What You Need to Know About SIDS

An infant’s sleep environment can be harmful—know how to prevent a tragedy.

Newborn baby in pink outfit asleep in crib

There’s plenty to worry about when it comes to an infant’s health, but how do you prevent a serious condition that has no obvious cause? Sudden infant death syndrome (SIDS) is a big concern for parents and caregivers, yet it continues to take the lives of children when in many cases it was preventable.

SIDS is the sudden death of an infant younger than one year of age that remains unexplained after a thorough case investigation, explains Kate Hewett, MD, who specializes in pediatric emergency medicine at Summerville Medical Center in Summerville, South Carolina.

“There really are [no symptoms], because the infant shows to us in the emergency room pretty much already deceased. That's why we have to be very, very vigilant about it,” Hewett says.

SIDS risk factors

It’s not just young infants at risk—even children up to a year in age could die of SIDS. Hewett recommends talking to your baby’s pediatrician to evaluate where your child is in their development. A two-month-old and one-year-old are very different in their abilities to maintain head control and turn their body over, for example.

“Sometimes the child can help themselves out of a suffocation situation. Other times, it may be something beyond the child's control completely. Focusing on the risk factors is what's most important,” Hewett says.

While some risk factors can’t be changed, like whether an infant was born preterm, there are some things parents and caregivers can address. Safe sleep guidelines from the American Academy of Pediatrics were released in October 2016 regarding:

1. Sleep surface and sleep position

A study published by the American Academy of Pediatrics in August 2016 found that parents are still putting their infants in dangerous sleep environments. And, if the child was moved during the night, the second sleeping environment had more hazards.

Infants should sleep on their backs. The American Academy of Pediatrics and other groups recommended this position for infants in 1994 with the “Back-to-Sleep” campaign. “Some parents either forget, or are too sleepy to remember, or do something differently than ‘back to sleep’,” Hewett notes.

If another caregiver is putting your child to bed, show them exactly what you want them to do.

To reduce an infant’s risk of suffocation and SIDS, keep the following out of their crib or other sleep surface:

  • Blankets and loose bedding
  • Pillows
  • Bumpers
  • Stuffed animals
  • Sleep positioners

Make sure the infant’s bed is relatively firm. Non-approved sleep surfaces include a car seat, co-sleeper, adult’s bed, sofa or swing.

2. Sharing the same bed (co-sleeping)

Parents should be diligent about making sure the child isn’t sleeping in the same bed as them. Co-sleepers are not much safer.

“There's a lot of devices now where they can attach them to the bed. Again, that poses risks, the child rolling into bed with you. I know every parent thinks, 'Well, I'm not going to do that,' but that's what the parents who have actually had that happen thought,” Hewett says.

You can still share your room with your child, which the AAP recommends doing until the child’s first birthday, or at least for the first 6 months of life. An infant sleeping in their parents’ room on a separate sleep surface decreases the risk of SIDS by as much as 50%.

3. Smoking, alcohol and illicit drug use

To decrease your child’s risk of SIDS, it’s best to stop drinking alcohol, smoking cigarettes and/or using illicit drugs while pregnant. Limit postnatal exposure to all three, as well.

After sleep position, smoking while pregnant and exposure to secondhand smoke after birth are the next largest risk factors for SIDS. The AAP recommends eliminating all tobacco smoke exposure before and after birth, as they estimate that this could prevent one-third of all SIDS-related deaths. 

A March 2019 study published in Pediatrics found that SUID risk doubled with just one cigarette per day during pregnancy. With each additional cigarette, SUID risk increased by .07, up to 20 cigarettes per day.

In addition, combined prenatal exposure to smoking and alcohol may greatly impact SIDS risk. According to a January 2020 study, mothers who drank and smoked throughout their pregnancies had a 12-fold increased risk for SIDS compared to mothers who did neither or quit during the first trimester. The study, published in EClinicalMedicine, found that prenatal exposure to either alcohol or cigarettes impacted SIDS risk but not as much as when both were combined.

Speak to your healthcare provider if you become pregnant and have difficultly stopping use of cigarettes, drugs or alcohol.

4. Swaddling

Swaddling at very young ages seems to quiet babies and to keep them comfortable. But, infants are less likely to be aroused by stimuli when swaddled, Hewett notes. “That can be a risk factor for SIDS as well, because sometimes the problem is them being arousable enough to protect their airway.” 

The AAP recommends always placing a swaddled infant on their back and to stop swaddling once babies start trying to roll over. 

5. Room and body temperature

Overheating is another risk factor, so Hewett says to use a comfortable temperature in the room—not too cold or too hot. Signs of overheating include sweating or the baby’s chest feeling hot to the touch.

While parents may worry their child will be cold without a blanket, Hewett recommends the infant wear a onesie that is warm enough. When selecting clothes for the infant, remember that they will run cooler than adults.

Do you need new technology to prevent SIDS?

Even when taking every precaution, parents and caregivers may still worry their child will stop breathing unexpectedly. Monitors are on the market that can be placed on a child’s foot to measure oxygen levels and heart rate, or under their mattress to check for a lack of movement.

While it may be warranted for a premature infant or one with a history of apnea, Hewett recommends having a conversation with your pediatrician before using any of these monitors.

“The AAP had a task force on sudden infant death syndrome and found that there's no evidence to support the role of home cardiorespiratory monitors,” Hewett says.

Many of these monitors are conveniently connected to mobile devices, but they should be used with caution, Hewett notes.

“You could be panicking that your baby stops breathing, when actually it was a malfunction in the app or the device. Conversely, you can be falsely reassured that everything is fine because everything that you're seeing from afar is registering as normal, but it truly is not,” Hewett says.

Education is key

For SIDS prevention, it comes down to education. “You're not born knowing how to take care of a baby,” Hewett says.

Information can come from parenting classes before a child’s birth and be reinforced before the mother is discharged from the hospital. It should also be discussed in the child’s first visit with their pediatrician, about three to five days after birth.

“Talking to your pediatrician, making sure that you’re vigilant every night—not just some nights —and throughout the night,” can all help prevent SIDS, Hewett says.

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