Do you ever stand in the doorway of your baby’s nursery and watch for the rise and fall of their chest while they sleep? If you do, you’re definitely not alone. Most parents find themselves checking on their infant at night and during nap time just to make sure everything is okay.

Infant sleep safety has become a major topic of concern among researchers and physicians who are continually on the lookout for ways to decrease the risk of Sudden Infant Death Syndrome, or SIDS. While experts have yet to find an exact cause of SIDS, there are steps parents and other caregivers can take to help keep their infant as safe as possible while sleeping.

What is SIDS?

SIDS is the sudden, unexplained death of a baby younger than one year of age that doesn’t have a known cause, even after a complete investigation. SIDS is the leading cause of death among babies between one month and one year of age. While the SIDS rates for the United States have dropped steadily since 1994, there were still about 1,600 deaths due to SIDS reported in 2015.

This number is part of a larger statistic that is commonly referenced under the category of sudden unexpected infant deaths (SUID). When looking at the total number of infant deaths that fall under this category, the number rises to 3,700. In addition to SIDS, accidental suffocation and strangulation in bed (900 infants) and unknown cause (1,200 infants) make up the remainder of the deaths.

What Causes SIDS?

Unfortunately, the cause of SIDS is unknown. However, research  suggests that infants who die from SIDS are born with brain abnormalities or defects. At this time, we’re not able to test for these abnormalities, which researchers believe occur in the part of the baby’s brain responsible for activities like breathing.

Luckily, there are other factors that contribute to SIDS which we can control and change for the better. To illustrate this, researchers use the Triple-Risk Model, which looks at the convergence of three conditions that may lead to SIDS: a vulnerable infant, the critical development period, and outside stressor(s).

Risk Factors for SIDS
  • Vulnerable Infant: A child who may have a brain defect or abnormality, which is undetectable.
  • Critical Development Period: The period of time between ages 1 month and 1 year, during which infants are most likely to die from SIDS.
  • Outside Stressors: Include an unsafe sleep area, bed-sharing, or improper sleep positioning, among others.

Researchers hope that this model can help reduce the risk of SIDS by educating caregivers on ways they can remove outside stressors.

What Does a Safe Sleep Environment Look Like?

According to the National Institutes of Health (NIH) and the American Academy of Pediatrics (AAP) policy statement on sleep safety, you can reduce your baby’s risk of SIDS and other sleep-related causes of infant death in the following ways:

As of 2011, drop-rail cribs may no longer be made or sold because of possible infant safety risks.

Consumer Product Safety Commission
  • Use a firm sleep surface. Use a firm sleep surface, such as a mattress in a safety-approved crib covered by a fitted sheet. Always refer to the safety standard of the Consumer Product Safety Commission (CPSC) when choosing a crib or bassinet.
  • Remove all items from sleep area. The crib area should be bare. Do not use pillows blankets, sheepskins, or crib bumpers anywhere in your baby’s sleep area. Keep soft objects, toys, and loose bedding out of your baby’s sleep area. Make sure nothing is covering the baby’s head.
  • Place baby their back for sleeping. Always place your baby on their back to sleep, for naps and at night. If you have a preemie (infants born preterm) you should place them on their back to sleep as soon as possible after birth. If you have a baby that rolls onto their stomach after being placed on their back you do not have to return your baby to the back, as long as your baby is comfortable rolling both ways (back to tummy, tummy to back) and there are no blankets, pillows, stuffed animals, toys, or bumper pads around your baby.
  • Baby should sleep next to where parents sleep. Baby’s sleep area should always be next to where parents sleep (in a bassinet or crib). This is called room-sharing, and is recommended for the first 6 months to year because it can decrease the risk of SIDS by as much as 50%.

Bed-sharing is not recommended for babies, because it can increase the risk of SIDS and suffocation.

  • Avoid unsafe sleeping areas. Never place your baby to sleep on a couch, sofa, or armchair. Do not use a car seat, stroller, swing, infant carrier, infant sling or similar products as baby’s regular sleep area. Additionally, a baby should not sleep in an adult bed, on a couch, or on a chair alone, with you, or with anyone else.
  • Keep baby warm. Dress your baby in sleep clothing, such as a one-piece sleeper, and do not use a blanket. You also need to make sure your baby does not get too hot and overheat, increasing the risk for SIDS.

Other Ways to Reduce SIDS Risk

  • Breastfeed your baby. Babies who breastfeed, or are fed breast milk, are at a lower risk of SIDS than babies who were never fed breast milk. If you bring your baby into bed for feeding, make sure and put the baby back in their own sleeping area when feeding is complete.
  • Provide a safe home environment. Do not smoke or let anyone smoke around your baby and avoid using alcohol or illicit drugs after the baby is born (especially before bed).

Tummy time helps build muscles, lets baby interact with their surroundings, and gets them ready to sit up, crawl, and walk.

  • Offer your baby a pacifier. Pacifiers have been found to reduce the risk of SIDS for all babies. If you are breastfeeding, wait until the process is going well to give the pacifier. Don’t attach anything to the pacifier that may cause suffocation, strangulation, or choking.
  • Avoid using products that are not approved by the CPSC. Do not use home monitors or commercial devices, including wedges or positioners, marketed to reduce the risk of SIDS, unless that have a certification of approval from the CPSC.
  • Provide lots of opportunity for tummy time. Giving your baby supervised tummy time on the floor helps strengthen their neck, shoulders, and arm muscles.
  • Vaccinate your baby. The AAP says infants should receive all recommended vaccinations.