When it's time for your baby to sleep, do you set him down on his back? If so, you've taken a crucial step toward protecting his health and safety. That's because putting babies sunny-side up for naps and nighty-night helps protect them from sudden infant death syndrome (SIDS). In fact, in the nine years since experts first began urging parents to put their newborns "back to sleep," the number of SIDS cases has fallen by more than half.
Still, this dreaded syndrome -- in which a child between 1 month and 1 year of age suddenly dies for no apparent reason, usually in her sleep -- remains an all-too-real threat. It's the leading killer of babies more than a month old, striking more than one in every 2,000 infants, according to statistics from the National Institute of Child Health and Human Development (NICHD). And while certain groups of babies seem to be especially vulnerable -- SIDS strikes slightly more boys than girls, and two-and-a-half times more African-American babies than white ones -- the causes are still a mystery. Even experts can't predict which newborns will become victims.
But that doesn't mean parents are powerless against it. There are plenty of ways to protect your little one from SIDS, above and beyond tiptoeing into his nursery every night to watch each gentle rise and fall of his tiny chest (although you'll probably do that anyway). Parents interviewed leading experts and researchers around the country to get their lifesaving advice. Take these measures today, and you -- and your baby -- will sleep better tonight.
1. Tell all your child's caregivers to put him to sleep on his back. It's not totally clear why this position is so effective against SIDS, but it is. One theory is that some infants' breathing instincts aren't fine-tuned at birth. If they sleep tummy down and end up rebreathing a pocket of air until their oxygen supply runs low, no internal alarm prods them to try to turn their head. Back-sleeping eliminates this risk -- in fact, babies whose parents and caregivers position them that way are two to three times less likely to succumb to SIDS.
But once you institute the "back to sleep" rule, your child must always go to sleep that way, even for naps. A recent study by the NICHD found that babies who normally sleep on their back and then are placed on their side or stomach, even just once, are seven to eight times more likely to die of SIDS on that occasion than those who consistently back-sleep. The reasons are unclear, researchers say, but babies who are accustomed to sleeping on their back apparently have difficulty adjusting to the dramatic change.
The lesson: Everyone who watches your child must put him on his back for sleep, including day-care workers (recent research indicates that 20 percent of child-care centers that provide overnight care place babies to sleep on their stomach at least occasionally). Don't forget the neighbor who babysits in emergencies -- up to 50 percent of SIDS cases occur when a child is with a caregiver other than a parent, according to the SIDS Alliance of Illinois. "Refrain from tummy sleep until your baby is old enough to have rolled over a few times on his own, usually at about 5 to 6 months," says Bradley Thach, M.D., of the Washington University School of Medicine, in St. Louis.
2. Don't let your baby snooze in your bed. It's tempting to bring your newborn into your bed, at least occasionally. And more moms and dads are making it a permanent arrangement: Nearly 13 percent of babies under 8 months of age usually share an adult bed at night, up from just 5.5 percent in 1993, according to the NICHD.
Don't jump on the bandwagon. "Adult beds are not designed for babies," says Marian Willinger, Ph.D., special assistant for SIDS at the NICHD, in Bethesda, Maryland. "An infant can get pinned between the mattress and the bed frame, or sink into the pillow and quilt." The crowded environment might also cause the child to rebreathe air pockets, just as tummy-sleeping can. Possibly for these reasons, a baby who sleeps with Mom or Dad in a grown-up bed is nearly one-and-a-half times more likely to die of SIDS, according to one preliminary study. Most experts consider that increase to be negligible, says Fern R. Hauck, M.D., a SIDS researcher at the University of Virginia, in Charlottesville, but the risks can quickly rise if parents cover their baby with a comforter, or if either or both have been drinking, are taking sleep-inducing drugs, or are very tired -- which may make them unaware that they're crowding their child. If Mom or Dad smokes, the risks increase too (for more on why, see Tip #6).
Putting your little one in bed with her big sister or brother is even more dangerous: A recent study found that sleeping with one or more siblings makes a baby nearly five-and-a-half times more likely to die of SIDS. "This might be because siblings don't or can't monitor the infant or make as much of an effort to give him space," Dr. Hauck speculates.
3. Always put your baby to sleep in his bassinet or crib. Adult beds aren't the only dangerous slumber zones for babies. Almost every family has a photo of Junior snoozing on the couch, for instance, but this scenario raises a baby's risk of SIDS by as much as 20 times, especially if he's sleeping tummy down and a parent falls asleep there with him. "He could get wedged into a crack in the cushions, where there's no fresh air," Dr. Willinger points out.
Other sleep surfaces that can increase a baby's chances of SIDS by three times or more include waterbeds, soft adult mattresses, and sheepskins. One study that recently appeared in Pediatrics speculates that African-American infants may die from SIDS at a higher-than-average rate because their parents are more likely to practice bed-sharing or to place them in nonstandard beds.
What about car seats and bouncy seats? While babies fall asleep in them all the time, they should only remain there under an adult's watchful eye. "Young infants, especially those born prematurely, have decreased muscle tone, particularly in the upper airway during sleep. This decreased tone and their tendency to scrunch down in infant and car seats, can result in a partial upper-airway obstruction," says Debra Weese-Mayer, M.D., a SIDS researcher at Rush-Presbyterian Children's Hospital, in Chicago. This can interfere with the infant's breathing.
4. Unclutter the crib. You'd probably love to put some cute accessories in there, like lacy pillows and stuffed animals. "But they can all get in front of the baby's face and hinder breathing," Dr. Thach warns.
For at least the first year of your child's life, the only things that should be in her crib (approved by the Juvenile Products Manufacturers Association) are a firm mattress, a secure, fitted sheet, and your baby. Don't hang anything over the side, like a comforter that your wiggly little one could pull down over herself. Crib bumpers should be firmly tied.
On chilly nights, don't reach for blankets and comforters. Dress your child in a sleeper or a sleep sack, which zips around his feet and torso but leaves his arms and head free.
5. Keep an eye on the thermostat. There's been a lot of debate about whether a baby's risk of SIDS goes up when she's overheated. Some doctors think extra-warm air lulls little ones into a deeper sleep, which may make them more vulnerable, or that it dulls their respiratory controls, so they can't respond to conditions that might make their breathing and heart rate slow down.
And don't reach for the cigarettes after your baby's born, either: He'll be twice as likely to die of SIDS if one or both of his parents smoke in the house.
On the other hand, SIDS is more prevalent in the colder months. NICHD experts think this may be because infants face a greater risk of infections during this time, or because they're overbundled.
As a rule, keep your baby's room at a temperature that you yourself feel is comfortable. Don't put her crib or bassinet directly next to a radiator or other heat source. In warm weather, cool the room with an air conditioner or fan, and dress your baby in lightweight sleepwear.
6. Stop smoking. If a woman smokes while she's pregnant, her baby is about three times more likely to die of SIDS than if he'd been born to a nonsmoker. No one's sure whether it's the nicotine in Mom's blood that's to blame or a decreased blood supply to the fetus (smoking constricts blood vessels, including those leading to the placenta). "We think that when a pregnant woman smokes, it may affect her fetus's brain or lung development, changing the baby's response to low oxygen levels," says Dr. Willinger, of the NICHD. "Smoking also hampers a fetus's general growth and development, so quitting can improve your child's health far beyond just decreasing his SIDS risk."
If you let your baby have a Binky while he sleeps, here's a point in your favor: Recent research by Fern R. Hauck, M.D., of the University of Virginia, suggests those little suckers may just help protect against SIDS. According to Dr. Hauck's two-and-a-half-year study, which involved more than 500 infants in the Chicago area, those who had no pacifiers at sleeptime were three times more likely to die of SIDS. The link needs to be investigated, Dr. Hauck says. But two theories are that sucking on a pacifier may ensure that a baby stays faceup and that sucking may keep his airway open.
Rumor vs. Reality
At one time, these things all seemed to be likely SIDS culprits. But experts now know that they don't pose a risk.
Plastic baby mattresses
In the early '90s, a British TV program claimed that mattresses treated with a chemical fire retardant could emit antimony, a gas that in turn could cause SIDS. Several years later, a major study published in the medical journal Lancet showed there was no such link. "Still, it's a good idea to buy a brand-new mattress for each baby you have," says Nancy Maruyama, R.N., a SIDS mom and coexecutive director of the SIDS Alliance of Illinois, in Naperville. That's because cracks in used mattresses may trap germs that cause blood infections and pneumonia.
The DtP vaccine
In the mid-'80s, some experts claimed that the diphtheria vaccine could increase a baby's chances of dying of SIDS. That rumor still makes the rounds today, but most experts now agree the claim is groundless. "There are some rare instances in which a child has a serious or even fatal reaction to a vaccine, but those reactions are not SIDS-related," explains Dr. Marian Willinger, of the NICHD. "In general, immunization protects against SIDS because it makes babies stronger and healthier."
There's a persistent myth that SIDS is a virus that can spread from one baby to another, or from adults to children. SIDS can't be caught, since it is not a disease.
Copyright© 2004. Reprinted with permission from the August 2003 issue of Parents magazine.