The USA and Sudden Infant Death Syndrome (SIDS): babies' lives on the line

Every parent wants the best for their new baby, and most would almost literally do anything to keep them safe. As a GP, I give advice on almost a daily basis to new parents terrified at the thought of their baby suffering cot death. But a new US study (1) involving videotaping parents and babies in their homes (with their consent, of course) suggests that all too many are putting their babies' health at risk with their bedtime habits.

In the USA, there are about 3,500 sudden unexpected infant deaths (SUID) every year. Sudden Infant Death Syndrome (SIDS) accounts for about 1,500 deaths in the USA and 270 in the UK. The other causes of SUID have changed little in the last 25 years - but cases of SIDS have dropped dramatically, from about 130 to under 40 per 100,000 live births. The Back to Sleep campaign, following 1992 guidance to lay all babies to sleep on their backs, is credited with causing much of this improvement.

Factors that increase the risk of SIDS include babies not sleeping on their backs; loose bedding; a soft sleeping surface; not breast-feeding; use of tobacco by anyone living in the house; and bed sharing (2). Babies should never have pillows, and should always have tucked-in sheets and blankets (or a baby sleeping bag) rather than duvets. Cot bumpers should only be used if they are firmly attached, with no loose ties that could cause strangulation. Soft toys are also a definite no in the cot.

The official advice to avoid bed-sharing has proved controversial. This is partly because of different definitions. Firstly, there are strong arguments in favour of 'co-sleeping' - sharing a room but not a bed with your baby - as this may reduce the risk of cot death (3, 4).

Secondly, few would argue that falling asleep with your baby in a sofa or armchair is to be avoided. Likewise, sleeping in a bed with your baby if you've been smoking, drinking or taking drugs that might cause drowsiness is a deeply bad idea. But there are ardent advocates of babies sharing an adult bed with one or both parents, who argue that once the dangerous behaviours above are taken out of the equation, bed-sharing in the right circumstances does not lead to SIDS and can have all sorts of benefits (5).

But the findings of this recent study were in much more clear-cut territory. Parents and their 1, 3 and 6 month old infants were filmed and the footage examined for possible risk factors for SIDS. Remember, the parents in this study knew they were being videoed, and are therefore likely to have been on 'best behaviour'. Despite this:

- Between 10 and 21% were placed on surfaces that were too soft

- Over 85% of babies of all three ages had loose items (pillows, loose cot bumpers, stuffed animals etc.) in their cots

- 14% at 1 month, 18% at 3 months and 33% at 6 months were not put to sleep on their backs.

SIDS is not common - today in the UK, one in 3,000 babies dies from 'cot death' each year. Being a new parent is exhausting, both physically and emotionally. Twenty years on, I still remember feeling as if there was not a single muscle in my body that didn't ache from tiredness, and struggling to clear the constant mental fog of exhaustion. But the stakes are unbelievably high - I have never met a parent who has suffered the tragedy of SIDS who hasn't tortured themselves wondering if it was 'their fault'.

So if you are a new parent, take a few minutes out in one of the few times of day you're not on your knees with exhaustion. Go through a checklist of all the ways you can keep your baby safe and put all the steps into action. That way you can sleep soundly - until the next time they wake you up….



2) Moon RY; Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics. 2011;128(5):1030-1039pmid:22007004

3) Blair, P.S., Fleming, P.J., Smith, I.J. et al. Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome. CESDI SUDI research group. British Medical Journal. 1999; 319: 1457-1462

4) Carpenter, R.G., Irgens, L.M., Blair, P.S. et al. Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet. 2004; 363: 185-191

5) Gessner, B.D., Ives, G.C., and Perham-Hester, K.A. Association between sudden infant death syndrome and prone sleeping position, bed sharing, and sleeping outside an infant crib in Alaska. Pediatrics. 2001; 108: 923-927

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