SIDS Risk Factors

The American Academy of Pediatrics (AAP) issues policy statements detailing known SIDS risk factors and recommendations to reduce SIDS.  Several other authoritative sources on SIDS are typically involved in producing and supporting the AAP recommendations.

As we understand it SIDS risk factors are conditions, behaviors, and activities researchers have found correlate with SIDS deaths.  This does not mean the risk factors cause SIDS.  It just means that when a child has died from SIDS, researchers have found these factors have been present more than normal.

The AAP writes their papers for doctors and healthcare professionals.  They can get incredibly technical, but are without question among the best sources of information on SIDS.  At the bottom of this page we link to the AAP SIDS report and policy statement for those who would like to explore them further, but also briefly summarize them below.


What Does AAP Recommendation Look Like?
Sometimes a picture is worth a thousand words.  Here is a link to a one page pamphlet that illustrates many of the 2011 AAP policy statement recommendations to reduce the risk of SIDS.


Quick Way to Remember:  The ABCs of Safe Sleep
While this does not cover all the 2011 AAP recommendations, we find the “ABCs of Safe Sleep” message hits many of the big points and is super easy to remember.  This messaging is being used by the US Food and Drug Administration (FDA), and many other public health organizations.  ABCs of Safe Sleep states babies should always sleep Alone on their Back in a bare Crib.


Good Video:  Quick 12 minute overview
The US Consumer Product Safety Commission (CSPC), in partnership with the AAP and Keeping Babies Safe has produced one of the better videos we have seen.  The video hits on many of the AAP recommendations, but also includes some additional specific things related to safe cribs.  Click here to go to the video.


Detailed Summary of the AAP Recommendations
A number of credible sources have summarized the full AAP recommendations so that they are easier for non-health professionals to understand.  The following summary combines’ language from three different sources (Children’s National, Boston Children’s, and SIDS Center at Georgetown) we have found easiest to understand as well as some of the language specifically from the AAP Technical Report.

• Pregnant women should seek and obtain regular prenatal care 1
  • early and regular prenatal care can help reduce the risk of SIDS 6
• Babies should always be put to sleep on their backs 2
  • Parents, babysitters, day care workers and other caregivers should always put babies to sleep on their backs, instead of on their stomachs 6
  • Once an infant can roll from the supine (back) to prone (front) and from the prone (front) to supine (back) position, the infant can be allowed to remain in the sleep position that he or she assumes 13
• Infants should sleep in a safety-approved crib, portable crib, play yard, or bassinet 3
  • Infants should not be placed for sleep on adult-sized beds 3
  • Car seats and other sitting devices are not recommended for routine sleep at home or in the hospital, particularly for young infants 3
  • Use a firm sleep surface. 4  Use a firm mattress with a tight-fitting sheet. 2
• Room-sharing without bed-sharing is recommended 4
  • Parents should not share a bed with baby 2
  • For the first 6 months, babies should sleep in the same room as parents (but not in your bed) 2
• Keep soft objects and loose bedding out of the crib 4
  • Pillows, quilts, comforters, sheepskins, and other soft surfaces are hazardous when placed under the infant or loose in the sleep environment 5
  • Don't place soft stuffed toys or pillows in the crib 6
  • Don’t place bumper pads around your baby’s crib 6
  • Wedges and positioning devices are not recommended 1
• Avoid smoke exposure during pregnancy and after birth 4
  • Don't smoke when you’re pregnant 6
  • It is estimated that one-third of SIDS deaths could be prevented if all maternal smoking during pregnancy were eliminated 7
  • Keep your baby away from smokers 2
  • Don't let anyone smoke around your baby. Babies and young children exposed to smoke have an increased risk of SIDS 6
• Avoid alcohol and illicit drug use during pregnancy and after the infant’s birth 4
• Breastfeeding is recommended 4
  • If possible, breastfeed your baby 6
  • If a breastfeeding mother brings the infant into the adult bed for nursing, the infant should be returned to a separate sleep surface when the mother is ready for sleep 8
• Consider offering a pacifier at nap time and bedtime 8
  • Offer your baby a pacifier (once breastfeeding has been established) 2
  • Use pacifiers at naptime and bedtime during the first year, but not during the first month for breast-fed babies 9
• Avoid overheating and head covering in infants 10
  • Don’t let baby get too warm during sleep.  A general rule is that babies need one more layer than you do. 8
  • Make sure baby’s head and face stay uncovered during sleep 9
• Infants should be immunized in accordance with recommendations of the AAP and Centers for Disease Control and Prevention 11
  • Parents should be sure to take their babies for their regular well-baby check-ups and routine immunizations 6
• Supervised, awake tummy time on a daily basis 3
  • Tummy time should begin as early as possible to promote motor development, and facilitate development of the upper body muscles 10
  • “Awake time” spent on the stomach may help prevent flat spots from developing on the back of your baby's head 6
• Infant home monitors should not be used as a strategy for preventing SIDS 12
• Expand the national campaign to reduce the risks of SIDS to include a major focus on the safe sleep environment and ways to reduce the risks of all sleep related infant deaths, including SIDS, suffocation, and other accidental deaths; pediatricians, family physicians, and other primary care providers should actively participate in this campaign 4
• Media and manufacturers should follow safe-sleep guidelines in their messaging and advertising 4

Link to Full AAP Recommendations
The AAP has released recommendations several times over the last several decades; for instance, 1992, 1998, 2005, and 2011.  It can be interesting to see how the recommendations have progressed.  But it is important to note some of the older recommendations are repealed by newer recommendations.  For instance prior recommendations encouraged back sleeping or side sleeping, but additional research proved side sleeping too hazardous and it was removed as a recommendation.  Use caution if looking at old recommendations or old data.

Here is a link the latest and most accurate full AAP SIDS policy statement and report.



 

Footnotes and Additional Reading

1 Source:  http://pediatrics.aappublications.org/content/128/5/e1341.full.pdf+html    (see page 13)
2 Source:  http://www.childrensnational.org/files/PDF/research/SIDStips2011.pdf
3 Source:  http://pediatrics.aappublications.org/content/128/5/e1341.full.pdf+html    (see page 10)
4 Source:  http://www.sidscenter.org/AAPguidelines.html  
5 Source:  http://pediatrics.aappublications.org/content/128/5/e1341.full.pdf+html   (see page 12)
6 Source:  http://childrenshospital.org/az/Site1654/mainpageS1654P4.html
7 Source:  http://pediatrics.aappublications.org/content/128/5/e1341.full.pdf+html   (see page 14)
8 Source:  http://pediatrics.aappublications.org/content/128/5/e1341.full.pdf+html   (see page 15)
9 Source:  http://www.childrensnational.org/research/OurResearch/disorders/cccr/CribDeathSIDS-Facts.aspx
10 Source:  http://pediatrics.aappublications.org/content/128/5/e1341.full.pdf+html   (see page 16)
11 Source:  http://pediatrics.aappublications.org/content/128/5/e1341.full.pdf+html   (see page 17)
12 Source:  http://pediatrics.aappublications.org/content/128/5/e1341.full.pdf+html   (see page 18)
13 Source:  http://pediatrics.aappublications.org/content/128/5/e1341.full.pdf+html   (see page 9)