How can the risk of Sudden Infant Death Syndrome (SIDS) be reduced?

Reducing the Risk of Sudden Infant Death Syndrome (SIDS)

To reduce the risk of SIDS, parents should always place infants on their backs to sleep on a firm surface, share a room but not a bed with the infant, avoid soft objects and loose bedding in the sleep area, offer a pacifier at naptime and bedtime, and avoid smoke exposure. 1

Key Evidence-Based SIDS Prevention Strategies

Sleep Position and Environment

• Back to sleep for every sleep - This is the most important recommendation with Level A evidence 1
• Use a firm sleep surface - Soft mattresses can increase risk of suffocation 1
• Room-sharing without bed-sharing - Infants should sleep in parents' room on a separate surface for at least the first 6 months 1
• Keep soft objects and loose bedding away from sleep area - Pillows, blankets, bumper pads, and toys should be removed from the crib 1
• Avoid overheating - Dress infant with no more than one layer more than an adult would wear to be comfortable 1

Feeding and Pacifier Use

• Breastfeeding is recommended - Associated with reduced risk of SIDS 1
• Consider offering a pacifier at naptime and bedtime - Pacifier use during sleep significantly reduces SIDS risk by 50-60% 2
  • For breastfed infants, delay pacifier introduction until breastfeeding is firmly established (around 3-4 weeks) 2
  • Formula-fed infants can start using pacifiers as soon as desired 2

Prenatal and Postnatal Care

• Avoid smoke exposure during pregnancy and after birth - Both maternal smoking during pregnancy and environmental smoke exposure after birth are major risk factors 1
• Avoid alcohol and illicit drug use during pregnancy and after birth - These substances increase SIDS risk, especially when combined with bed-sharing 1
• Pregnant women should seek and obtain regular prenatal care - Regular prenatal care is linked to lower SIDS risk 1
• Infants should be immunized according to recommended schedules - Evidence suggests vaccination may have a protective effect against SIDS 1

Additional Recommendations

• Supervised, awake tummy time - Recommended to facilitate development and minimize positional plagiocephaly 1
• Do not use home cardiorespiratory monitors - These have not been proven to reduce SIDS risk 1
• Avoid commercial devices marketed to reduce SIDS risk - No evidence supports their efficacy 1
• No evidence to recommend swaddling as a SIDS prevention strategy - If swaddling is used, infants should always be placed on their backs 1

Implementation of SIDS Prevention

• Healthcare providers should model and endorse these recommendations from birth 1
• Education should target all caregivers, not just parents 1
• Media and manufacturers should follow safe sleep guidelines in messaging and advertising 1

Common Pitfalls to Avoid

1. Side sleeping position - No longer recognized as a reasonable alternative to fully supine sleeping 3
2. Bed-sharing - Particularly dangerous for infants under 12 weeks 4
3. Using soft bedding or pillows - Significantly increases suffocation risk 1
4. Relying on commercial monitoring devices - These have not been proven to reduce SIDS risk 1
5. Inconsistent application of recommendations - All caregivers need to follow the same safe sleep practices 5

Special Considerations

• If concerned about positional plagiocephaly (flat head), alternate the direction the infant faces in the crib and ensure adequate supervised tummy time when awake 4
• Despite significant reductions in SIDS rates since the "Back to Sleep" campaign began, SIDS remains a leading cause of post-neonatal mortality 6
• Healthcare professionals should stay updated on SIDS prevention guidelines to effectively counsel parents 5

By consistently following these evidence-based recommendations, parents and caregivers can significantly reduce an infant's risk of SIDS.