The day you bring that precious bundle of love home from the hospital is one you'll never forget. Nine months of anticipation and preparation have culminated in the birth of a new baby and you've finally met your belly-mate for the first time.
Along with the irresistible chubby cheeks, teeny, tiny toes, and softest skin you've ever felt, babies bring with them a whole lot of responsibility. As a parent, that responsibility can feel overwhelming - you are now in charge of keeping this little human fed, rested, healthy, safe, comfortable, and content. All day. And all night.
You are in charge of keeping this little human alive. It's a beautiful, yet daunting responsibility.
One of the most important responsibilities you have as a parent is to protect your baby while he or she is sleeping. Babies are extremely vulnerable while they are sleeping because they have absolutely no control over their environment and hardly any control over their own bodies. If a hazard presents itself, the baby is essentially helpless. This is why safe sleep should be given the utmost importance in every household.
So let's take this opportunity to learn more about sleep safety and go over some plain and simple steps you can take to reduce your baby's risks of sleep-related death.
What is SUID and SIDS?
Sudden Unexpected Infant Death (SUID) is the death of an infant under the age of 12 months that occurs suddenly and unexpectedly, of which the cause is not immediately apparent before investigation. After investigation, most SUID cases are reported as one of two types: Sudden Infant Death Syndrome (SIDS) or accidental suffocation and strangulation during sleep. SIDS is defined as the unexpected death of a seemingly healthy baby 12 months or younger, where no cause of death is found after a death scene investigation, autopsy, and review of the child's medical history.
SUID is a significant problem today. Nationwide, approximately 4,000 babies die every year from sleep-related deaths, with about 2,200 of those deaths from SIDS (6 infants daily) and the remaining 1,800 from accidental suffocation and strangulation during sleep (5 infants daily). SIDS is the most common cause of death for infants between the ages of 1-12 months.
What causes SIDS?
The cause of SIDS is unknown, but we do know specific factors that increase an infant's risk. SIDS is mostly likely to occur when a combination of the three following factors are present:
1. Vulnerable infant - A child with something like a family history of SIDS, low birth weight, respiratory issues, an undetectable developmental defect, a dysfunction in the brainstem, a problem with arousal, or maternal smoking during pregnancy.
2. External Stressor - Environmental factors such as: tummy sleeping, loose or soft bedding, an inappropriate sleep surface, bed sharing, and smoking around the baby.
3. Critical Development Period - The highest age at risk of SIDS is those infants under 6 months, especially around the age of 2-3 months. Boys are also more likely to die of SIDS than girls.
Because so much is still unknown about the cause of SIDS, there is no way to completely prevent it. In some SIDS cases, parents have done everything right (meaning that they follow the current guidelines) but still lose their infant to SIDS.
The only factor we can control is the external stressors that our child is exposed to. This blog post will discuss specific external, environmental stressors you can focus on to reduce the risk of SIDS, many of which also relate to accidental suffocation and strangulation during sleep. Consider all of the following safe sleep guidelines as protective measures you can take to reduce the risk of both forms of SUID.
What can you do to reduce your baby's risk of SIDS and other sleep-related deaths?
1. Back to sleep - ALWAYS put your baby to sleep on their back. The most important risk factor for SUID is the baby's sleep position. A baby sleeping on their side or tummy has a three-fold increased risk of SUID. In 1994, the NICHD (National Institute of Child Health and Human Development) launched the "Back to Sleep" campaign to educate and encourage parents to have their infants sleep on their backs. Since the initiative was launched, national rates of SIDS have dropped by more than 50%.
Placing your baby to sleep on their tummy not only compromises their airway, but also makes it more likely that they will "re-breathe" - breathe in carbon dioxide that was just breathed out, rather than fresh oxygen. Sleeping on the tummy means that the baby's face is right next to the mattress, which creates a pocket of carbon dioxide around the nose and mouth. Babies also tend to sleep more deeply on their stomachs, which makes it harder for them to wake.
Side sleeping is just as dangerous as tummy sleeping because the baby, no matter the age, can easily roll onto their tummy. As soon as your baby can roll from back to front and front to back, you don't need to be concerned if they roll to their tummy after you place them to sleep on their back. Once they have this much control over their body, they will naturally reposition themselves to breathe easier by either moving their head or rolling onto their back. Before your baby can roll both ways on their own, give them frequent opportunities to practice during awake times so they can master this skill quickly. Only swaddle your infant until they exhibit signs of attempting to roll or until they are two months old, whichever comes first, then discontinue swaddling.
It might seem counterintuitive, but a baby sleeping on their back actually has a decreased risk of choking or aspirating if they spit up, compared to sleeping on their tummy. This is because of the anatomy of the throat as well as reflexive mechanisms.
There are just a few, rare medical reasons for why a baby shouldn't sleep on their back: 1) Pierre-Robin Sequence, 2) recent spinal surgery, or 3) GERD babies - only if they don't have a normal gag reflex or if they have a rare condition such as a type 3 or 4 laryngo-tracheal-esophogeal cleft that hasn't been repaired. ALL other infants should always sleep on their backs.
Make sure that all caregivers always place your baby to sleep on their back. Babies used to sleeping on their backs who are then placed to sleep on their tummies are 18x more likely to die from SIDS.
2. Sleep alone - Your baby should sleep in their own space for the entire duration of all naps and all night sleep. Make sure they are always sleeping in a CPSC (Consumer Product Safety Commission) sleep-approved crib, bassinet, or portable crib with a new, completely flat, firm mattress designed for the specific product.
Products such as the Rock 'n Play are not approved for infant sleep and are very dangerous, despite clever marketing by manufacturers. Also, car seats, strollers, swings, infant carriers, and infant slings are not recommended for infant sleep. These devices place the baby at an increased risk of upper airway obstruction and oxygen desaturation as well as strangulation. If an infant falls asleep in one of these devices, they should be moved to a safe sleep space as soon as is safe and practical.
NEVER bed-share with your baby, which means sleeping in the same space as your baby, such as a bed, couch, sofa, etc. Bed-sharing is the single greatest risk factor for sleep-related infant deaths. More than 69% of all sleep-related infant deaths are associated with bed-sharing. Even absent all other risk factors, bed-sharing nearly triples the risk of SIDS, plus adds new risks for suffocation, strangulation, and other types of sleep-related infant death. The most conservative estimate shows that the risk of suffocation is 20X higher when infants sleep in adult beds instead of their own cribs.
3. Room share (NOT the same as bed-sharing!) - The AAP (American Academy of Pediatrics) recommends that infants sleep in their parents' room, close to the parents' bed, but on a separate surface for at least the first 6 months of the baby's life. Room sharing allows for closer monitoring of the infant.
The only risk with room sharing is that it can easily lead to bed-sharing. Parents are about four times more likely to bring their infant into bed with them if they are room sharing. So be vigilant. Keep your infant in your room, but never bring your baby into bed with you. I recommend feeding your baby in a hard wooden chair, like a dining chair, so that you won't fall asleep during the feed. After each night feeding, always place your infant back in their own crib.
3. Bare crib and surroundings - The only things that should be in your baby's crib are a firm mattress, a tightly fitted sheet, and your baby. There should be no bumpers (not even mesh bumpers, which pose entrapment and strangulation hazards), no stuffed animals, no blankets/quilts/comforters, no toys, no pillows, no sheepskins, etc. Dress your baby in a well-fitting sleep sack instead of using a blanket. Twins should have separate cribs.
NEVER use sleep positioners such as pillows, wedges, loungers, nests, and all other similar products, unless ordered by the baby's doctor. All types of sleep positioners present real suffocation hazards. The use of products such as the Doc-A-Tot and other similar devices should never be used for any sleeping, whether in the baby's crib or outside of it.
Keep hazards such as dangling cords, electric wires, window blind cords, curtains, and decor at least 3 feet from your baby's crib. Avoid using mobiles above the crib as they also present a strangulation risk if they were to fall.
4. Prevent over-heating - Babies are unable to regulate their own body temperature, so it is important that caregivers dress infants properly for sleep and keep the room temperature cool but comfortable. Getting too hot is a risk factor for SIDS. Dress your baby in one more layer than you are covered with at night and keep the room between 68-72°. Do not put a hat on your baby's head, which not only could cause them to overheat, but also presents a suffocation hazard.
5. Breastfeed when possible - Breastfeeding reduces the risk of SIDS. The protective effect of breastfeeding increases with exclusivity, but any breastfeeding has been shown to be more protective against SIDS than no breastfeeding. Breastfed infants are more easily aroused from sleep than formula-fed babies. Breastfeeding results in fewer incidence of diarrhea, upper and lower respiratory infections, and other diseases that are associated with an increased vulnerability to SIDS. The antibodies and micronutrients in breastmilk also contribute to the infant's overall immune system health. Evidence shows that the protective effect of breastfeeding is found only for infants who sleep alone.
6. Immunize your infant - There is no evidence that there is a casual relationship between immunizations and SIDS. In fact, immunizing your infant can reduce the risk of SIDS by as much as 50%.
7. Pacifier use - Consider offering a pacifier at all sleep times. Pacifier use has been shown to reduce the risk of SIDS by 50-90%, even if the pacifier falls out after the infant falls asleep. The reason for this strong protective effect is still unclear, but it may help the infant maintain an open airway during sleep. The pacifier should never be hung around the baby's neck or attached to their clothing in any way. Stuffed toys that may present a suffocation risk should also not be attached to the pacifier. If using a pacifier for sleep times, it should simply be the pacifier without any modifications to it.
8. Avoid cigarette smoke - Maternal smoking during pregnancy has been identified as a major risk factor for SIDS. An infant whose mother smoked during pregnancy is 3x more likely to die of SIDS. Exposure to smoke affects the fetus' developing brain and impairs the infant's ability to wake from sleep when needed. The cumulative effects of cigarette smoke on a developing fetus are staggering. If the mother smokes just 5 cigarettes per day, her fetus is exposed to a cumulative effect of 1,350 cigarettes, or the equivalent of 67 packs.
Not only is maternal smoking during pregnancy extremely dangerous to the developing fetus, second hand smoke after the child is born is also detrimental and significantly increases the risk of SIDS. Thirdhand smoke refers to the toxins that remain after a cigarette has been extinguished and build up on a smoker's hair, clothing, and any surface exposed to smoke. An infant's developing brain is uniquely susceptible to extremely low levels of toxins, so even touching these toxins exposes the child and poses a serious risk factor for SIDS.
While there is no way to completely prevent SIDS or totally eliminate the risk of other sleep related deaths, by strictly following these guidelines you can drastically reduce your child's risk of SUID and rest assured that your little one is as safe as possible while sleeping.
And while the "Back to Sleep" campaign has done much to educate caregivers and reduce infant sleep-related deaths, we still have a lot of work to do. Despite the prevalence of unsafe sleep environments and products marketed these days (how many pictures of unsafe sleep do you see on just Instagram in one day!?), we know better. Spreading this knowledge starts with me and you. Share your knowledge and promote safe sleep wherever and whenever you can - we can save lives!