The Medical Minute: Parents can guard against Sudden Infant Death Syndrome

While it’s near the top of the list of misfortunes new parents hope they’ll never face, Sudden Infant Death Syndrome (SIDS) can be guarded against, experts say.

It’s both common and unthinkable. Each year devastated parents, guardians and caregivers discover about 3,400 infants a year old or less have stopped breathing and died, according data from the U.S. Centers for Disease Control and Prevention (CDC). Some are strangled accidently. For others, no cause is ever determined ― a new baby simply went to sleep and somehow stopped breathing.

But parents aren’t powerless. Heather Stephens, a neonatal clinical nurse specialist and co-lead of Penn State Health’s Safe Sleep team, says taking the right precautions at bed or naptime can decrease their chances of ever having to face a tragedy.

What is SIDS?

“It is a sudden and unexpected death, whether explained or unexplained,” Stephens said. “It happens during infancy.”

SIDS primarily affects babies under one year of age. It usually happens in a sleeping environment ― a baby sleeping in a bassinet or a crib. Sometimes, parents take an infant to bed and roll over during the night and accidently smother a child. Some infants become tangled in bed linens or lie against a pillow in a way that obstructs their breathing and their young and developing head and neck muscles haven’t built up enough strength to reposition themselves.

For others, it’s a mystery.

Babies born premature are at a higher risk of it happening, Stephens said, but few warning signs exist. The number of cases increases for children between two and four months of age, and the rates are higher among Alaskan, Native American, Black and Hawaiian people, Stephens said.

Pennsylvania had a rate of 87.5 cases per 100,000 children between 2016 and 2020. The national average is about 40 cases per 100,000.

What can parents do to prevent it?

The American Academy of Pediatrics launched a campaign in the early 1990s called “Back to Sleep,” where they encouraged families to practice safer sleep practices for infants. It was effective, Stephens said, and the number of cases began to decline, but “have since leveled off.”

Organizations like CDC continue to promote what they believe are the best ways to prevent SIDS:

• Parents should make sure babies sleep on their backs – even for naps. “A lot of families become concerned about ‘What if the baby spits up? Won’t they choke on their own spit?’” Stephens said. “The answer is no.” The trachea ― the tube through which you breathe ― is located on top of the esophagus ― the pipeline that delivers food from your mouth to your stomach. If a baby is positioned on their back, “that fluid would almost have to overcome gravity to block the trachea,” Stephens said. The chances of an infant breathing in their own fluid are great when the child is face down, because the fluid can pool near the opening to the trachea.
• Don’t use soft bedding such as pillows, blankets or soft toys to help your baby sleep. The infant can move into a position among the objects that obstructs its breathing. “Whenever they’re so small, they don’t have the muscle strength to turn their head back,” Stephens said. “So, they could put their face up against a blanket or a toy or the bumper pad and they could suffocate like that.”
• Babies should sleep in their cribs alone. Many parents opt to take their child to bed with them at night, but ― as with the loose pillows and soft toys ― there’s a greater chance of suffocation.
• Keep the baby’s bassinet or crib in the same room where you sleep until your baby is at least six months old, ideally. “Don’t sleep in the same bed,” Stephens said. “Sleep in the same room.”
• When breastfeeding a child, be sure to set an alarm on your phone. Parents are often tired and it’s easy to drift off to sleep during a feeding, which can be risky.
• That cute hat you bought to keep your baby warm is probably adorable, but it’s not for bedtime. Check to see if your baby is too hot or too cold, but don’t cover their head with a hat that can also obstruct breathing.

How do parents make sure what they choose for their child’s bedtime is safe?

According to the Consumer Product Safety Commission, a safe crib should feature:

• A firm, tight-fitting mattress so a baby cannot get trapped between the mattress and the crib.
• No missing, loose, broken or improperly installed screws, brackets or other hardware on the crib or mattress support.
• No more than 2 3/8 inches (about the width of a soda can) between crib slats so a baby’s body cannot fit through the slats; no missing or cracked slats.
• No corner posts over 1/16th inch high so a baby’s clothing cannot catch.
• No cutouts in the headboard or foot board so a baby’s head cannot get trapped.
• Cribs that are incorrectly assembled, have missing, loose or broken hardware or broken slats can result in entrapment or suffocation deaths. Infants can become strangled when their head and neck become entrapped in gaps created by missing, loose or broken hardware or broken slats.

For mesh-sided cribs or playpens, look for:

• Mesh less than 1/4 inch in size, smaller than the tiny buttons on a baby’s clothing.
• Mesh with no tears, holes or loose threads that could entangle a baby.
• Mesh securely attached to top rail and floor plate.
• Top rail cover with no tears or holes.
• If staples are used, they are not missing, loose or exposed.

When buying bedding, make sure whatever products you choose were approved by the Consumer Product Safety Commission, Stephens said. It should say so on the packaging.

Programs like Penn State Health’s Injury Prevention Program and the national Cribs for Kids charity provide safe cribs for families that can’t afford them.

In fiscal 2023, Penn State Health provided 33 cribs to families that were referred to the health system by its community partners, three times more than it provided the previous year.

Call 717-531-SAFE for details.

Related content:

• The Medical Minute: Keeping your baby safe while sleeping
• The Medical Minute: Despite warnings, unsafe infant sleep practices persist

The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

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