Safe sleep and SIDS

This is likely the most grim but most important topic you need to know as a new parent.

Sudden infant death syndrome SIDS is an umbrella term for a child under 1 year of age inexplicably dying in their sleep. While the exact cause is unknown, several risk factors were identified and guidelines for prevention issued.

In 1994 the US National Institutes of Health launched the Safe to sleep/Back to sleep public information campaign which resulted in significant drop in SIDS incidence. According to my research most of the recommendations world-wide are based on it.

In 2022, the chance of being affected by SIDS in the US was 0.042%. In europe the data from 2018 shows a probability of 0.015%. The risk is low, but the guidelines have been proven to work, be sure to follow them.

Note

While I researched this topic extensively, I am not an authority on the subject. I include my understanding of “why something is dangerous” as I think it is useful for decision-making, but I do not claim any special expertise. This topic is important enough for you to double and triple check it with your pediatrician.

Place baby on their back for sleep

Young babies can not roll or reposition by themselves. Placing them on their back ensures their airways are straight and the parent does not accidentally obstruct their breathing when putting them down.
This applies for all sleep times including naps.

The danger comes from setting a baby in a position they cant escape from. Once a baby gains the ability to roll on their front (3-6 months) they might choose to sleep on their front, that’s fine, you don’t need to re-set them to their backs. If the baby got into a position by themselves they are likely able to move away from it if they want to.

Infant car seats or any other product that is not designed for extensive sleep operate by different rules.

Under no circumstance a swaddled baby is allowed to sleep on their front!

Share the room, not the bed

Bed sharing aka co-sleeping is another major risk factor. Many people do it and get away with it, that does not mean it’s a good idea.

• A sleeping adult can roll over the baby suffocating them.
• The baby might get tangled on loose bedding like pillows/blankets/sheets etc.
• Baby can fall off the bed.
• Adult mattresses are too soft which is a suffocation hazard if the baby ends up on their front.

I recommend investing in a “sidecar bassinet” (one side of the bassinet is removable or slides down). Installing it next to your bed gives you easy access to the baby at night. It is designed for newborn sleep: mattress is firm, you can’t roll over them, there is no risk of entrapment. This gets you very close to the convenience of co-sleeping without any of the risk associated with it.

Sharing the room is recommended, it is both convenient and allow you to check on your baby during the night.

Use a firm mattress

If the mattress is to soft the baby’s face can sink into it and cause re-breathing.

Fortunately the majority of developed countries heavily regulate baby sleeping surfaces. For example in the EU the EN 16890:2017+A1:2021 requirement for “Mattresses for cots and cribs” amongst other hazards, specifically tests the mattress hardness. It is illegal to sell baby sleep products on European markets without passing this certification.

If it’s a cot or a bassinet from a reputable brand from a developed country, more than likely the mattress is both firm and breathable enough to be safe.

Avoid antique or DYI mattresses and beds. These did not pass any regulatory testing and also might use prohibited materials like formaldehyde or led paint.

There is methodology for a mattress firmness test you can perform at home. I don’t believe it is reasonable to run this test, it is always better to rely on experts and accredited certifications than “to be clever”. I strongly urge you to buy certified products, if that is not possible for any reason, the methodology in the miscellaneous section.

No clutter in the crib

No pillows, blankets, plush toys, cot bumpers, etc. they pose suffocation risk.

Use a fitted sheet over the mattress and swaddle your newborn with a weather appropriate blanket, that’s it. If you don’t want to swaddle a sleeping bag also works.

It does look a bit spartan, but im 100% convinced the baby does not care if they have a nicely decorated bed or not.

Cot bumpers are also considered clutter, posing the same risks and are banned in US since 2022.

Avoid overheating

Young babies have poor temperature regulation, they loose heat quickly but also overheat easily. Overheating is another major risk factor for SIDS that can easily be avoided.

• Avoid placing the bassinet next to a heat source (like a radiator).
• Take off baby’s hat while inside.

Our pediatrician recommended to keep the inside temperature around 21 degrees Celsius and dress our daughter with 1 layer more than we are wearing.

A baby that is too warm will have sweaty clammy back of the neck and their cheeks will flush red. In more severe cases their breathing will become more rapid. A baby that is too cold will usually complain by crying and their cheeks and chest will be cold to the touch. Cold feet and hands are not a good indicator for a baby being cold, their circulatory system is immature and their feet and hands will be normally colder than an adult’s.

Where I am from (eastern-central europe) people tend to overdress their babies both inside and outside. I’m with reddit on this one: Slightly cooler is always better.

No smoking or vaping around the baby

Obviously don’t!

Even after airing out the room the tar from smoke accumulates on surfaces and also counts as second-hand smoking (even if there is no direct smoke inhalation),

Pacifier use is recommended

“Published case-control studies demonstrate a significant reduced risk of SIDS with pacifier use, particularly when placed for sleep”. source

There are some caveats when it comes to pacifiers, breastfeeding and mouth development. Read the chapter dedicated to that before introducing a pacifier.

Do not use baby nests/pods

Several products exist on the market which are advertised “for baby sleep”. Some of them even go as far as to claim they reduce the risk of SIDS when in fact it is the opposite. These products are not regulated the same way bassinets and cots are.

Canada recalled several products in this family specifically because they pose an elevated risk of entrapment.

Less is more.

A note on predatory advertising:

SIDS is very scary (I am reliving the stress even when writing about it) and there are actors trying to capitalize on your fears.

I remember receiving many ads for gadgets that claim to prevent it: oxygen monitors, inclined sleepers, smart baby monitors with breathe rate detection and all other kinds of similar snake oil. These will be advertised as “the definitive preventative measure”, but when inspecting the fine-print you are guaranteed to see keywords like “for comfort” or “fitness tracker” or “not a medical device”.

None of these passed any sort of certification. The ads can claim anything but if something is legally classified as and “infant lounger” (as is the case for the baby nests) it can skip all the testing that is legally required for baby sleep products.

At best, they do nothing, at worst they are actually putting your newborn in danger. For example did you know that oximeters can cause skin burn if not used correctly?

There are of course medical cases where special products are needed, but in this situation an actual medical professional will tell you exactly what to use, where to rent it and how to use it correctly.