Sudden Infant Death Syndrome (SIDS)

• It is nobody’s fault when a baby dies of sudden infant death syndrome (SIDS). You can't predict it or prevent it.
• There are some things you can do to try to lower the risk of SIDS. The most important one is to always place your baby to sleep on his or her back rather than on the stomach or side.
• Make sure your baby’s caregivers know what you expect them to do. Don't assume they know what to do to reduce the risk of SIDS.

What is sudden infant death syndrome (SIDS)?

Sometimes a baby who seems healthy dies during sleep. This is called sudden infant death syndrome or SIDS. SIDS is also known as crib death.

In most cases, a parent or caregiver places the baby down to sleep and returns later to find the baby has died. It’s no one’s fault. SIDS can happen even when you do everything right.

Although SIDS is rare, it is one of the most common causes of death in babies between 1 and 12 months of age. Most babies who die of SIDS are between the ages of 2 and 4 months. More boys than girls die of SIDS, and most deaths occur in the winter.¹

What causes SIDS?

Doctors don't know what causes SIDS. It seems to happen more often in premature and low-birth-weight babies. It also is seen more often in babies whose mothers did not get medical care during the pregnancy and in babies whose mothers smoke. SIDS may also be more likely in babies who were part of a multiple pregnancy (for example, twins or triplets) or whose mothers are younger than 20.

When babies sleep on their bellies, they may not breathe well. Not too long ago, side sleeping was said to be okay. But babies placed on their sides can easily roll onto their bellies and could have trouble breathing.

Researchers are studying the possibility that SIDS may be caused by problems with how well the brain controls breathing and/or temperature during the first few months of life.² More research on this is needed.

What are the symptoms?

SIDS has no symptoms or warning signs. Babies who die of SIDS seem healthy before being put to bed. They show no signs of struggle and are often found in the same position as when they were placed in the bed.

How is SIDS diagnosed?

SIDS is named the cause of death only when no other cause is found. To find out why a baby died, medical experts review the baby's and parents' medical histories, study the area where the baby died, and do an autopsy.

What can you do to reduce the risk of SIDS?

There is no sure way to prevent SIDS, but doing certain things may help protect a baby:³

• The most important thing you can do is to always place your baby to sleep on his or her back rather than on the stomach or side.
• Don't smoke while you are pregnant. Also, do not let anyone smoke around your baby after he or she is born.
• For the first 6 months, have your baby sleep in a crib in the same room where you sleep.
  • Make sure the baby sleeps on a firm mattress (with a fitted sheet).
  • Don't put anything in the crib that a baby can pull over his or her head, such as blankets, comforters, stuffed toys, or pillows.
  • If you use bumper pads, use ones that are thin and firm, and make sure they are attached tightly to the crib.
  • Keep the room warm enough so that your baby can sleep in lightweight clothes without a blanket.
• Consider offering your baby a pacifier at nap time and bedtime. This may help prevent SIDS, though experts do not know why. If you breast-feed, wait until your baby is about a month old before you start giving him or her a pacifier.

Make sure your baby’s caregivers know what you expect them to do. Don't assume they know what to do to help reduce the risk of SIDS.

Frequently Asked Questions

Sudden infant death syndrome (SIDS) has no symptoms or warning signs. Babies who die of SIDS:

• Cannot be revived (resuscitated).
• Seem healthy before being put to bed.
• Show no signs of having struggled. The baby is often found in the same position as when he or she was put to bed.

Only about 5% of babies who die of SIDS have a history of apparent life-threatening events (ALTE), and the relationship between SIDS and ALTE is unclear.¹ During ALTE, a baby has abnormally long pauses in breathing (longer than 20 seconds). The skin changes color (bluish and blotchy) or becomes pale, and the body stiffens and then goes limp. The baby may also choke or gag. One or more ALTE events have been suspected in some babies who later died of SIDS. However, machines (apnea monitors) that are commonly used to detect these periods of interrupted breathing have not been effective in preventing SIDS.

No diagnostic exam or test can predict whether a baby is likely to die of sudden infant death syndrome (SIDS).

A thorough investigation is conducted after every suspected SIDS incident. The baby's funeral can be held before the report is complete. Exams and tests related to the investigation include:

• An autopsy performed by a medical examiner (preferably one experienced in identifying diseases and causes of death in babies). This may include X-rays, blood tests, and tissue cultures to rule out other causes of death.
• Questions regarding the parents' and the child's medical histories.
• A careful examination of where the baby died.

Early Detection

There are no known tests that can determine whether a baby may die of SIDS, even for those who are suspected of having a higher risk.

Machines called apnea monitors have been used on some babies believed to be at high risk for SIDS. These machines sound an alarm when they detect a lapse in breathing. However, monitoring a baby's breathing while asleep has not been shown to prevent SIDS.

There is no treatment for sudden infant death syndrome (SIDS). A baby's death from SIDS cannot be predicted or prevented. However, you can take precautions that may reduce the chance that your baby might die of SIDS. The single most important thing you can do is place your baby to sleep on his or her back.

There are products that are marketed to help prevent SIDS, such as ventilated mattresses. However, no mattress or other product has been proven to lower the risk of SIDS. The American Academy of Pediatrics (AAP) does not advise the use of any product to help prevent SIDS.

Remember, sudden infant death syndrome (SIDS) is rare. Don't let your fear of SIDS keep you from enjoying your baby.

Studies have found that some risk factors are associated with SIDS, although the relationships are not entirely clear. You can take the following precautions that may help reduce your baby's risk of SIDS:³

• Do not smoke, and take care of yourself when you are pregnant. During pregnancy, you can lower your baby's risk for SIDS by getting prenatal health care and taking general precautions. Also, do not allow anyone to smoke around your baby after he or she is born. Secondhand smoke also increases your baby's risk of SIDS.
• Always place your baby down to sleep on his or her back. This is the safest sleep position for a baby. The rate of SIDS deaths has greatly decreased in most countries that have encouraged parents to place babies who are less than 1 year old on their backs to sleep.⁴ It is important to follow these guidelines every time your baby sleeps. Children who are unaccustomed to sleeping on their stomachs and are then placed on their stomachs for sleep may be at an even higher risk for SIDS.² Unless your health professional advises otherwise, do not place your baby to sleep on his or her side or stomach.
• For the first 6 months, place your baby to sleep in a crib in the same room you sleep in. (You can use a cradle or bassinet.) The American Academy of Pediatrics (AAP) now recommends that you do not sleep with your baby in the same bed. If you do sleep together, take precautions to make bed sharing safer. Do not ever share a bed with your baby if you smoke, have had alcohol, used medicine that makes you sleep very soundly (sedatives), or used illegal drugs. Never sleep with a baby on a couch or armchair.
• Use firm bedding materials, including a firm mattress. Make sure the baby sleeps directly on a firm mattress with a fitted sheet.
  • Choose a crib, cradle, or bassinet that meets all the safety standards set by the Consumer Product Safety Commission. (Baby beds that attach to the side of the parents' bed have not yet been tested enough to have set safety standards.)
  • Don't put anything in the crib with your baby. A baby may pull items like blankets, comforters, stuffed toys, or pillows over his or her head and increase the chance for SIDS.
  • If a sheet or blanket is needed for warmth, tuck it into the bottom of the crib. Place your baby so his or her feet touch the end of the crib where the sheet is tucked in. Make sure the sheet or blanket does not reach higher than the baby's chest.
  • Bumper pads should be thin, firm, and securely tied to the crib if they are used at all. They usually are not needed.
• Avoid overheating your baby or the bedroom where the baby sleeps. Keep the room where your baby sleeps warm enough [around 65° (18.3°)] so that he or she can sleep with light clothing without needing covers. Usually, the temperature is about right if an adult can wear a long-sleeved T-shirt and pants without feeling cold. But make sure your baby does not get too warm. Putting extra blankets or clothes on your baby in winter can increase the chance that he or she gets too warm. Your baby is likely too warm if he or she sweats or tosses and turns a lot.
• Give your baby a pacifier at nap time and bedtime. ⁵ This may help prevent SIDS for reasons that experts do not yet fully understand.
  • If you breast-feed, wait until your baby is about 1 month old before you offer a pacifier. Pacifiers sometimes confuse a newborn baby and can make breast-feeding more difficult.
  • Don't worry about putting the pacifier back into your baby's mouth after he or she has fallen asleep.
  • Don't force your baby to use a pacifier is he or she does not want it.
• Talk with your child care providers and babysitters about these precautions. Explain in detail on the first day of child care (or before) what you expect the staff to do. Do not assume that your child care providers or babysitters know these new guidelines to prevent SIDS. About 20% of SIDS deaths occur in child care settings.⁶

Don't rely on home monitors or other devices marketed as a way to reduce your baby's risk of SIDS. These items have not been tested enough to prove they work.

Help your baby develop a normal head shape

The back of your baby's head may get a little flat from always placing him or her to sleep on the back. Usually, the flat area is not very noticeable. Your baby's head shape will return to normal after he or she can sit and crawl. But sometimes the head can become very noticeably flat. You can help prevent this by helping your baby get stronger and by changing his or head position regularly.

• Make sure your baby gets "tummy time" every day. Place your baby on his or her tummy for playtime while you are watching closely. Let your baby "squirm" around, making sure that he or she can breathe easily. Tummy time helps your baby build strength and develop motor skills. These are important for helping your baby learn to move and hold his or her head up.
• Cuddle your baby while holding his or her head up as much as you can. Don't place your baby in car seat carriers or bouncers for long periods each day. Holding your baby is better for all areas of development.
• At least every week, change your baby's head position during sleep. (Remember to always keep your baby on his or her back during naps and at bedtime.) A good way to make sure your baby's head rests in different positions is to switch which end of the bed you place him or her each week. One week, place your baby so his or her feet are at the end of one end of the crib; the next week, place the feet at the other end. Babies usually turn their heads away from the wall, toward the inside of a room. If your baby's crib is not against a wall, you can try moving your baby's head position more to one side while he or she is sleeping.

Dealing with grief

Losing a baby to SIDS is a tremendously painful experience. It can take months or years before you begin to feel as if your life is getting back to normal. Everyone in your household will have his or her own unique way of grieving for the lost baby. These different ways of coping with death can strain a marriage and a family. Some aspects of your family's grief may relate specifically to a SIDS death. For example, along with grief, family members may be struggling with feelings of guilt. Support from family, friends, and possibly health professionals during this process is very important for everyone.

Trusted health professionals can help you after your baby's death. Be aware that your baby's death also can affect your health professional. He or she may recommend other trained professionals to give you the needed support. If you feel the response from your health professional is inadequate, seek help somewhere else. For instance:

• Join a grief support group. Ask your health professional if one specifically for parents who have lost babies to SIDS is available in your area.
• Visit a mental health professional (psychiatrist, psychologist, licensed professional counselor). Many families benefit from group counseling to help them deal with the tensions that arise after the loss of a baby.
• Talk with a close family member, friend, or clergy member.

For more information about and help with grief in general, see the topic Grief and Grieving.

Organizations

• Grief and Grieving

Citations

1. Brooks JG, Darnall RA (2001). Sudden infant death syndrome. In RA Hoekelman, ed., Primary Pediatric Care, 4th ed., pp. 1869–1875. St. Louis: Mosby.

2. Hunt CE, Hauck FR (2003). Sudden infant death syndrome. In RE Behrman, ed., Nelson Textbook of Pediatrics, 17th ed., pp. 1380–1385. Philadelphia: Saunders.

3. Task Force on Sudden Infant Death Syndrome, American Academy of Pediatrics (2005). The changing concept of sudden infant death syndrome: Diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics, 116(5): 1245–1255. Also available online: http://www.aap.org/ncepr/revisedsids.pdf.

4. Creery D, Mikrogianakis A (2005). Sudden infant death syndrome. Clinical Evidence (14): 420–428.

5. Hauck F, et al. (2005). Do pacifiers reduce the risk of Sudden Infant Death Syndrome: A meta-analysis. Pediatrics, 116(5): 716–723.

6. Moon RY, et al. (2000). Sudden infant death syndrome in child care settings. Pediatrics, 106: 295–300.

Other Works Consulted

• American Academy of Pediatrics (2005). Policy statement: The changing concept of sudden infant death syndrome: Diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics, 116(5): 1245–1255.

• Kline A, Gibson E (2006). Sudden infant death syndrome. In FD Burg et al., eds., Current Pediatric Therapy, 18th ed., pp. 258–260. Philadelphia: Saunders Elsevier.

Author:	Amy Fackler, MA Debby Golonka, MPH	Last Updated October 4, 2006
Medical Review:	Michael J. Sexton, MD - Pediatrics Julien I. E. Hoffman, MD - Pediatrics
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