Sudden infant death syndrome (SIDS) is the leading cause of death of children between one month and one year of age in the United States, with most victims between two and four months old. SIDS is determined to be the cause of death for any infant under the age of one who has had an unexplained death after a thorough investigation, including an autopsy. Boys are at a slightly increased risk, as well as children of black, American Indian and Alaskan descent. Additionally, up to 20% of all SIDS deaths occur in daycare settings. It is believed that a number of underlying risks, including heredity, combined with an environmental trigger at a developmentally vulnerable stage are what contribute to the unexplained sudden death of the infant. Thus, an awareness of your infant’s individual risks, as well as behaviors that reduce the chance of SIDS, will arm you with the tools you need to protect your child.
Factors That Increase a Child’s Risk of SIDS
Inherent Risks
Some children are born with certain risks that predispose them to the possibility of SIDS. By being aware of these risks, parents have the opportunity to be vigilant, and to create an environment that will decrease the likelihood of the sudden death of their child. Premature infants have a 3 to 4 times higher risk of SIDS than other infants. Low birth weight is also associated with SIDS. Compared to single births, children who are twins are twice as likely to have SIDS, but this may also reflect the fact that twins are more likely to be premature and have a low birth weight. Infants whose siblings experienced SIDS have a 5 to 6 times higher risk of SIDS than other children. Historically, apnea has been thought to contribute to SIDS, but studies have shown that it is not a significant risk factor, and using an apnea monitor does not appear to reduce the risk.
There are also specific behaviors and qualities of a child’s mother, as well as events during pregnancy that will predispose the child to SIDS. Smoking during pregnancy, as well as in the same space as an infant after birth increases their chances of SIDS. Alcohol and drug abuse during pregnancy and after birth also increases risks. Other pregnancy complications that can lead to SIDs include placenta previa, placenta abruption, premature rupture of membranes and elevated alpha-fetoprotein.
Environmental Risks
In addition to hereditary and biological contributors to SIDS, there are a number of environmental factors that are known to significantly increase risk. The position in which a child is placed to sleep is very important to his or her wellbeing. Lying facedown or on the side is known to increase the risk of SIDS. However, the bedding also matters. Soft surfaces, especially very soft mattresses, sofas, recliners, waterbeds and air mattresses all contribute to the incidence of SIDS. Loose accessories in the bed such as blankets, toys or bumpers pose an additional danger to sleeping infants because, depending on their positioning and closeness to the face, they can prevent adequate airflow during breathing.
The sitting position tends to increase gastroesaphogeal reflux and to decrease the ability of oxygen to reach the blood in young children. This is the reason experts say that sleeping in a car seat increases the risk of SIDS. The safety of napping in the car is probably outweighed by the benefits of being in a car seat while the vehicle is moving, but sleeping in a car seat on a regular basis is not safe. Being overheated also seems to increase the risk of SIDS as well as tight swaddling, especially in older children who should be free to move to safer positions during sleep. There has been some misinformation circulated regarding the risk of vaccines. There is no evidence that any childhood vaccines increase the risk of SIDS. In fact, while the number of vaccines administered has steadily risen since the 1980s, the incidence of SIDS has declined by at least 50% during that same time.
Behaviors That Reduce Risk and Prevent SIDS
Knowing what risks your child may have, as well as what you can do to minimize those risks, is key to being able to provide a safer environment for the health of your infant.
Prevention starts during pregnancy. Be sure to get regular prenatal care, and do not smoke, drink alcohol or take illicit drugs. Once your baby is born, make sure to provide a safe and healthy environment, including the avoidance of second-hand smoke. Ensure that his or her bed has a firm mattress and the crib or bassinet is free from loose items, including blankets, toys and bumper pads. If you swaddle your child, this should stop as soon as he or she is beginning to roll over. Never lay your child on a sofa, soft surface, waterbed or air mattress; and remember that car seats are for safe car travel only, and not for naptime. Lay your infant on his or her back for sleep. You can lay them on their stomachs only during supervised time so they exercise and practice their rolling. Room sharing (and not bed sharing) is recommended for at least the first 6 months. Remember that it is never safe to share a bed with your infant.
Breastfeeding has a number of health benefits, and this includes protection against SIDS. This does not necessarily mean exclusive breastfeeding, but at least part of the time. Try to avoid overheating by not overdressing your child and regulating the environmental temperature. The use of a pacifier may also help reduce the incidence of SIDS. It is recommended that after one month of age, an infant be given a pacifier while falling asleep, however, it should not be reinserted after the child is sleeping.
If you have any more questions regarding SIDS, your child’s risk of SIDS or ways to prevent respiratory problems, please call us at Gingras Sleep Medicine in Charlotte and Concord, North Carolina at (704) 944-0562. We look forward to being of assistance. You can also request an appointment online at http://gingrassleepmedicine.com/contact-us/request-an-appointment/