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How to Decrease the Risk of Sudden Infant Death Syndrome

Reviewed by James Brann, M.D.

Do You Know the Risk Factors, of Sudden Infant Death Syndrome

No parents want to face the nightmare of having to plan a funeral for a new baby. In the United States, more than 2,300 American babies die annually from a silent and unexplained killer - SIDS (Sudden Infant Death Syndrome). Unfortunately, despite all the years of research and preventative measures, SIDS remains unpredictable and mysterious.

Sudden Infant Death Syndrome is defined as the sudden and unexpected death of a child who has not yet reached his or her first birthday. In the United States, SIDS is the number one cause of death in infants under age one. A majority of victims (90 percent) are under six months of age. SIDS is more likely to happen when the child is between two and four months old, but it can also strike in the later months.

Physicians don't consider SIDS to be a single illness or condition. Rather, it is caused by many different factors. Sudden infant death syndrome is only diagnosed when a seemingly healthy child under age one dies without any warning, and the exact cause of death can't be determined, even after a review of the baby's medical history, an autopsy of the body, and a death scene investigation.

SIDS is also called "crib death" or "cot death," because it often occurs during the nighttime hours between 10 p.m. and 10 a.m. Sudden Infant Death Syndrome can also strike during the day.

The American Academy of Pediatrics reports that 20 percent of SIDS deaths occur in childcare situations – i.e. someone other than the parent is taking care of the child.

This is a high statistic, considering that infants in childcare spend less time sleeping than they do when they're at home. Due to this high number of SIDS deaths, parents need to be sure that any babysitter, daycare provider, or caregiver watching their babies are familiar with safe sleeping guidelines and other SIDS safety measures.

Learn about how to decrease your risk of sudden infant death syndrome.

Possible Causes and Risk Factors of SIDS

For the last three decades, scientists have been trying to understand Sudden Infant Death Syndrome. The definite cause of SIDS remains unknown, but experts have a number of theories.

Experts believe that SIDS victims may have trouble with sleep arousal, or they may be unable to sense a build-up of carbon dioxide in their blood. These babies may have an underlying abnormality that puts them at higher risk for Sudden Infant Death Syndrome.

A research study out of the Journal of the American Medical Association, published in 2010, found that infants who passed away from SIDS had low levels of the brain chemical serotonin.

Serotonin helps the brainstem regulate temperature, breathing, waking and other automatic functions.

Normally, serotonin helps sleeping babies recognize high levels of carbon dioxide in their blood by waking them up and causing them to shift their head to get fresh air. When an infant is placed to sleep face down, his or her exhaled carbon dioxide may pool in the loose bedding, and it may be breathed back in. A baby with normal levels of serotonin will automatically wake up. Babies with low levels might not wake up, and may become a SIDS victim.

In addition to brain vulnerabilities, researchers have pinpointed a number of risk factors, which increase your baby's risk of Sudden Infant Death Syndrome. They include:

  • Maternal Smoking – Smoking during pregnancy, and exposure to secondhand smoke can double or quadruple a child's risk for SIDS. Researchers don't know whether smoking at a specific period is more harmful than another, but SIDS rates increase the more a mother smoked. Smoking is considered of the most preventable risk factors for Sudden Infant Death Syndrome.

    In healthy babies, they are able to detect and respond to oxygen deprivation by automatically waking up and moving their head. This arousal mechanism doesn't work as well in babies exposed to smoke. Nicotine exposure during pregnancy can make it harder for these infants to develop a healthy arousal system.

  • Alcohol and Drug Use – Drinking alcohol in pregnancy, especially first trimester binge drinking, is associated with a significantly higher risk of SIDS. In addition, illegal drug use increases a baby's risk for SIDS by five-fold. It's not understood whether this causal relationship is due to the affect of the harmful drugs itself, or because drug use increases prematurity and low-birth babies.

  • Premature Birth – Compared to full-term babies, premature infants are at higher risk for SIDS. Among babies who were born with a very low birth weight, they have a three to four-fold higher risk of Sudden Infant Death Syndrome.

  • Sleep Apnea and Impaired Respiratory Function – Babies who suffer from sleep apnea (a condition that is characterized by a pause in breathing for at least 20 seconds) or who have impaired respiratory function are at higher risk for SIDS.

  • Sleeping on Stomach – The prone sleeping position (placing your child to sleep on his or her stomach) increases the risk of SIDS. The rates of Sudden Infant Death Syndrome have dramatically decreased since the 1990s, when pediatricians first recommended that parents placed their babies to sleep on their backs.

  • Sibling of SIDS Victim – Unfortunately, the siblings of SIDS victims are at five to six-fold risk of infant death themselves. Not to worry though – the risk of a sibling succumbing from SIDS is less than one percent. This risk may be a combination of genetic and health factors.

Over 95 percent of Sudden Infant Death Syndrome cases are related to one or more of the above risk factors. Fortunately, in many cases, the risk factors can be changed – such as avoidance of smoking, and the avoidance of placing your baby to sleep on his or her stomach.

What is Recommended to Decrease the Risk of Sudden Infant Death Syndrome

Unfortunately, there is no way to completely prevent SIDS. However, experts have pinpointed a number of strategies that will lower your baby's risk of Sudden Infant Death Syndrome. According to the National Institute of Child Health and Human Development's "Back to Sleep" Campaign, the following ten strategies will help reduce your baby's risk of SIDS.

1. Babies should sleep on their backs. The back sleeping position is considered the safest way for your infant to sleep – for naps and for extended sleeping times. (Stomach sleeping is too dangerous, and it dramatically increases your baby's risk of SIDS.) Don't worry about choking – healthy babies automatically swallow and cough up liquids and fluids. There hasn't been an increase in choking in infants who sleep on their backs.

2. Use a firm mattress or sleep surface. Never allow your infant to sleep on a soft surface. A firm sleep surface, such as a safety-approved crib mattress, that is covered by a fitted crib sheet will lower your child's risk of SIDS.

3. Keep loose bedding and soft objects out of the crib. You may think that your baby needs a soft toy to snuggle with, or a pillow underneath his head, but you should keep any pillows, blankets, quilts, or soft objects out of your baby's sleeping environment. You should also avoid pillow-like crib bumpers. All of these objects can increase the suffocation hazard. Laying your child to sleep on a flat, firm surface is best.

4. Never smoke around baby. You should protect your baby from secondhand smoke. Smoking around your baby increases the risk of SIDS.

5. Don't allow baby to sleep with you. Co-sleeping is not recommended, and it may increase the risk of SIDS. Your baby should never be allowed to sleep in the same bed or couch with you or your children. Babies are safest when they sleep in a separate sleep area, such as their crib, cradle, or bassinet.

6. Use a pacifier. When placing your baby down to sleep, give him a clean, dry pacifier. Using a pacifier during sleep may lower the risk of SIDS. (Don't force your child to take the pacifier, and don't reinsert it into your child's mouth once he or she is asleep.) If you are breastfeeding, you should wait until your baby is one month old before introducing the pacifier.

7. Don't let your baby get too hot. Overheating has been associated with SIDS. You can lower your baby's risk by keeping the room temperature comfortable. (If you are too warm in the room, chances are your baby is too.) You should dress your baby in light sleeping clothing.

8. Avoid using any products touted to reduce SIDS. Experts don't recommend that you use any products that claim to reduce the risk of SIDS. Most products haven't been tested for their safety or effectiveness.

9. Don't use home monitors to lower SIDS risk. Healthcare providers don't recommend that you use home monitors to reduce the risk of SIDS.

10. Remember "Tummy Time." Whenever your baby is awake, and there is adult watching, place your baby on your stomach. Tummy time will help your baby develop his or her head, neck, and shoulder muscles, and it helps prevent flat spots on the back of the head.

Sudden Infant Death Syndrome, or SIDS, is a scary thought, but it is a fairly rare phenomenon. Keep the above prevention techniques in mind, and most likely, your baby will be perfectly fine. By the time your baby reaches six months of age, the risk significantly drops.


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