Sudden Infant Death Syndrome

What's the Problem?

Sudden Infant Death Syndrome (SIDS) is defined as the sudden death of an infant under one year of age that cannot be explained after a thorough case investigation, including a complete autopsy, examination of the death scene, and review of the clinical history. It is the leading cause of death in children aged one to eleven months in the U.S. Between 1983 and 1994, SIDS was the underlying cause of death in almost 62,000 cases, an average of some 5,636 deaths a year. Although SIDS deaths have declined substantially since 1992, about 2,643 infants died from SIDS in 1999.

Who's at Risk?

SIDS deaths occur among all socioeconomic and racial/ethnic groups, but are higher among African-Americans and some American Indian tribes. Increased risk of SIDS is associated with low birth weight, young maternal age, poor pre-natal care, and poverty. An infant who sleeps on its stomach is also more at risk for SIDS. Babies who are not breastfed, who are exposed to tobacco smoke, and who get overheated because of too many clothes also seem to be at increased risk, as are infants whose sleeping surface is too soft and excessively padded. The risk increases when a baby shares a bed with an adult; the risk is greater still if more than one adult is in the bed or if the adult is under the influence of alcohol or drugs. Most deaths occur during the fall, winter, and early spring months.

Can It Be Prevented?

While the cause of SIDS remains unknown, the risk can be reduced by understanding and being aware of the risk factors, but no single behavior can eradicate the risk completely. Still, it is heartening that SIDS has decreased by 50% nationwide since the "Back to Sleep" campaign was introduced. SIDS prevention messages must reach all pregnant women regardless of their ability to obtain prenatal care, thus innovative techniques are needed for reaching young, poor women and those who are geographically isolated.

Parents and other caretakers can reduce the risks of SIDS by:

• being sure babies sleep on their backs on a firm surface; babies should not sleep on their stomachs;
• abstaining from smoking, drinking, or using drugs during pregnancy and after birth;
• avoiding putting quilts, comforters, sheepskin or any soft material in the crib or on the sleeping surface; infants should not sleep on waterbeds, sofas or other soft surfaces;
• using a crib that conforms to the safety standards of the U.S. Consumer Product Safety Commission;
• not allowing babies to get too warm; the temperature in the baby's room should feel comfortable for an adult; and
• breastfeeding the baby as long as possible.

Adults (other than parents), other children, and siblings should avoid sharing a bed with an infant. If parents choose to do so, they should avoid smoking, drinking, and using illicit drugs.

The Bottom Line

Although deaths related to SIDS have dropped, many babies still die each year. There are known risk factors for SIDS. It is important that all pregnant women be aware of these risk factors, especially poor women and young women who may have limited access to prenatal care. These women are less likely to find out about the risk factors from their health care providers.

Case Example

New parents return home from the hospital and set up their baby's room based on information they have about SIDS. They discuss keeping the room temperature comfortable for an adult (not overheated) and sleeping position; they ensure that the bedding is not too soft, and that no stuffed toys are placed in the crib with the baby. They also discuss not smoking in the house and their plan for breastfeeding.