Protecting Your Baby from SIDS

5 Safety Guidelines

With the goal of continuing to reduce the number of SIDS deaths, the AAP published its latest policy statement on SIDS in November 2005 (visit aap.org to view the statement in its entirety). Here is what you need to know to keep your baby safe:

"Back to sleep" -- always. Infants should be placed for sleep in the supine position, both for naps and nighttime sleep. "Until recently, we thought that side-sleeping was a reasonable alternative to back-sleeping, but now we know it is not," says Dr. Kattwinkel. "We have a number of studies showing that the side-sleeping position is unstable and increases a baby's chance of rolling onto his stomach," he says. In fact, one 2000 study found that the risk of SIDS for side-sleeping babies is similar to the risk for stomach-sleepers.

Share your room -- but not your bed -- with baby. There is growing evidence that having your baby's crib or bassinet in your room reduces the risk of SIDS. Members of the SIDS Task Force suggest placing a bassinet or crib next to your bed or in your room for at least the first six months of the baby's life. "That seems to the most protective sleep setting," says Dr. Moon. When babies are in the same room as a parent, she explains, they don't fall into as deep a sleep as they do when they're alone in the nursery. "Babies stir at the noises the parents make," she says, "and these frequent awakenings are protective." It's fine to breastfeed or hold your baby in your bed, says Dr. Moon, "but you should return your baby to his bassinet or crib when you're ready to go back to sleep."

As for bed-sharing, Dr. Moon discourages the practice. "We use soft mattresses and typically lots of pillows and bedding in this country," she says, "and a baby in a parents' bed is at risk for suffocation, overheating, strangulation, entrapment, and falls."

Don't overdress your baby. Some researchers believe that a baby who is too warm falls into such a deep sleep that it is difficult for him to awaken if he is in trouble. A bodysuit and a blanket sleeper are generally sufficient.

Breastfeed. Babies who are breastfed are more easily roused from sleep than formula-fed babies, which may be a reason breastfed babies are less likely to die from SIDS. Mothers who breastfeed are also less likely to smoke, and a baby's exposure to smoke -- both in the womb and secondhand -- increases the risk for SIDS.

Give your baby a pacifier. Using a pacifier lowers the risk of SIDS by about two-thirds, says Dr. Moon. "We don't know why yet," she says, "but it may be that sucking on a pacifier brings a baby's tongue forward, which opens the airway a little bit more." Or it could be that babies who use pacifiers don't fall into as deep a sleep as babies who don't. By the way, you needn't reinsert the pacifier if it falls out of your baby's mouth; while the reasoning is unclear, just putting your baby to bed with the pacifier seems to offer protection.

While some breastfeeding advocates have protested giving your baby a pacifier because it is thought to be an obstacle to nursing, Dr. Moon notes that the AAP guidelines specify that pacifiers should not be introduced until breastfeeding is well established, around 4 to 6 weeks. Using a pacifier anytime before age 4 will not ruin your baby's teeth or cause dental problems, and if you wait until breastfeeding is well established, it won't interfere with nursing either. (Keep in mind: Substituting a bottle for a pacifier is not recommended. It can lead to choking, increases dental decay, and may cause ear infections.)

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