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SIDS- Sudden infant death syndrome.  There is no other acronym that strikes more fear and angst in a parent than SIDS.  Whether it is your first child or your 10th child, this is a worry that no amount of experience can completely erase.  As a pediatrician, I cannot tell you what causes SIDS for sure…that is the tough part. However, we do know that there are things parents can do to reduce the risk of SIDS, and ensuring a safe sleep environment for your little one is on the top of the list.  Safe sleep environment is also crucial to reduce sudden unexpected infant death (SUID) which can include suffocation or entrapment.  There is much overlap when talking about sleep environment and SIDS and SUID, so for the purpose of this discussion, I will simply stick with SIDS.  You may have heard that the American Academy of Pediatrics (AAP) came out with updated recommendations in regards to safe sleep practices and SIDS just last month, so here are the highlights (you can click here to read the full policy statement).

The Back to Sleep Campaign was started in 1994, and since that time there has been a 50% reduction in the incidence of SIDS.

Back to Sleep- ALWAYS

Yes, grandma and great-grandma might give you a sidelong look here and tell you stories about how, back in their day, they never put babies to sleep on their back for fear of choking.  Here is where you can nod your head and politely let them know that for over 20 years now, the recommendation has been to put babies to sleep on their back.  The Back to Sleep Campaign was started in 1994, and since that time there has been a 50% reduction in the incidence of SIDS.  This has been, by far, the most important way to reduce the risk of SIDS.  Healthy infants have airway anatomy and mechanisms that prevent choking and aspiration, and this even includes those infants with reflux.  Once your child can roll over and get themselves to a different position, they can stay there (as long as you are following a few of the recommendations below).  So back to sleep, always, every sleep, no matter what grandma says.

What’s in a bed?

Besides a mattress with a single fitted sheet, nothing! That’s right…no blankets, pillows, or stuffed animals should exists in your infants crib with them.  All of these objects can pose a suffocation risk if the infant gets tangled up in them. And let’s talk about those crib bumpers…you know the ones that are oh so precious and were probably the most expensive part of your crib set.  Those need to go as well!  When crib bumpers were first “invented,” it was to prevent infants heads from getting entrapped through the crib slats.  Well, now there are very specific guidelines for the space between the slats on a crib that take care of this concern.  Those crib bumpers pose a suffocation risk for your young infant and are a great launching pad for your starting to pull up, getting adventurous nine month old, so they really have no place at any point for your baby.

Let me take a moment here to comment on a product that I have seen popping up all over Facebook recently.  It is from a company called “Elephant Collection,” and it is a plush elephant pillow.  While in the fine print they say it is intended for children 3 years and older, their marketing certainly states otherwise…take a look at these two images:

elephant-pillow-2 elephant-pillow-1

These images gives me chest pain! In all seriousness, this product is being marked as an infant sleeping pillow that is a great present for an expectant mom.  This couldn’t be farther from the truth.  As you all now know from the above paragraph, infants do not need pillows or stuffed animals and they should be on a firm sleeping surface, all of which are not happening in this infant “product.”  I implore you to never, ever purchase such a product.

These are some of the most dangerous places for infants as they can easily slip between you and the cushions with absolutely devastating consequences.

So where should infants sleep?

These newest guidelines recommended for infants to sleep in the parents room until at least 6 months but ideally until 12 months of age.  Now, I am going to be honest with you here as a mama to 3 Littles…I would have never made it with my children in my room until they were 1 year of age! There I said it! I find this recommendation a little bit of a challenge since I think there comes a time and place for sleep training in infants (or at least getting infants to be able to go to sleep on their own).  This would be a difficult skill for a little one to learn if their favorite two people were within their eyesight at all times (can you imagine those two little eyes peering at you over the edge of their pack-n-play?).  Also, I don’t know about you, but I never really slept well when my babies were in my room in their pack-n-play as every little whimper, sigh, or grunt would make me dart straight up in bed.  I think the time to transition a baby to their own room will be different for each baby/parent unit, but when you do make that move, having a good monitor in their room to hear them if they need you is key.  

Where should your infant NEVER sleep?

While it might be rather cozy, do not ever intentionally sleep with your infant in a recliner, arm chair or couch.  These are some of the most dangerous places for infants as they can easily slip between you and the cushions with absolutely devastating consequences.  These recommendations have also reinforced that newborns should not bed share with their parents.  Again, pillows, blankets and fluffy bedding are not intended for infants.  These recommendations do acknowledge the fact that it can be easy for parents to fall asleep while feeding infants.  If parents choose to feed their infant in bed, they should make sure to remove all pillows and blankets from the area and then immediately return the infant to their own sleeping environment as soon as possible when feeding is completed.  

There are a number of other things parents can do to reduce the risk of SIDS.

  • Breastfeeding- or I really should say breastmilk - likely the most benefit comes from exclusive breastfeeding, but any amount of breastmilk is beneficial and protective
  • Use of pacifier when sleeping
  • VACCINATE according the recommended schedule (click here to see that schedule)
  • No smoking- this is both before baby’s arrival and afterwards as well
  • Avoid alcohol and drugs- again both pre and postnatally
  • Avoid overheating- depending on the time of the year, infants can wear a single onesie or footed cotton jammies with a single swaddle wrap or wearable blanket.  Again, they should not have additional blankets when sleeping
  • Commercial breathing and heart rate monitors such as Angle Care, Owlet or Snuza DO NOT reduce the SIDS risk.  Unless these monitors are ordered by your pediatrician prior to leaving the hospital (this will sometimes be done in certain medical conditions), these products generally just increase parental anxiety and again do not reduce the SIDS risk.

There is an amazing company called The Baby Box Co. which I would love for all parents to be aware of.  This company is producing “baby boxes” which have been commonplace for over 75 years in Finland.  These boxes, which literally are a cardboard box, mattress and sheet, have helped to reduce Finland’s infant mortality rate from 63 deaths per 1,000 babies in 1938 to 3 deaths per 1,000 babies in 2013…one of the world’s lowest infant mortality rates.  The Baby Box Co. was founded by two moms looking to reduce infant mortality here in the US, and they are currently working with 20 states to distribute these boxes for free to expectant mothers here in the US.  Here is what one of these baby boxes look like:


Not only do these boxes provide a safe sleeping environment for infants up to 8 months of age, these boxes can be purchased with other newborn necessities including clothing, sleep sacks, board books as well as lots of educational materials for new parents.  If you are in the market for a baby box or just want to find out more about this amazing company, you can click here.