The memory of losing her infant son, Colton, is still unbearable to Kristen Marr nearly seven years later. "He was 2 months old and in perfect health when I put him down on his back for a nap," she recalls. But when she tiptoed into the nursery of her home in Crofton, Maryland, to check on him, Colton had stopped breathing. Marr dialed 911 and tried to perform CPR on her infant. But it was too late. Doctors later concluded that Colton was a victim of sudden infant death syndrome (SIDS). While its incidence has dropped by half since the launch of the Safe to Sleep (formerly Back to Sleep) campaign in 1994, SIDS is still linked to about 2,500 baby deaths every year. And even taking the right precautions (as Marr did) doesn't guarantee that your child will be protected. But here's some reassuring news: Recent research is revealing more ways than ever to reduce your child's risk. Are you doing everything you can to fend off SIDS? Here are answers to your top questions.
Q: What causes infants to stop breathing while they sleep?
A: Experts believe SIDS victims have an immature arousal center in the brain. Put simply, they can't wake themselves up when they're having trouble breathing. Infants who sleep on their stomach are particularly vulnerable to SIDS. One theory is that this position increases the likelihood that they will re-inhale oxygen-depleted air. "The peak danger is between 2 and 4 months," says Marian Willinger, Ph.D., special assistant for SIDS at the National Institute of Child Health and Human Development, in Bethesda, Maryland. However, you should continue to safeguard your child until he turns 1.
Q: Who's most at risk?
A: Three out of five SIDS victims are boys. African-American and Native American infants are two to three times more prone to the syndrome. Other groups at increased risk include preemies, low-birthweight babies, and infants who are exposed to cigarette smoke.
Q: Is putting my baby down on her back really that important?
A: It's vital. Back-sleeping increases a baby's access to fresh air and makes her less likely to get overheated (another factor linked to SIDS). But not all new mothers are getting the message: Eighteen percent of Parents readers say they usually put their infants to sleep on their stomach, and another 13 percent do so some of the time. "Some exhausted new parents may do it out of desperation, because infants tend to sleep better and more deeply on their stomach," says Parents advisor Jodi Mindell, Ph.D., author of Sleeping Through the Night: How Infants, Toddlers, and Their Parents Can Get a Good Night's Sleep. "But having your baby sleep on her tummy is a no-no."
Q: I put my child to sleep on his back at night, but can I let this rule slide for a short nap?
A: It's not worth the risk. Babies who normally sleep on their back are 18 times more likely to die of SIDS when placed down on their tummy for a snooze. "Infants seem to have difficulty adjusting to the change," says Rachel Moon, M.D., a SIDS researcher at the Children's National Health System, in Washington, D.C.
Q: Is side-sleeping safe?
A: No. Studies show that putting a baby down on her side rather than on her back doubles the SIDS risk. "It's easier for an infant to roll onto her tummy from her side than from her back," says Dr. Moon, who is also a member of the American Academy of Pediatrics (AAP) Task Force on SIDS. "And she may not yet have the skills to roll back in the other direction."
Q: My baby has a flat spot on his head from sleeping on his back. Will it go away?
A: That depends. Flattened-head syndrome, or positional plagiocephaly, occurs when the back of an infant's pliable skull is reshaped from constantly lying in the same position. By some estimates, the incidence has jumped sixfold during the past decade. Yet back-sleeping isn't entirely to blame. "This condition is preventable," says John Persing, M.D., a craniofacial specialist at Yale-New Haven Hospital, in Connecticut. "Most babies with this problem spend way too much time on their back when they're awake." To correct (or prevent) a flat spot, give your baby several supervised "tummy time" sessions every day. You can also position your baby's head when you put him down to sleep -- one night to the left, the next night to the right -- to help balance the shape of his head. And don't let your child spend too much time in car seats, bouncy seats, or infant swings. If the flattening doesn't show significant improvement by the time he's 6 months old, consult a pediatric craniofacial specialist.
Q: I'm worried about my baby getting cold. Is it safe to cover her with a blanket?
A: Wait until her first birthday. Blankets, pillows, comforters, and stuffed toys can hinder your child's breathing; even soft or improperly fitting mattresses can be dangerous. If you're worried that your little one may get chilly, swaddle her in a receiving blanket or use a sleep sack. According to a Belgian study, swaddling helps fussy infants sleep better on their back and may protect them from SIDS by causing them to startle more easily. But make sure you don't overheat your baby. "A nursery that's too warm substantially increases an infant's SIDS risk," says Warren Guntheroth, M.D., professor of pediatrics at the University of Washington, in Seattle. Set the thermostat at 68 degrees, don't put the crib near a radiator, and dress your child in light layers that you can remove easily if she gets hot.
Q: Is it dangerous to give my baby a pacifier?
A: Not at all. Binkies actually reduce the risk of SIDS, possibly by preventing babies from falling into an extremely deep sleep. The AAP now recommends that you consider giving your child a pacifier at night and for naps during his first year. Note: If you're breastfeeding, don't introduce a Binky until your infant is 1 month old and nursing well.
Q: My baby has started to flip onto her stomach during the night. How can I stop this?
A: You can't -- but don't worry. "Once a baby can roll over by herself, her brain is mature enough to alert her to breathing dangers," says Dr. Moon. "And by the time she's 6 months old, her improved motor skills will help her to rescue herself, so the SIDS risk is greatly reduced."
Q: My baby sleeps better in my bed. What's the big danger of co sleeping?
A: Actually, there are lots of them. Your infant could be suffocated by a pillow or a loose blanket. His air supply may be cut off if you or your spouse inadvertently rolls over onto him. And he could be strangled if his head gets trapped between the headboard and mattress.
Despite numerous studies that confirm the heightened SIDS risk caused by co sleeping, many moms continue to do it. According to a parents.com poll, 52 percent of readers do it all or some of the time, citing the added convenience for nighttime feedings and the security of having their infants next to them.
If you decide to co sleep, don't put your baby right in the bed. Instead, get a co sleeping crib that clamps onto the frame of your bed. Or you might simply try moving your baby's crib into your room. Several studies show this sleeping arrangement reduces the SIDS risk.
- DO always put your baby to sleep on his back.
- DON'T put blankets or toys in her crib.
- DO use a pacifier at sleep time.
- DON'T smoke while pregnant, and don't allow anyone to smoke around your infant.
- DO try swaddling your child.
- DON'T put your baby to sleep on his side.
- DO have her sleep in a crib in your room.
- DON'T share your bed with your baby.
- DO make sure the crib mattress is firm and tight-fitting.
- DON'T overdress your child or put his crib near a heat source.
Just because you're up-to-date on SIDS safety doesn't mean your child-care provider is. Consider these frightening statistics: One out of five SIDS deaths occurs when a baby is in day care or being watched by someone other than a parent, according to research in the journal Pediatrics. And more than 20 percent of babies in day-care centers are put down for naps on their tummy. "Most states don't have safe-sleep guidelines for licensed providers," says Dr. Rachel Moon.
Review SIDS precautions with everyone who watches your child, whether it's a day-care worker, a babysitter, a relative, or a friend. They must know how to keep your infant safe while he sleeps -- so you can rest easy.
Can These Products Help?
They all claim to safeguard your baby from SIDS. Here's the bottom line on what really works.
What is it: A blanket that zips around a baby's feet and torso but leaves her arms and head free.
Worth it? Yes. It keeps an infant warm and (unlike a loose blanket) can't suffocate her. Sacks also help babies sleep better once they outgrow swaddling.
What is it: An infant bed that attaches to the side of an adult bed.
Worth it? Absolutely. It's the only safe way to co sleep. Just make sure there are no gaps between your bed and your baby's.
What is it: A foam device with raised sides that keep a baby on his back.
Worth it? No. The FDA and the Consumer Product Safety Commission issued a warning about their use because they are hazardous.
What is it: A crib mattress designed to keep fresh air circulating around a baby's face.
Worth it? Possibly. But no research has been done to confirm its effectiveness, so follow other SIDS-prevention steps if you buy it.
Originally published in the August 2006 issue of Parents magazine. Updated September 2014.