What you can do to reduce the risk of SIDS

For most parents, SIDS, or sudden infant death syndrome, is a big concern. SIDS occurs when a healthy baby under age one dies suddenly and unexpectedly while sleeping. This is the reason how (and where) you put your baby down to sleep matters—a lot. There is ample research on how to reduce the risk of SIDS. 

And yet research suggests many parents aren’t following the sleep guidelines that reduce the risk of SIDS. In a Penn State University study published in Pediatrics in August, researchers videotaped 160 parents and babies. The results: Up to 91 percent of one-month-olds were allowed to sleep with bumpers, stuffies or loose blankets or pillows, and 14 percent were put to bed on their sides or tummies, despite current back-sleeping recommendations.

Not every SIDS death can be attributed to the wrong sleep position or loose blankets in the crib; sometimes they’re a mystery. Researchers are exploring a number of possibilities. For example, according to a 2014 study by the US National Institutes of Health, in more than 40 percent of studied cases, an abnormality was found in the hippocampus area of the brain, which influences breathing, heart rate and body temperature through its connection to the brain stem. Researchers think this abnormality might weaken the brain’s control of breathing and heart rate patterns during sleep.

Meanwhile, doctors at Seattle Children’s Hospital are looking at a link between SIDS and inner ear damage at birth, which may predispose certain babies to SIDS. And a 2014 study out of Adelaide University may have found a connection to inherited sleep apnea, after researchers noticed similarities between the brains of babies who had died of SIDS and children who had been accidentally asphyxiated.

The cause may be unclear, but we do know that certain activities can affect a baby’s risk of SIDS, which accounts for about 2.8 percent of infant deaths in Canada. For starters, the likelihood is greater if mom smoked during pregnancy or if baby is exposed to smoke after birth. Parents’ drinking or taking certain meds can also increase the risk of SIDS: The sedative effect of alcohol and some drugs can make you less alert to your baby’s distress in the night.

A safe sleep environment also reduces the risk of SIDS and, because they are closely connected, accidental strangulation and suffocation. To encourage easy breathing, the Public Health Agency of Canada and Canadian Paediatric Society recommend putting your baby to sleep on her back. She should be placed in a crib, bassinet or cradle that meets Health Canada safety standards, in the same room as her parents for at least the first six months. “Room sharing facilitates breastfeeding and frequent contact with infants during the night,” says Natasha Saunders, staff paediatrician at Toronto’s Hospital for Sick Children. Some researchers hypothesize that breastfeeding reduces the risk of SIDS because of the antibodies babies receive through breastmilk, which could protect them from infections that may increase the risk of SIDS.

The guidelines don’t end there. “Teddy bears and loose blankets should not be left in the crib with a sleeping infant,” says Saunders. Same goes for pillows, bumpers and positioners, because they can all end up in front of a baby’s face and impede breathing or reduce the flow of oxygen, contributing to SIDS or even causing suffocation. Sleep sacks are a safe alternative to blankets—just make sure your baby isn’t too warm.

A baby should never be left to sleep in a car seat, swing or stroller for long, since her head can fall forward, blocking her airway. “Move them to their bassinet or crib as soon as you can,” says Denis Leduc, paediatrician and clinical director of the newborn nursery at Montreal Children’s Hospital.

Saunders points out another risk: not making it to the crib at all. “I see parents who are exhausted fall asleep with their infant in their bed or on the couch.” Experts say this could contribute to SIDS—and other dangers, too. “I have witnessed the repercussions and seen infants getting gently pushed off the bed by accident, rolling off on their own or even being suffocated under a parent’s weight, and it is devastating,” Saunders says. “It’s so important to take that extra step and put the infant in a safe sleeping environment, before you doze off yourself.” 

Did you know? While mesh bumpers might seem like a safe option because they allow some air to flow into the crib, there is no data to support their safety. “The American Academy of Pediatrics advises against all crib bumpers, including the mesh ones,” says Natasha Saunders, staff paediatrician at Toronto’s Hospital for Sick Children, adding that the ties pose a further risk of entrapment and strangulation.

A version of this article originally appeared in our October 2016 issue, titled "Sleep safety," pg. 48.

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