Sudden Infant Death Syndrome (SIDS)

Sudden Infant Death Syndrom

* What is SIDS?
* Cigarette Smoke is linked to SIDS
* Safe Sleeping
* Safe Places to Sleep
* Safe Bedding
* Sleep Dangers
* Common Questions

What is SIDS?
Sudden Infant Death Syndrome (SIDS), formerly known as 'cot death', refers to the sudden unexpected death of a baby from no known cause. I have put together this fact sheet on SIDS to help prevent other families experiencing the grief my family did, when I lost my brother to SIDS. The number of babies dying of SIDS is dropping and this is due to the SIDS researchers all over the world educating parents and carers to always place a baby on her back to sleep with her face and head uncovered and keeping her in a smoke free environment. To give you an example of the help the education is doing the Australian Bureau of Statistics shows that 500 babies died of SIDS in 1989 and in 2003 the number had reduced to 73 babies. So please read the information given in this fact sheet and let's help the number decrease even further.

SIDS is the most common cause of death in babies between one month and one year of age but the majority of babies who die of SIDS are under six months of age. More babies die of SIDS in winter than summer. To this day, the cause of SIDS remains unknown and there is no way of predicting which babies it will affect. However, what has been discovered is that some factors are thought to reduce the risk of SIDS. Since parents were first made aware of these factors through the various educational programs introduced by SIDS researchers, SIDS deaths have dropped and continue to drop.

Babies and young children spend a lot of their time sleeping, so you need to be aware that some sleeping arrangements are not safe and can increase the risk of SIDS or cause fatal sleeping accidents. Research has found some important ways to reduce the risk of SIDS and create a safe sleeping environment for babies and young children. This fact sheet provides you with information to help you create such an environment for your baby or child.
Cigarette Smoke is linked to SIDS
Cigarette smoke harms babies before and after they are born. Parents who smoke during pregnancy and after the birth of their baby increase the risk of SIDS for their baby. In fact, if a mother smokes then the risk of SIDS doubles, and if the father smokes too it doubles again. There is still an increased risk of SIDS if parents smoke outside, away from the baby, and if smoking parents co-sleep with their babies the risk of SIDS is increased again. The reasons for this are not clear. However, we do know that being a non-smoker or smoking less will reduce the risk for your baby. Try not to let anyone smoke near your baby and try not to let anyone smoke in your house, your car or anywhere else your baby spends time.

If you want to quit smoking and you're not finding it easy, ask for help. Call the local Quitline or ask your doctor, midwife or child health nurse for information and advice.
Safe Sleeping
Sleeping a baby on her back reduces the risk of SIDS. The chance of babies dying of SIDS is greater if they sleep on their tummies or sides. Healthy babies placed to sleep on their backs are also less likely to choke if they vomit than babies placed on their tummies to sleep.

Babysitters, nannies, staff at day care centres and other people who care for your baby may not know that tummy- and side-sleeping increase the risk of SIDS. Explain this to them before you leave your baby in their care.

Older babies who can turn over and move around the cot should be put to bed on their backs but then let them find their own sleeping position. The risk of SIDS in babies over six months is extremely low but still there so please keep practicing safe sleeping habits.

Make sure your baby's face and head stay uncovered while your baby is sleeping. A good way to ensure this is to put your baby's feet at the bottom of the cot so that she can't slip down underneath the bedclothes. Tuck in bedclothes securely so they can't become loose. Never put quilts, doonas, duvets, pillows, lambskins or cot bumpers in a cot or under the sheet covering the mattress. All these are thought to increase the risk of SIDS. You might decide to use a safe sleeping bag to help keep your baby's bedding in place but these should be used with bedding and not as an alternative to bedding. (To read more about this please read my safe bedding guide) If you do, use a safe sleeping bag make sure it has a fitted neck and arm-holes like the ones I recommend.

Taking a baby into an adult bed may be unsafe as the baby could get caught under the adult bedding or pillows. The baby could also get trapped between the bed and the wall, or fall out of the bed, or an adult could roll onto the baby if they are sleeping very deeply or have taken any drugs or alcohol.

Tips:

* Make sure your baby's head remains uncovered during sleep.
* Do not put your baby to sleep on a waterbed or beanbag.
* Tummy play is safe and good for babies when they are awake and an adult is present, but never put your baby on her tummy to sleep.
* Put your baby on her back to sleep.
* Use a firm, clean, well-fitting mattress. That passes the safe hand test. Place you hand on the mattress and press down firmly. If you remove your hand and you can see its imprint then this mattress is not safe for a baby to sleep on.
* Tuck in your baby's bedclothes securely.

Safe Places to Sleep
Cots
Every country has their own standards for baby products and cots so please look into what they are in your country before you purchase a cot. All new and secondhand cots sold in Australia must meet the Australian/ New Zealand Standard for cots (AS/NZ 2172) and will carry a label to say so. If you cannot find the label, do not risk buying the cot.

Read my advice on purchasing a safe cot.

If you are using an old or secondhand cot in particular, check for the following problems:

* Wobbly or broken parts that make the cot less stable.
* Bars a toddler or baby could get caught between (shouldn't be less than 50 mm or more than 85 mm).
* Knobs, corner posts or exposed bolts that could hook onto a toddler's or baby's clothing, especially around the neck.
* Too much space (more than 25 mm) between mattress and cot edge.
* Sides that are too low and can be climbed over by active little toddlers.
* Sharp catches or holes in the wood that can hurt curious fingers.
* Old paint that might contain poisonous lead.

Babies can become trapped in a tilted rocking cot or cradle. If you have a rocking cradle or cot with a locking pin, make sure you secure the pin firmly in place whenever you leave your baby and check to make sure the cradle cannot move in your absence.
Portable Travel Cots
These are sometimes called portacots. Always use the firm mattress that is supplied with the cot and don't add additional padding under or over the mattress as your baby may become trapped face-down in the gaps created between the mattress and the cot wall. Also adding padded fitted sheets or foam mattresses normally results in the mattress failing the safe hand test. Also please avoid inflatable cot mattresses because the mattress might pass the test initially but fail later in the night. There is a separate standard that is used for all portable cots and all cots that reach this standard will carry a label to say so.
Sleeping dangers
The following are dangerous things to look out for and avoid wherever your toddler or baby sleeps – both during the night and for any daytime sleep or naps. Check both your own home and anywhere else your child is cared for, including day care, childcare centres and the homes of family and friends.
Safe Bedding
An unsupervised adult bed may be unsafe for babies or toddlers because they could get caught under bedding or pillows, become trapped between the wall and the bed or fall out. The risk of accident is increased if you leave the baby or toddler alone on an adult bed or bunk bed.

Never put your baby or toddler in a soft place to sleep because her face may become covered. If you fall asleep with your baby while on a couch or sofa, there is a very high risk of a sleeping accident. Babies don't need pillows, cushions or tri-pillows as they are too soft and can cover baby's face. Don't ever put your baby or toddler on a waterbed or beanbag.
Dangling cords or string
Keep your baby's cot away from any cords hanging from blinds, curtains or electrical appliances because they could get caught around your baby's neck. You will also need to keep hanging mobiles out of the reach of your baby's curious little hands and mouths.
Heaters and electrical appliances
Keep heaters or any electrical appliances well away from the cot to avoid the risk of overheating, burns and electrocution. Don't use electric blankets, hot-water bottles or wheat bags for babies or young children. Remember that your toddler or baby cannot escape from a bed or cot to cool down and does not know how to remove bedclothes.

A baby that becomes too hot or cold is at an increased risk of SIDS.
Common Questions

1. Is it safe to put my newborn baby on his back to sleep and what happens if he vomits?

Yes, healthy newborn babies can be safely placed on the back to sleep. Healthy babies sleeping on the back are less likely to choke on vomit than tummy sleeping infants. Some babies, with rare medical conditions, might have to sleep on the side or the tummy. If you are unsure about the best way to sleep your baby, speak with your doctor or nurse.

Is it safe to put my newborn baby on his back to sleep?
What happens if he vomits? Yes, healthy newborn babies can be safely placed on the back to sleep. Healthy babies sleeping on their back are less likely to choke on vomit than tummy-sleeping infants. Some babies with rare medical conditions might have to sleep on the side or the tummy.

Can babies be put on the tummy to play?
Yes, tummy play is safe and very good for babies when they are awake and an adult is present. Tummy play helps muscle development in the arms, neck and back and prepares babies for crawling.

Is side-sleeping safe?
Side-sleeping can increase the risk of SIDS, possibly because a young baby can roll onto her tummy from her side. A baby sleeping on her back cannot roll onto her tummy until about five or six months of age, when most of the risk for SIDS has passed.

Will formula-feeding increase the risk of SIDS?
There is no consistent evidence that bottle-feeding increases the risk of SIDS or that breastfeeding reduces the risk.

If I sleep my baby in the same room as me will it reduce the risk of SIDS?
Research in New Zealand and the United Kingdom indicates that sleeping a baby in the same room, but not in the same bed, as the parents in the first six to twelve months of life may be protective. This is thought to be because parents can easily see the baby and check she is safe. This protective effect does not transfer if a baby sleeps in a room with other children, probably because children do not know if an infant is safe or not.

Is it okay to fall asleep on the couch with my baby?
Some research into SIDS has shown that an adult sleeping on a couch with a baby can be dangerous because the baby may accidentally become wedged between cushions or the back of the sofa. Put your baby into her own bed before you doze off if you feel yourself getting sleepy.

Will bed-sharing increase the risk of SIDS?
Bed-sharing does not appear to increase the risk of SIDS for any of the following groups:

* When you bed-share to feed and cuddle your baby then put her back in her cot.
* When the baby is older than four months.
* If you and your partner are non-smokers.

If you or your partner smokes, sleeping with your baby in the first four months may increase the risk of SIDS. Particular circumstances that may increase the risk for all parents include when you or your partner have consumed alcohol or have taken drugs, which make you sleep more heavily.

If you sleep with your baby, make sure the bedding cannot cover her head and keep her away from the pillows. Use lightweight blankets rather than doonas or duvets and place your baby in a position where there is no risk of her falling out of the bed or becoming wedged in.

I am not sure what to dress my baby in at bedtime. What do you suggest?
A useful guide is to dress baby as you would dress yourself – to be comfortably warm, not hot. Conversely, some parents underdress their baby, worrying she will get too hot. Babies mainly keep themselves cool through their head, in particular their face, so make sure baby's face and head remains uncovered and she will stay comfortably warm.

Remove hats or bonnets from a baby as soon as you come indoors or enter a warm car, bus or train, even if it means waking your baby up. Babies regulate their temperature through their head.

How should we sleep our baby?
Current research suggests that if your baby becomes either too hot or too cold, the risk of SIDS is increased. To prevent this I have put together a safe bedding guide for you. Clink here to read more about the safe bedding guide .

Does dummy use reduce the risk of SIDS?
Some research indicates an apparent decrease in the incidence of SIDS with dummy use, however the evidence is not overwhelming and the other effects of using a dummy outweigh this fact. One major reason not to use one is that babies who suck on dummies tend to have an increased risk of ear infections, which in turn may bring on high fevers and the use of antibiotics (both of which have side effects of their own).

What do we do now that our baby has started to roll over onto her tummy?
Most SIDS cases occur when babies are under six months of age and generally babies who are placed on their back to sleep cannot roll onto their tummies until about five or six months of age, when most of the risk has passed. Try not to let your baby sleep on her tummy before six months of age. You could put your baby in a safe baby sleeping bag as these delay babies rolling over and keep them warmer. My research shows a cold baby will roll to their tummy to warm up as explained in Rylen's case study. Click here to read Rylen's case study.

Older babies who can turn over and move around the cot should be put on their backs to sleep and allowed to find their own sleeping position. The risk of SIDS in babies over six months is extremely low.

Remember to reduce the risk in other ways: make sure that baby is on a firm, well-fitting mattress and don't tuck the bed covers in firmly if baby is on her tummy. Make sure her face and head remain uncovered during sleep and keep baby smoke-free. Make sure she has supervised tummy time when awake to strengthen her upper body muscles.

My grandmother says I should put a hat on my five-week-old baby to make him sleep better. What do you think?
I have heard this a few times and believe it to be a very dangerous old wives' tale. You should most definitely not put a hat on your baby to help him sleep as this could cause your baby to overheat and will increase the risk of SIDS. If your baby is too hot and needs to cool down, he will need to be able to lose that heat through his head. You may put a hat on your baby if you are outdoors in cold weather, but take it off once inside.
Tips:

* Never tuck a sleeping bag in under the mattress because this will restrict your little one's movement and is dangerous.
* The most important rules to remember to protect your little one from SIDS are to have a totally smoke-free pregnancy and environment for your baby, and always place a baby in the safe sleeping position on their back to sleep.

About the Author

Tizzie Hall teaches parents to identify issues affecting their baby's sleep, to interpret their cries and deal with problems when they arise. For more information from the international baby whisperer, or for baby products, visit Baby Books.