Sudden Infant Death Syndrome (SIDS) rates are increasing. SIDS, also known as “cot death” or “blue baby” is a devastating situation where a previously healthy infant dies in his or her sleep. Over the last 20 years of my practice as a pediatrician, I have sadly seen many cases of SIDS deaths. Just last week, I firsthand dealt with a reportedly previously healthy two-month-old female baby whose mom reported co-sleeping with the baby. It had been an overnight stay at a relative’s house, and mom decided that it was just one night and it would be OK to co-sleep. But unfortunately, that was the night that the baby died from SIDS. It’s horrible when these babies come into the ER– found dead and blue, the parents start CPR and call 911, hoping and praying for a miracle. It doesn’t usually happen. Instead, we finish the code and call time of death, then try to comfort the parents.
Causes of SIDS
Did the baby accidentally suffocate during co-sleeping, or was it a coincidental tragedy that happened from another cause that night? We might not know the exact cause, but one rule of thumb- babies should sleep ALONE, on their BACK, in a CRIB. Yet these “ABCs” of safe sleep are the center of controversy, especially among breastfeeding mothers who share a bed with their baby. The vast majority of pediatricians agree that the safest place for a baby to sleep is in the same room as their mother, but not in the same bed.
Research published in the medical journal Pediatrics shows that most infants that die of SIDS had underlying brainstem abnormalities that prevent them from responding appropriately to a lack of oxygen (https://bit.ly/2MU54TM). Specifically, they had abnormalities in serotonin levels and receptors, as well as GABA receptors. So it’s not just suffocation that causes SIDS. The good news is that SIDS is largely preventable.
The “ABCs” of SIDS
A: Babies should sleep ALONE.
B: Babies should sleep on their BACK.
C: Babies should sleep in a CRIB.
Common Questions about Safe Sleep
Q: “How long should my baby sleep on his back?”
A: The American Academy of Pediatrics recommends that babies sleep on their backs until they are one year of age. As a mother, I know this is hard to accomplish! Put your baby to sleep on his back from the time he is born and let him learn to be a back sleeper. Do not let him sleep on his belly even if he is on your chest. Do not let him sleep on his side.
Q: “Will my baby choke if he spits up while sleeping on his back?”
A: No, neurologically healthy babies cannot choke on their own spit-up, even if they are sleeping on their backs. They may cough a bit but this is normal.
Q: “Is it safe to have a crib with a bumper, blanket, stuffed animal, and other matching pieces?”
A: No… Nothing goes in a crib except the baby and a tight-fitting crib sheet. The “crib sets” marketed by many retail stores include many unsafe items. Never use a blanket in your baby’s bed except to swaddle the baby as described below. Bumpers are not recommended because many experts feel they are a suffocation hazard. Never put pillows, blankets, stuffed animals, or other objects in your baby’s bed.
Q: “Can I swaddle my baby like they did in the nursery at the hospital?”
A: Yes, you may swaddle your baby tightly until he knows how to get out of his swaddling blanket, which usually occurs within the first month. “Wearable blankets” and swaddling blankets with Velcro closures are now highly recommended to keep your baby warm and safely swaddled. They can also help your baby sleep for longer periods of time at night, which means you get more sleep, too! Be careful that your baby is not too warm.
Q: “Can I use a sleep positioner or wedge?”
A: Sleep positioners and wedges are now considered suffocation hazards. Only a few years ago these were marketed as SIDS prevention devices, yet now they are known to be dangerous (see this previous MomDocs column for more: https://bit.ly/2nJaYwd). If your baby spits up a lot or has been diagnosed with gastroesophageal reflux, you may consider raising the head of the crib mattress. Remember, nothing goes in the crib except the baby and a tight-fitting crib sheet.
Q: “Is it safe to sleep with my baby, especially when she needs to feed during the night?”
A: Sleeping with your baby in the same bed or couch puts your baby at significant risk for suffocation. Sadly, many babies die when they get wedged between a parent and a couch cushion or get their faces buried in bedding. Breastfeeding itself reduces SIDS risk and has many other benefits to mother and baby, so please don’t let a fear of suffocation discourage you from breastfeeding. Bedside bassinets and other cribs can make life easier when your baby wakes frequently in the night for feeding. Be sure that your baby’s bed is SIDS safe, though. Many beds such as “Moses baskets” and beds with soft bedding and blankets are not safe.
Another option is “co-sleepers,”- three-sided cribs that abut the edge of a parent’s bed. Most co-sleepers meet safe sleeping recommendations. They are especially helpful for breastfeeding mothers. It is easy to breastfeed even every 1-2 hours as needed, then simply place your baby back in her “co-sleeper” crib where you know she is safe and can sleep soundly. And your feet never have to touch the floor. Of note, the American Academy of Pediatrics feels there is insufficient research to recommend for or against “co-sleepers.” I personally view co-sleepers as a sort of compromise between bed-sharing and crib sleeping. I feel co-sleepers help optimize breastfeeding and maternal-infant bonding while minimizing risks of suffocation/SIDS.
Thank you for taking the time to learn about SIDS prevention! Please, spread the word. Additional resources regarding SIDS are available on the St. Louis Children’s Hospital website, or from SIDS Resources, a St. Louis-based not-for-profit network.