Sudden Infant Death Syndrome (SIDS) and Safe Sleep

SIDS is the sudden death of an infant under one year of age that remains unexplained after a thorough investigation of the case, including an autopsy and the exclusion of other factors that could have caused the death, including medical conditions.

Recommendations from the AAP (the American Academy of Pediatrics), PrevInfad (the working group of the Spanish Association of Primary Care Pediatrics) and the WHO (the World Health Organization) for reducing the risk of SIDS:

Sleep position and the sleep space

“Infants should be placed on their back on a firm surface (a crib mattress) covered by a fitted sheet, with no other bedding or soft objects, to reduce the risk of SIDS and suffocation.”

• Items such as blankets, pillows, soft toys, bumper pads and anything worn around the neck should be kept away from your baby’s sleep space.

Overheating and how to dress your baby

“Avoid overheating and head coverings in infants. In general, infants should be dressed appropriately for the environment, with no more than 1 layer more than an adult would wear to be comfortable in that environment.”

• Overheating is a risk factor for SIDS, and wearing a hat contributes to overheating. Both the AAP and PrevInfad have stated that several studies have shown overheating (including the ambient temperature and the baby’s clothing) to be associated with an increased risk of SIDS.

PrevInfad recommends keeping the room where the baby sleeps between 20 and 22 °C and avoiding excessive clothing, especially if the baby has a fever. The AAP recommends that infants be dressed appropriately for the environment, with no more than one layer more than an adult, and that parents check their baby for signs of overheating — increased sweating, or the baby’s chest feeling hot to the touch.

Sleeping in the parents’ room

“It is recommended that infants sleep in the parents’ room, close to the parents’ bed, but on a separate surface designed for infants, ideally for the first year of life, but at least for the first 6 months.”

• Bed-sharing with your baby is a risk factor for SIDS.

Tummy time while awake

“It is recommended that babies be placed on their tummy for limited periods while they are awake, to encourage development and to minimise the development of positional plagiocephaly.”

Bed-sharing

“Bed-sharing is not recommended if the father or mother smokes tobacco, or has consumed alcohol, anxiolytics, antidepressants or sleep medication.”

Pacifier use

“Offer a pacifier at naptime and at bedtime.”

• Pacifier use is a factor that reduces the risk of SIDS. For breastfed infants, introducing a pacifier should be delayed until breastfeeding is well established, or until the baby is 1 month old.

Breastfeeding

“Breastfeeding on demand is recommended.”

• Breastfeeding is a factor that reduces the likelihood of SIDS. Exclusive breastfeeding is recommended for the first 6 months of life.

Smoking during pregnancy and after birth

“Smoking should be avoided during pregnancy, around the pregnant woman and around the baby.”

• Maternal smoking is a risk factor for SIDS. This association has been found both for mothers who smoked during pregnancy and for those who smoked after giving birth.

Source:

https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-021-02536-z

Side sleeping in babies

Many parents, as well as medical staff in maternity units and hospitals, place babies on their side to sleep in order to prevent spitting up and, with it, aspiration.

However, research shows that placing a baby on their back to sleep DOES NOT INCREASE THE RISK of aspiration, while side sleeping remains a risk factor for SIDS:

“To reduce the risk of SIDS, it is recommended that infants sleep on their back for every sleep until they reach 1 year of age. Side sleeping is not safe and is not recommended.”

“Sleeping on the back on a firm, flat, non-inclined surface does not increase the risk of suffocation or aspiration in infants and is recommended for every sleep, even for infants with gastroesophageal reflux.”

Numerous studies in different countries have shown no increase in the rate of aspiration during back sleeping:

One study found that more than 96% of 3,240 healthy newborns had no episodes of spitting up while sleeping during the first 24 hours after birth. Moreover, of the 3.4% of newborns who did spit up while sleeping on their back, none required significant medical intervention and none had an emergency. In particular, there were no deaths and no admissions to the neonatal intensive care unit.

“The supine position does not increase the risk of suffocation or aspiration. Only infants with certain upper airway conditions, such as a type 3 or 4 laryngeal cleft, and infants with gastroesophageal reflux disease in whom the risk of aspiration may outweigh the risk of SIDS, may be placed on their side to sleep.”

“Side sleeping may be recommended only for specific medical indications (severe gastroesophageal reflux disease, active respiratory illness in preterm infants and certain malformations of the upper airway).”

Source:

https://jamanetwork.com/journals/jamapediatrics/fullarticle/570313