What Really Works to Protect Your Newborn From SIDS

The exact cause of SIDS is unknown, but you can still take steps to reduce the risk.

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It’s not uncommon to find a parent standing next to their sleeping newborn’s crib in the middle of the night, hand gently placed over the child’s chest to check on their breathing. Many new moms and dads worry about the possibility of Sudden Infant Death Syndrome (SIDS), the unexplained death of a child under 1 year old.

In 2015, there were 3,700 sudden unexpected deaths of children under age 1 in the United States. Risk peaks between 1 and 4 months old, and while 90 percent of SIDS deaths occur before 6 months, the possibility is still present throughout the first year. For children who are low-risk, the chances of SIDS are relatively small—only 1 in 46,000 low-risk babies will die of SIDS while sleeping in a crib in their parent’s room.

Current research suggests there may be a link between SIDS and brain abnormalities controlling breathing and heart function, but doctors still don’t entirely understand exactly why it occurs.

While SIDS can’t always be prevented, there are steps you can take to reduce your child’s risk. Alison Niebanck, MD, F.A.A.P and Assistant Professor of Pediatrics at Memorial Health University Medical Center in Savannah, Georgia, shares what parents can do to prevent SIDS—as well as certain risk factors that are out of our control.

Medically reviewed in March 2019. Updated in March 2019.

The most effective way to reduce SIDS risk

2 / 10 The most effective way to reduce SIDS risk

Creating a safe sleep environment for your infant is the most important thing any parent can do to protect their newborn from SIDS. Babies should always be placed on their back to sleep—never on their stomach or side.

Dr. Niebanck advises her patients to follow the American Academy of Pediatrics (AAP) safe sleep recommendations: “All babies should be on their back, alone in a crib or bassinet. The mattress should be firm, with no space between the mattress and the crib.” Parents should be sure that mattress sheets are tight-fitting, with no loose bedding surrounding a child.

Resist the urge to cover your newborn or let them sleep with a cherished toy. “The crib should not have any bumpers, blankets, pillows or stuffed animals in with the baby,” Niebanck adds. Parents are advised never to use any sleep positioners or wedges in their child’s crib, as well, since it creates the potential for suffocation or entrapment.

AAP also recommends that children should sleep in the same room as their parents, in their own crib, bassinet or play yard, for preferably one year, but at least six months. However, Niebanck acknowledges there are some limitations to this advice. “I know that several babies around 9 or 10 months old can have sleep disruption if they see their parent in the room," she says. "If that happens, parents should talk with their pediatrician about sleep habits and development.”

Controversies around co-sleeping

3 / 10 Controversies around co-sleeping

Sharing your adult bed with an infant, known as co-sleeping, is common in many cultures and recently has increased in popularity in the United States. The Centers for Disease Control and Prevention (CDC) reports that in 2015, more than half of American parents surveyed admitted that they shared a bed with their infant, with 24 percent saying they co-slept often or always. It's a divisive topic—many parents swear by bed-sharing, even though the AAP urges caregivers not to do it.

“Co-sleeping increases the risk of SIDS anywhere between 5 and 15 times,” says Niebanck “We know that it is a risky behavior mostly because the parent is asleep, and they think that they may wake up, but the sleep deprivation that occurs when babies are young is a true thing.”

Even with the recommendations against co-sleeping, there are situations where it may occur, such as middle-of-the-night feedings. Tired parents are encouraged to be vigilant during these sessions. The AAP acknowledges that bringing your infant into your bed is less hazardous than sitting on a chair or sofa, especially if there is chance that a parent will inadvertently fall asleep. Be sure that the area where the baby is being fed is free of blankets, pillows or anything else that is a potential suffocation hazard. Feedings should be positioned on the bed so that a child can’t accidentally roll and become wedged between the bed and the wall. If a parent awakens to find they have fallen asleep with their child in their bed, the newborn should go back to their own crib for the duration of their snooze.

If you do co-sleep, don’t hide it from your pediatrician. Bring it up at your child’s wellness visit so they can assess your infant's risk for SIDS.

The case against swaddling

4 / 10 The case against swaddling

Learning how to swaddle your newborn is a mainstay of most parenting classes. Tightly wrapping your infant in a blanket is fine in the hospital, but new evidence shows that it may not be as safe as once thought.

A 2016 study in Pediatrics found that swaddling can lead to an increased risk of SIDS for a number of reasons. Swaddled infants were sometimes put to sleep on their side or stomach, despite current recommendations. A newborn in a swaddle can be less likely to wake up from sleep if they are having cardiovascular difficulties. 

Achieving a proper swaddle can be surprisingly difficult, especially when you have an active infant. An overly tight swaddle may lead to overheating, a known risk factor for SIDS. On the opposite end, a loose swaddle allows for easy escape, leaving a blanket that could pose a suffocation risk. Plus, as an infant gets older, they will begin to flip to their stomach on their own during sleep. If arms are in a swaddle, babies may not be able to freely adjust their sleep position.

Niebanck says she prefers sleep sacks or sleepers with feet for newborns. Both allow a child’s arms to be free and prevent any excess fabric from covering the face. Another alternative to calm a fussy sleeper is to give them a pacifier. Although the reason why is still somewhat unclear, pacifiers reduce the risks of SIDS. Choose pacifiers without toys, stuffed animals or clips to clothing attached. And if you do choose to swaddle, transiton away from the practice around the two month mark, when your baby begings to move more within the crib.

Safe sleep while traveling

5 / 10 Safe sleep while traveling

A vacation with your newborn should be a fun-filled experience, but there also may be difficulties. Established routines are often sacrificed when a family travels to a new location, causing sleep disruptions during nap and bedtime.

To help babies to sleep in an unfamiliar environment, parents may resort to tactics they would not try at home, such as co-sleeping or letting their child rest in their car seat.

“Car seats are great and perfect for the car, but they create unsafe sleep environment when taken out of the car,” cautions Niebanck.

Sitting up in a car seat for an extended period may results in breathing difficulties, especially in younger infants. Car seats are also not steady when out of the car, posing the risk of a tip over and accidental suffocation. Parents may also turn to strollers and baby swings when they are desperate to get their child to sleep, but both also pose a risk for tipping over. Many baby swings are only approved for infants up to three months, creating a suffocation hazard if a baby rolls over within one. A very brief, supervised nap is fine, but a longer snooze should still take place in a crib.

Niebanck also tells traveling parents to make sure they pack their own travel play yard or call the hotel to see if they offer one. Steer clear of renting or using a crib of unknown origin. “You don't know how old the crib is, or if it's a drop side crib, and we do know that drop side cribs are an increased risk for entrapment and SIDS,” says Niebanck.

Many airlines offer to check these items for free, so reach out to your carrier before flying.

Link between smoking and SIDS

6 / 10 Link between smoking and SIDS

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 looked further into pre-pregnancy smoking, including how the number of cigarettes smoked during pregnancy could increase risk of sudden unexpected infant death (SUID). Analyzing CDC data from over 20 million live births, including more than 19,000 sudden infant deaths, researchers 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.

The study also found that women who smoked within three months of becoming pregnant but quit during pregnancy still had increased SUID risk compared to women who had never smoked. Still, it’s beneficial to quit at any point during pregnancy rather than continue smoking. Mothers who reduced the number of cigarettes or quit during pregnancy decreased their child’s risk for SUID compared to those who continued to smoke.

One of the best defenses against SUIDs is to limit exposure to secondhand smoke prior to pregnancy or immediately after finding out you are pregnant. Mothers and other family members should also be encouraged to not resume smoking following the end of a pregnancy. If you discover you’re pregnant, speak with your doctor about a smoking cessation plan.

Wellness visits for both mom and baby

7 / 10 Wellness visits for both mom and baby

Receiving regular medical care is important for expectant mothers and their newborn children. Access to prenatal care and wellness visits for infants both decrease the risk of SIDS. 

Once your child is born, following guidelines for regularly scheduled pediatrician visits is crucial. “Newborns should receive a checkup within the first 72 hours or so of leaving the hospital and at 1 month, 2 months, 4 months, 6 months, 9 months and 12 months,” says Niebanck. “The pediatrician can assess the baby's development and screen for any other possible situations that could contribute to SIDS.”

During every visit, your pediatrician will discuss your child’s sleep patterns and go over suggestions for a safe snoozing environment. It’s also important that infants follow a vaccination schedule during this time. Childhood vaccines are not linked to SIDS, despite any myths parents may have heard.

The benefits of breastfeeding and other family health measures

8 / 10 The benefits of breastfeeding and other family health measures

Among the benefits of breastfeeding is that it protects against SIDS. “It decreases the risk of SIDS by about half, although we’re not quite sure what the reasons are behind it,” says Niebanck.

Research has also found that partial breastfeeding, when breast milk is supplemented by some formula feedings, can impart those same benefits of SIDS protection. A 2017 study in Pediatrics found that any amount of breastfeeding for 2 to 4 months cut risk of SIDS by 40 percent. If the mother continued to breastfeed in some capacity for 4 to 6 months, the decrease in risk was 60 percent.

Pregnant women should also refrain from consuming alcohol or using illegal drugs. Drinking alcohol around the time of conception is also associated with a higher risk. In addition, a 2020 study in EClinicalMedicine found that women who drank alcohol and smoked during pregnancy had a 12-fold higher risk for SIDS compared to women who did neither or stopped within the first trimester.

If you or your spouse consume alcohol after your child is born, do not attempt to bed share with your baby—the combination could be especially dangerous.

What you can’t control for

9 / 10 What you can’t control for

“About 95 percent of SIDS cases can have some preventable risk factors, but there is a subset of crib death for which we do not have an answer,” says Niebanck. “Presumably there may be a genetic component, but the research has not been able to exactly determine what those issues are.”

Among other risk factors parents can’t control for are preterm birth or a low birth weight. Children born to mothers who are under 20 years old also carry an increased risk, although Niebanck says that doctors do not know if it is related to age, lack of access to doctors for younger mothers or the increased likelihood of preterm birth.

Don’t be fooled by at-home monitors

10 / 10 Don’t be fooled by at-home monitors

Parents may be swayed into buying a home cardiorespiratory monitor that measures an infant’s breathing. However, these devices should never be viewed as a SIDS prevention technique. “There are a lot of options on the market but there has been no data to show that they prevent episodes of SIDS,” cautions Niebanck. Many times, these breathing monitors can either lead to complacency in parents, or on the opposite end of the spectrum, unnecessary anxiety about a newborn’s health.

SIDS is scary and may be constantly on your mind if you have a newborn. To allay those fears, continue to make healthy choices for your family, schedule visits with your pediatrician regularly, and most of all, create the safest sleep environment possible for your child.

“The most powerful thing that you can do for a child is having the baby sleep alone and on their back in a crib with nothing else around them,” stresses Niebanck. “Those are the things that will make the most difference.”

Updated in January 2020

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