in the womb or is later exposed to secondhand smoke, they have a higher risk of SIDS.
According to some studies, babies whose mothers smoked during pregnancy are three times more likely to die of SIDS, and secondhand smoke doubles a baby’s risk for SIDS.
It appears that the chemicals found in secondhand smoke affect the brain in ways that interfere with the brain’s regulation of an infant’s breathing. Some research also showed that babies who died of SIDS had higher nicotine levels in their lungs and cotinine, which is a biological marker for secondhand smoke, than infants who died of other causes.
Babies whose mothers use drugs or alcohol are also at a greater risk of SIDS.
Additionally, babies born to young mothers are more susceptible to SIDS. This is probably due to a young mother’s lack of knowledge of properly handling a baby. Several researchers have theorized that young mothers tend to put their babies in a non-supine position when sleeping, thus increasing the risk for SIDS.
Low socioeconomic status and crowding index
This leads to other theorized risk factors, which are the low socioeconomic status and crowding index.
The crowding index is the quantitative measurement of the number of people living in a dwelling place within a certain dwelling place size. Overcrowding is an indication of low socioeconomic status, which results in poor nutrition, lack of sleep, poor development, and increased risk of infection.
When a baby is born into an already overcrowded family, the risk of SIDS increases. Without proper bedding and ventilation, coupled with an increased risk of infection, SIDS is a possibility in overcrowded houses.
What is the difference between SIDS and SUID?
Sudden Unexpected Infant Death (SUID) is the sudden and unexpected death of a baby less than 1 year old in which the cause was not obvious before investigation. It is a broad term that encompasses all sudden infant deaths, including accidental deaths (such as suffocation and entrapment), sudden natural deaths (e.g., related to infection, ingestion, metabolic diseases, cardiac arrhythmias, etc.), trauma, or SIDS.
SIDS is one of several causes of SUID. However, unlike other causes of SUID, SIDS is given as a diagnosis only after all the other possible causes of sudden, unexplained death have been excluded (after a full investigation that includes an autopsy, death scene examination, and review of the clinical history).
Can a Baby Survive Sudden Infant Death Syndrome?
A common question to ask is whether a baby can survive SIDS.
However, since SIDS is diagnosed only after death and by excluding other causes of death, it is not possible to survive SIDS.
So, even if the answer to this question may seem horrific, the reason is that SIDS is diagnosed after all other possible causes have been ruled out and is mostly made after death.
How to Reduce the Risk of SIDS?
There are several important things you can do to lower the risk of SIDS.
Back to Sleep
As mentioned above, you should always place your baby on their back to sleep—for naps and at night. Once your baby is able to roll over both ways without help, you don’t have to place them on their back for sleep anymore, and you can let them choose their own sleeping position.
Place your baby to sleep on a firm mattress that maintains its shape. It is also essential that you never sleep with your baby on the armchair, couch, or sofa. These pose a great risk to the baby’s safety and significantly increase the risk of infant death, including SIDS and suffocation due to entrapment.
A Bare Crib
Keep the crib as bare as possible. Remove any loose bedding, bumpers, nursing pillows, stuffed animals, or any soft objects from your baby’s crib. Your baby’s crib needs only a tight-fitted sheet.
Keep your baby in your bedroom, near your bed, but place them to sleep on their own sleep surface, such as a crib or a bassinet. Research indicates that room-sharing without bed-sharing lowers the risk of SIDS by as much as 50%. However, if you decide to bed-share occasionally, follow the guidelines that teach you how to do it in the safest way possible.
Avoid overheating your baby by maintaining a comfortable temperature in the room where your baby is sleeping and by dressing them appropriately for the season. You can also consider using a baby sleep sack.
Don’t smoke during pregnancy, and avoid smoking around your baby. Also, make sure that no one else smokes around your baby.
Breastfeeding has been shown to lower the risk of SIDS by as much as 50%, so it is advisable to breastfeed as long as possible.
Use a Pacifier
Consider using a pacifier because it has been shown that putting your baby to sleep with a pacifier may lower the risk of SIDS, although it is still not known why. However, it is recommended to wait until your baby is breastfeeding regularly (if you’re breastfeeding) before introducing the pacifier so it doesn’t lead to nipple confusion. If your baby refuses a pacifier, don’t force it. If your baby falls asleep with a pacifier in their mouth but spits it out during sleeping, don’t put it back in their mouth while they are asleep.
It feels good to end this page on a positive note. I think it’s wonderful that something as simple as having your baby sleep on their back can make such a big difference in the risk of SIDS. Also, many doctors believe that the relatively new recommendation of using a pacifier is likely to lower the risk quite a lot further.
A Monitor or Not
If you are truly worried about Sudden Infant Death Syndrome, there are very advanced baby monitors available. Be aware, though, that there is currently no published research that supports the idea that using a baby monitor will save your baby from SIDS. Due to this, and their popularity, the American Academy of Pediatrics issued a recommendation in 2017 not to rely on baby apnea monitors unless your baby needs home oxygen or has serious breathing problems.
That said, many parents still use them to ease some of their worryings. If you choose to do it, just remember that they may give you a false sense of security. Following the above recommendations to reduce the risk of SIDS are far more important.
For more help on how to protect your baby from SIDS, read this article on how to provide a safe sleeping environment for your baby.
And if you are worried that your baby will, for example, get a flat head from all the back sleeping – read this article about common worries that parents have when it comes to placing their babies on their backs to sleep, such as a flat head, choking, and similar.
Video On Sudden Infant Death Syndrome
Remember this to reduce the risk of Sudden Infant Death Syndrome :
- Baby Sleeps On Back? Flat Head and Other Worried Sorted Out
- How to Create a Safe Baby Sleep Environment to Prevent SIDS
- Safe Co-Sleeping with Your Baby or Toddler? Risks and Benefits
- American Academy of Pediatrics. (2016). SIDS and other sleep-related infant deaths: Updated 2016 recommendations for a safe infant sleep environment. Pediatrics,138(5).
- American SIDS Institute. (n.d.). What is SIDS/SUID?
- Blair, P. S., Ward Platt, M., Smith, I. J., Fleming, P. J. & the CESDI SUDI Research Group. (2006). Sudden Infant Death Syndrome and the time of death: factors associated with night-time and daytime deaths. International Journal of Epidemiology, 35(6), 1563-1569.
- Boston Children’s Hospital. (n.d.). Sudden Infant Death Syndrome (SIDS): Symptoms and causes.
- Centers for Disease Control and Prevention. (n.d.). About SUID and SIDS.
- Infant Mortality | Maternal and Infant Health | Reproductive Health | CDC
- Centers for Disease Control and Prevention. (n.d.). Health effects of secondhand smoke.
- Duncan, J. R. & Byard, R. W. (2018). Sudden infant death syndrome: An overview. In J. R. Duncan & R. W. Byard (Eds.), SIDS Sudden Infant and Early Childhood Death: The Past, the Present and the Future. Adelaide (AU): University of Adelaide Press.
- Hobson, K. (2017, May 15). Racial and ethnic disparities persist in sudden infant deaths. NPR.
- Mayo Clinic. (n.d.). Sudden infant death syndrome (SIDS).
- Safe to Sleep. (n.d.). Common SIDS and SUID terms and definitions.
- Safe to Sleep. (n.d.). Research on other SIDS risk factors.
- University of Southern California. (2008, March 25). Baby boys are more likely to die than baby girls. Science Daily.
Paula Dennholt founded Easy Baby Life in 2006 and has been a passionate parenting and pregnancy writer since then. Her parenting approach and writing is based on studies in cognitive-behavioral models and therapy for children and her experience as a mother and stepmother. Life as a parent has convinced her of how crucial it is to put relationships before rules. She strongly believes in positive parenting and a science-based approach.
Paula cooperates with a team of pediatricians that you find here. They write or review all health-related articles.