It's not uncommon to find a parent standing next to their sleeping newborn's crib in the middle of the night, hand gently placed over the child's chest to check on their breathing. Many new moms and dads worry about the possibility of Sudden Infant Death Syndrome (SIDS), the unexplained death of a child under 1-year-old.
In 2015, there were 3,700 sudden unexpected deaths of children under age 1 in the United States. Risk peaks between 1 and 4 months old, and while 90 percent of SIDS deaths occur before 6 months, the possibility is still present throughout the first year.
Current research suggests there may be a link between SIDS and brain abnormalities controlling breathing and heart function, but doctors still don't entirely understand exactly why SIDS occurs.
While it sometimes can't be prevented, there are steps you can take to reduce your child's risk. Alison Niebanck, MD, F.A.A.P and Assistant Professor of Pediatrics at Memorial Health University Medical Center in Savannah, Georgia, shares what parents can do to prevent SIDS - as well as certain risk factors that are out of our control.
The most effective way to reduce SIDS risk
Creating a safe sleep environment for your infant is the most important thing any parent can do to protect their newborn from SIDS. Babies should always be placed on their back to sleep - never on their stomach or side.
Dr. Niebanck advises her patients to follow the American Academy of Pediatrics' (AAP) safe sleep recommendations: "All babies should be on their back, alone, in a crib or bassinet. The mattress should be firm, with no space between the mattress and the crib." Parents should be sure that mattress sheets are tight-fitting, with no loose bedding surrounding a child.
"The crib should not have any bumpers, blankets, pillows or stuffed animals in with the baby," Niebanck adds. Parents are advised never to use any sleep positioners or wedges in their child's crib, as well, as it creates the potential for suffocation or entrapment.
AAP also recommends that children should sleep in the same room as their parents for at least six months, but in their own crib, bassinet or play yard.
Controversies around co-sleeping
Sharing your adult bed with an infant, known as co-sleeping, is common in many cultures and recently has increased in popularity in the United States. The Centers for Disease Control and Prevention (CDC) reports that in 2015, more than half of American parents surveyed admitted that they shared a bed with their infant, with 24 percent saying they co-slept often or always. While many parents swear by bed-sharing, the AAP urges parents not to do it.
"Co-sleeping increases the risk of SIDS anywhere between 5 and 15 times," says Niebanck.
If you do co-sleep, don't hide it from your pediatrician. Bring it up at your child's wellness visit so they can assess your infant's risk for SIDS.
The case against swaddling
Learning how to swaddle your newborn is a mainstay of most parenting classes. Tightly wrapping your infant in a blanket is fine in the hospital, but new evidence shows that it may not be as safe as once thought.
Niebanck says she prefers sleep sacks or sleepers with feet for newborns. Both allow a child's arms to be free and prevent any excess fabric from covering the face. Another alternative to calm a fussy sleeper is to give them a pacifier. Although the reason why is still somewhat unclear, pacifiers reduce the risks of SIDS. Choose pacifiers without toys, stuffed animals or clips to clothing attached.
Safe sleep while traveling
A vacation with your newborn should be a fun-filled experience, but there also may be difficulties. Established routines are often sacrificed when a family travels to a new location, causing sleep disruptions during nap and bedtime.
To help babies sleep in an unfamiliar environment, parents may resort to tactics they would not try at home, such as co-sleeping or letting their child rest in their car seat.
"Car seats are great and perfect for the car, but they create an unsafe sleep environment when taken out of the car," cautions Niebanck.
Sitting up in a car seat for an extended period may result in breathing difficulties, especially in younger infants. Car seats are also not steady when out of the car, posing the risk of a tip over and accidental suffocation. Parents may also turn to strollers and baby swings when they are desperate to get their child to sleep, but both also pose a risk for tipping over. A very brief, supervised nap is fine, but a longer snooze should still take place in a crib.
Niebanck also tells traveling parents to make sure they pack their own travel play yard or call the hotel to see if they offer one. Steer clear of renting or using a crib of unknown origin. "You don't know how old the crib is, or if it's a drop-side crib, and we do know that drop-side cribs are an increased risk for entrapment and SIDS," says Niebanck.
Many airlines offer to check these items for free, so reach out to them before flying.
Wellness visits for both mom and baby
Receiving regular medical care is important for expectant mothers and their newborn children. Access to prenatal care and wellness visits for infants decreases the risk of SIDS. Late or no prenatal care is a known risk factor for SIDS.
Once your child is born, following guidelines for regularly scheduled pediatrician visits is crucial. "Newborns should receive a checkup within the first 72 hours or so after leaving the hospital and at 1 month, 2 months, 4 months, 6 months, 9 months and 12 months," says Niebanck. "The pediatrician can assess the baby's development and screen for any other possible situations that could contribute to SIDS."
During every visit, your pediatrician will discuss your child's sleep patterns and go over suggestions for a safe snoozing environment. It's also important that infants follow a vaccination schedule during this time. Childhood vaccines are not linked to SIDS, despite any myths parents may have heard.
The benefits of breastfeeding and other family health measures
"Breastfeeding decreases the risk of SIDS by about half, although we're not quite sure what the reasons are behind it," says Niebanck.
Research has also found that partial breastfeeding, when breast milk is supplemented by some formula feedings, can impart those same benefits of SIDS protection.
Beyond breastfeeding, parents can also make other lifestyle choices to protect their child against SIDS. Smoking while pregnant and exposure to secondhand smoke after birth are both the largest risk factors, after sleep position. In fact, a 2011 study in Pediatrics estimated that one-third of all SIDS deaths could be prevented if mothers did not smoke during their pregnancies.
Pregnant women should also refrain from consuming alcohol or using illegal drugs. Drinking alcohol around the time of conception is also associated with a higher risk. If you or your spouse consume alcohol after your child is born, do not attempt to bed share with your baby - the combination could be especially dangerous.
What you can't control
"About 95 percent of SIDS cases can have some preventable risk factors, but there is a subset of crib death for which we do not have an answer," says Niebanck. "Presumably there may be a genetic component, but the research has not been able to exactly determine what those issues are."
Among other risk factors parents can't control for are preterm birth or a low birth weight. Children born to mothers who are under 20 years old also carry an increased risk, although Niebanck says that doctors do not know if it is related to age, lack of access to doctors for younger mothers or the increased likelihood of preterm birth.
Don't be fooled by at-home monitors
Parents may be swayed into buying a home cardiorespiratory monitor that measures an infant's breathing. However, these devices should never be viewed as a SIDS prevention technique. "There are a lot of options on the market but there has been no data to show that they prevent episodes of SIDS," cautions Niebanck. Many times, these breathing monitors can either lead to complacency in parents or, on the opposite end of the spectrum, unnecessary anxiety about a newborn's health.
SIDS is scary and may be constantly on your mind if you have a newborn. To allay those fears, continue to make healthy choices for your family, schedule visits with your pediatrician regularly and, most of all, create the safest sleep environment possible for your child.