Safe sleep tips: How to reduce the risk of SIDS

Sudden infant death syndrome (SIDS or cot death) is when a baby of 12 months or younger dies without warning and for no clear reason, usually in their sleep. According to the most recent figures of the Centers for Disease Control and Prevention (CDC), in 2019 there were 35 SIDS cases per 100 000 babies in the US. 

“In South Africa, we don’t know the stats as most infants that die unexpectedly don’t undergo routine autopsies to establish cause of death,” says Dr Carmen Briner*, programme manager and investigator in clinical trials focusing on paediatric and maternal diseases at Wits VIDA Research Unit in Johannesburg.

To help reduce the risk of SIDS:

1. Lie babies on their backs

The 2019 US SIDS rate is three times lower than the 1994 rate, which was 103 babies in 100 000. The dramatic drop over the past 25 years has been attributed to the American Academy of Pediatrics’ ‘Safe to Sleep’ campaign, urging parents to place babies on their backs for night sleeps and naps. 

“They’re less likely to suffocate than if lying on their tummies or sides,” says Briner. She adds that there’s no evidence that lying on their backs puts them at greater risk of choking if they vomit or regurgitate. 

When babies begin to roll, generally around four months, keep placing them to sleep on their backs, but don’t feel you have to constantly reposition them if they roll over in their sleep, she says. “When they master the art of rolling, they can roll themselves out of trouble if breathing gets difficult.” 

Parents sometimes worry about their baby developing ‘flat head syndrome’ from always lying on their backs. “Babies’ skulls are soft, and constant pressure on the same spot can cause their heads to chance shape,” Briner says. “But you can avoid this by repositioning their head to face opposite sides with each sleep.” 

2. Choose a safe surface

To prevent babies smothering, they need to sleep on a firm, smooth surface, preferably in a crib or basinet with a fitted sheet. They shouldn’t sleep on anything soft, like an adult mattress, couch, pillow or blanket, which could encourage smothering, or in a car seat, baby swing or carrier, which could angle their heads and possibly obstruct their airways, says Briner.

3. Clear their beds

Before sleeps or naps, remove all loose items such as pillows, blankets, stuffed toys, and even cot bumpers. There’s no evidence that bumpers prevent injury, she says. “Also take care that they can’t reach mobiles, as strings or beads could become a strangulation or choking risk.”

4. Keep them close – but safely

The American Paediatric Association reports that keeping babies in your room can decrease the risk of SIDS by as much as 50%, as well as making it easier for you to feed, comfort and watch your baby. But it cautions against taking them into your bed, where you may roll onto them. 

Yet Briner reports that African and Asian countries, where babies often share parents’ or siblings’ beds, seem to have lower rates of sleep-related infant deaths. “Some researchers suggest this may be because the babies are constantly stimulated, so they spend less time in deep sleep, and are at less risk of stopping breathing,” she says. Never bring your baby to bed if you’re intoxicated or on medication that could make you drowsy. 

5. Keep them cool

Overheating can raise the risk of SIDS. Dress babies in something like a onesie of the right warmth, and use one or two light-weight blankets, tucking these under their arms to prevent their heads being covered. Better yet, use well-fitting baby sleeping bags or sleep sack.

6. Don’t smoke near them

It’s not only when you’re pregnant that smoking can harm your baby (raising your risk of abnormal bleeding in pregnancy and delivery, and baby’s risk of being born small, premature, with damaged lungs and brain, and birth defects such as cleft lip or palate). The CDC reports that “babies of moms who smoke during pregnancy – and babies exposed to cigarette smoke after birth – have a higher risk for SIDS.”

7. Keep breast-feeding

Finally, the National Institute of Child Health and Human Development reports that “babies who are breastfed or fed expressed breastmilk are at lower risk for SIDS compared with babies who were never fed breastmilk”. According to a 2017 New Zealand study in the journal Paediatrics, it’s possible breast milk helps boost babies’ immune systems and lowers the risk of infections that could lead to SIDS.

*Dr Carmen Briner is also founder of OneAid, which focuses on preventing and reducing the risk of childhood injuries through first aid products.

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