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Sudden Infant Death Syndrome: The Numbers Have Dropped but It Can Still Happen

The good news is that the rate of deaths due to sudden infant death syndrome (SIDS) has dropped phenomenally since 1990. The rate of these types of deaths in babies that year was 130.27 per 100,000 live births, according to the Centers for Disease Control and Prevention. The death rate for SIDS in 2020 was 38.4 per 100,000 live births. This is a great public health victory and shows the effectiveness of public health campaigns about SIDS.

But deaths due to SIDS still occur and researchers are still looking for what causes these deaths and ways to reduce the risk even further.

Sudden infant death syndrome, which is also called crib death, is almost a lack of a diagnosis as much as it is a diagnosis. It is the diagnosis given when a baby less than one year old dies suddenly and unexpectedly, and an autopsy or an investigation cannot find an explanation for the death. In other words, the death is diagnosed as SIDS after all other causes have been ruled out.

SIDS is one type of what is called Sudden Unexpected infant Death or SUID. SUID includes all unexpected deaths of a baby under a year of age, and also includes deaths from a known cause, such as accidental suffocation in a crib or other sleeping area. It is diagnosed when the cause of a baby’s death is not known until an investigation is done and a cause may be revealed then. According to the CDC, about 3,400 babies die each year in the United States suddenly and unexpectedly

There are several risk factors for SIDS. Most frequently, SIDS occurs in babies between the ages of two and four months old. A baby that has a sibling or cousin who has died of SIDS is at greater risk of SIDS.

Physical problems such as defects in areas of the brain that control breathing and arousal from sleep, low birth weight, and a respiratory infection such as a cold raise the risk of SIDS. Anything that can interfere with a baby’s breathing may play a role. A baby sleeping on stomach or side may have more difficulty breathing than those placed on their backs for naps or sleep. Similarly, if a baby is lying face down on a very soft mattress or on a fluffy blanket the baby’s nose and mouth may become partially or completely blocked.

Breastfed babies are less likely to die from SIDS than bottle-fed babies. This is another reason breastfeeding is so strongly recommended for at least the first year by healthcare professionals.

Having a baby sleep in the same bed as an adult or older child raises the risk of SIDS because the baby may accidentally be smothered. However, having the baby in its own crib in the same room as the parents lowers the risk of SIDS. This is called room sharing and is recommended.

Another risk factor is the temperature of the room. A sleeping environment that is too warm increases the risk of SIDS. Sweating or having red or hot skin are signs that the baby is overheated.

Finally, babies who live in a household where someone is a smoker have a greater risk of dying of SIDS.

There is no known way to absolutely prevent SIDS, but there are ways to help reduce the risk. In the 1990s, research found that SIDS appeared to be more likely to happen when babies were put down to sleep on their stomachs. Babies were also more likely to die from SIDS if they were in a crib with blankets, thick quilts, a lambskin, or stuffed animals.

Health organizations such as the American Academy of Pediatrics and the National Institute of Child Health and Human Development started a public health campaign to educate parents and caregivers about reducing the risk of SIDS. Parents and caregivers are now instructed that babies must be put down in their cribs for naps and sleep laying on their backs on a firm flat mattress that is covered by only a fitted sheet. The crib should not contain any blankets, pillows, or bumpers. The baby’s head and face should never be covered by anything, including hats. Instead of a blanket, use sleep clothing to keep the baby warm, but not too warm.

The campaign was originally called Back to Sleep, but in 2012, the campaign was expanded and renamed to Safe to Sleep campaign.

Many parents worry that a baby will choke if they spit up or throw up while they are sleeping on their back. Babies have the reflexes to cough and or swallow to clear their throat and airways.

There are products and devices on the market that are advertised as reducing the risk of SIDS. These include wedges or pillows that position the baby. Avoid these products since they do not meet guidelines for sleep safety. Devices that monitor a baby’s breathing or heart rate can be used but should not be the main way to reduce the risk of SIDS.

The sad news is that although the incidence of SIDS has dropped greatly, it is a tragedy that still happens.

You can read more about SIDS and ways to reduce the risk at https://safetosleep.nichd.nih.gov/.

Valerie DeBenedette
Valerie DeBenedette is an experienced health and medical writer who lives about an hour north of New York City with a dog that is smaller than her cat. Her work has appeared in magazines, newspapers, newsletters, and on websites. She is a member of the National Association of Science Writers.

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