Sudden Infant Death Syndrome: Prevention

SIDS appears to be at least partly preventable, which has been shown by a decrease in the case rate. The following are recommended as preventive measures:

• Sleep position. The United States Department of Health and Human Services initiated a "Back-to-Sleep" campaign in 1994 to educate the public about sleep position. Prior to that time, an estimated 70% of infants slept on their stomachs, since parents had been taught that a "back down" position contributed to choking during sleep. There are some conditions for which doctors will recommend the prone position, but for normal infants, side or back (supine) positions are better. When placing an infant on his or her side, the parent should pull the child's lower arm forward so that he or she is less likely to roll over onto the stomach. When babies are awake and being observed, they should be placed on their stomachs frequently to aid in the development of the muscles and skills involved in lifting the head. Once a baby can roll over to his or her stomach, he or she has developed to the point where the risk of SIDS is minimal.
• Good prenatal care. Proper prenatal care can help prevent the abnormalities that put children at higher risk for SIDS. Mothers who do not receive prenatal care are also more likely to have premature and low birth-weight babies. Expectant mothers should also be warned about the risks of smoking, alcohol intake, and drug use during pregnancy.
• Proper bedding. Studies have shown that soft bedding, such as beanbags, waterbeds and soft mattresses, contributes to SIDS. Babies should sleep on firm mattresses with no soft or fluffy materials underneath or around them—including quilts, pillows, thick comforters or lambskin. Soft stuffed toys should not be placed in the crib while babies sleep.
• Room temperature. Although babies should be kept warm, they do not need to be any warmer than is comfortable for the caregiver. An overheated baby is more likely to sleep deeply, perhaps making it more difficult to wake when short of breath. Room temperature and wrapping should keep the baby warm and comfortable but not overheated.
• Diet. Some studies indicate that breastfed babies are at lower risk for SIDS. It is thought that the mother's milk may provide additional immunity to the infections that can trigger sudden death in infants.
• Bedsharing with parents. Opinions differ on whether or not bedsharing of infant and mother increases or decreases the risk of SIDS. Bedsharing may encourage breast-feeding or alter sleep patterns, which could lower the risk of SIDS. On the other hand, some studies suggest that bedsharing increases the risk of SIDS. In any case, mothers who choose to bring their babies to bed should observe the following cautions: Soft sleep surfaces, as well as quilts, blankets, comforters or pillows should not be placed under the baby. Parents who sleep with their infants should not smoke around the baby, or use alcohol or other drugs which might make them difficult to arouse. Parents should also be aware that adult beds are not built with the same safety features as infant cribs.
• Secondhand smoke. It is as important to keep the baby's environment smoke-free during infancy as it was when the mother was pregnant with the baby.
• Electronic monitoring. Electronic monitors are available for use in the home. These devices sound an alarm for the parents if the child stops breathing. There is no evidence, however, that these monitors prevent SIDS. In 1986, experts consulted by the National Institutes of Health (NIH) recommended monitors only for infants at risk. These infants include those who have had one or more episodes of breath stopping; premature infants with breathing difficulties; and babies with two or more older siblings that died of SIDS. Parents who use monitors should know how to use them properly and what to for the baby if the alarm goes off.
• Immunizations. There is no evidence that immunizations increase the risk of SIDS. In fact, babies who receive immunizations on schedule are less likely to die of SIDS.

— Teresa Norris, RN