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Reviewed by the Faculty of Harvard Medical School

Sudden Infant Death Syndrome

Sudden infant death syndrome (SIDS) is the death of an apparently healthy infant (younger than 1 year of age) for which no cause can be determined. It generally occurs while the infant is sleeping; for this reason, it was once known as "crib death."

SIDS occurs most frequently in babies younger than 6 months old, with most cases occurring between 1 and 4 months. It strikes boys slightly more often than girls. African-American and Native-American babies are at two to three times greater risk than the national average.

Since 1992, when the American Academy of Pediatrics recommended placing healthy babies to sleep on their backs rather than their stomachs, the rate of SIDS in the United States has declined by more than 40 percent.

Healthy, full-term babies should be placed to sleep on their backs through their first year of life, for naps and nighttime, at home and at day care. While putting babies on their sides was once considered an option, it is no longer recommended because sometimes babies roll from their sides to their stomachs. Once a baby starts rolling over by himself, put him down to sleep on his back, but let him choose his sleep position. It is not necessary to put him on his back again if he changes position. By the time a baby is old enough to roll over, the risk of SIDS is significantly reduced.

Some babies develop a flat spot on the back of their heads from sleeping on their backs. The flattened area poses no harm and is temporary. Make sure your baby spends some time on his stomach while awake to help to prevent the flat spot and to aid neck and shoulder muscle development.

Some parents worry that babies placed on their backs will choke if they spit up or vomit. There is no evidence that sleeping on the back causes choking. However, a few babies, including premature babies and those with certain medical conditions such as breathing problems, heart defects and severe gastroesophageal reflux (spitting up), are better off sleeping on their stomachs or sides. Talk with your doctor about which sleeping position is best for your baby.

In 2005, the American Academy of Pediatrics updated the recommendations on preventing SIDS. Besides placing your baby on his back to sleep, here are other suggested precautions:

  • Don't place pillows, soft bedding, comforters, quilts or stuffed toys in your baby's crib.
  • Don't put a baby to sleep on a soft surface, such as a waterbed, sofa or soft mattress. The best sleeping surface is a firm crib mattress with a snug-fitting sheet.
  • Keep the temperature cool in the room where your baby sleeps; the temperature should be comfortable for a lightly clothed adult. Don't swaddle your baby, and don't cover him with a heavy blanket or quilt. If you use a thin blanket, place your baby toward the foot of the crib, and tuck the blanket around the mattress so that it only reaches up to your baby's chest.
  • Don't smoke in your home or car. Minimize your baby's exposure to secondhand smoke in other environments.
  • Use caution if your baby sleeps in your bed. Adult beds often have soft bedding, such as pillows and quilts that are not recommended for infants. In addition, adult beds do not meet crib safety standards and may be dangerous for small children. For example, a baby could become trapped between the mattress and a wall, or in headboard or footboard openings. Also, there have been cases in which babies were suffocated by adults who rolled onto them.
  • Consider offering a pacifier at naps and bedtime. Use the pacifier when you're placing the baby down to sleep, but there is no need to put it back in the mouth once the baby falls asleep. If the infant refuses the pacifier, do not force it.
  • Breast-feed your baby if possible. Breast milk contains infection-fighting substances and nutrients to keep your baby healthy.
  • Encourage "tummy time." Make sure your baby spends some time on his stomach while awake to help keep the back of the head from becoming flat and to aid neck and shoulder muscle development.

There is no evidence that devices that monitor a baby's breathing and heart rate help to prevent SIDS. However, home monitoring may be useful for some infants with certain conditions. Discuss any concerns you may have with your doctor.

Last updated March 11, 2008




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