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Cause

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The cause of SIDS is not clear. It might be linked to more than one medical issue, such as buildup of carbon dioxide in the blood or difficulty waking up. Researchers are currently looking into the possibility that SIDS might be caused by problems in how the brain controls breathing, heart rate, or body temperature in young infants.

Risk Factors

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We do know there are a number of risk factors for SIDS. Premature babies and babies with a low birth weight tend to be most at risk. Since babies of a multiple pregnancy (such as twins and triplets) tend to be at lower birth weights, they also have a higher chance of SIDS.

Women who do not get prenatal care during their pregnancy and mothers who smoke, drink alcohol, or use illegal substances are also at greater risk of having a baby die from SIDS. Also, if you had a baby who died from SIDS, your future children may be at higher risk.

Additional risk factors associated with an increased risk of SIDS include:

• Laying your baby on its tummy to sleep or nap.
  
• Sleeping with your baby in the same bed.
  
• Laying a baby on a soft mattress or sleeping surface.
  
• Placing soft objects, toys, and loose blankets in the crib.
  
• Keeping the bedroom too hot or allowing the baby to overheat.
  
• Gender. Boys are affected more often by SIDS than girls.

Recently, the U.S. Consumer Product Safety Commission (CPSC) issued a ban on drop-side cribs and a warning advising parents not to use drop-side cribs. A baby may suffocate when trapped by a drop side that slides partially down or is detached.

In addition, the U.S. Food and Drug Administration (FDA) warns parents not to use infant sleep positioners because they are dangerous. The infant can become trapped between the sleep positioner and the crib frame or bassinet, or they can flip from sleeping on their side over to their stomach, which is a known SIDS risk.

It is important to remember that even if your baby has any of the known risk factors that increase his or her chance of SIDS, there are steps you can take to help your baby stay safe.

Symptoms

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There are no noticeable symptoms or proven warning signs for SIDS. Most babies who die from SIDS seemed healthy before going to sleep. There are rarely any signs of a struggle, and babies are often found in the same position in which they were placed in their crib.

Some babies who died from SIDS previously experienced abnormally long pauses in breathing (longer than 20 seconds). Signs of breathing problems might include the baby turning a bluish or pale color, choking or gagging, and having a limp body.

If your child experiences any of these symptoms, you may want to use an apnea monitor to detect interrupted breathing; however, these monitors have not been proven to prevent SIDS.

Diagnosis

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There are currently no examinations or tests to predict whether a baby will develop SIDS.

If we suspect that a baby died from SIDS, a thorough investigation must be conducted. As a part of this investigation, the medical histories of the parents and baby are taken, an autopsy is performed, and there is a careful examination of where the baby passed away. In an infant under the age of 1 year, SIDS is named as the cause of death only when no other cause can be identified.

Prevention

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Since there are no symptoms, exams, or treatment for SIDS, we must emphasize prevention. Prevention of SIDS focuses on reducing known risk factors.

During pregnancy
It is important to get routine prenatal care throughout your pregnancy to improve the overall health of you and your baby. Eating a healthy, balanced diet can help prevent having a low-birth-weight baby. Avoid smoking, drinking alcohol, and using illegal drugs and other toxic substances to reduce your baby's chance of having SIDS.

During infancy
After your baby is born, take the following precautions to avoid SIDS:

Do not smoke, especially around your baby. Second-hand smoke increases the chance of SIDS. Do not smoke or let anyone else smoke around your baby. Even when someone does not smoke in the same room as your baby, your baby can be exposed to the toxins from the smoke that lingers on clothes and skin.

Place your baby on his or her back to sleep. You may reduce your baby's risk for SIDS by 15 percent to 20 percent simply by placing the child on its back when sleeping or napping. A baby may not breathe well when sleeping on its stomach and may also easily roll over when sleeping on its side onto its stomach.

When your baby is old enough to roll over from his or her back to the belly, you do not need to keep shifting your baby onto its back throughout the night. Just continue to place your baby on its back when first putting him or her to bed.

Sleep in the same room with your baby but not in the same bed. The American Academy of Pediatrics recommends that you have your baby sleep next to you in a bassinet, co-sleeper, or crib to reduce the risk of SIDS. Sharing a bed with your baby may potentially be dangerous because soft bedding can suffocate your baby or your baby can roll off of the bed. It is especially important not to share the same bed with your baby if you (or your partner) smokes or uses alcohol or other substances that might make you sleep more deeply than usual.

Use a safe crib and bedding. Do not use a drop-side crib. A baby may suffocate in the "V" between the mattress and a drop-side that has slid down or is detached.

Current crib safety standards state that the slats should be no more than 2⅜ inches apart. This will prevent your baby's head from getting stuck in between the slats. Remove corner post extensions and knobs. Ensure that all bolts, nuts, and screws are periodically tightened. The paint should be lead-free. Newer cribs meet these safety standards, but used and older cribs may not. Be sure to occasionally check recall lists to see if your child's crib has been recalled.

Make sure that the mattress in the crib or bassinet is firm, with just a fitted sheet. Pillows, thick bumpers, comforters, and other soft materials like stuffed animals are not recommended in the crib because a baby can suffocate on them. Babies should never sleep on waterbeds, couches, chairs, sheepskin, pillows, or other soft surfaces.

If a sheet or blanket is needed for warmth, tuck the ends into the bottom of the crib. Your baby should have his or her feet touching the end of crib where the blanket is tucked in, and the blanket should not reach higher than the chest (see illustration). Another option for warmth is to have your child sleep in a sleep sack or a warm sleeper.

Avoid using a sleep positioner. Once thought to prevent SIDS, sleep positioners are now known to potentially increase the risk of suffocation by trapping the infant between the positioner and the crib frame or bassinet. They can also allow the infant to flip from sleeping on its side to its stomach.

Avoid overheating the room where your baby sleeps. Keep the room where your baby sleeps warm enough so that he or she can sleep without covers but do not make the room too warm (around 65°F is a good temperature). Do not overheat the baby by using extra clothes and blankets, especially in the winter.

Have good ventilation in the room where your baby sleeps. Babies who sleep in rooms with fans or open windows may have a lower risk of SIDS. The theory is that this helps to promote better air circulation in the room so there is less of chance of carbon dioxide buildup in the bassinet or crib. Fans may also reduce the risk of overheating the room.

Give a pacifier at nap time and bedtime. There is a lower chance of SIDS in babies who use pacifiers. If you are breastfeeding, it is best to wait until your baby is about 1 month old so that the pacifier does not potentially confuse your baby when establishing breastfeeding. Do not worry about putting the pacifier back in your baby's mouth if it falls out during sleep. You also do not need to force your baby to use the pacifier. A few guidelines for safer pacifier use are:

• Do not use a homemade pacifier or a nipple from a bottle, which can cause your baby to choke.
• Do not tie pacifiers to a string, since the string can get wrapped around the baby's head or neck.
• Do not dip the pacifier in anything sweet, especially honey. Infants should not consume honey until they are over 1 year of age.
  
• Be sure to clean and check the pacifier often.

Talk to your child's caregiver(s). Up to 20 percent of SIDS deaths occur in childcare settings. Talk with your child's caregivers about the steps they take to reduce the chance of SIDS and explain in detail anything you would like them to do to watch out for the safety of your baby. Do not assume they know how to prevent SIDS. Also, make sure that grandparents or other older caregivers understand the newer SIDS prevention guidelines, which may have changed since they raised children. (In the past, parents were told to put babies to sleep on their stomachs, but now we know that it is safest to put babies to sleep on their backs.)

Be cautious about products claiming to reduce SIDS. Products that keep babies on their backs or their side have not been proven to reduce SIDS. Other products, such as breathing monitors, also have not been shown to help. The American Academy of Pediatrics does not advise the use of any product to prevent SIDS. If you have questions about a product, call the clinic or let us know at your baby's next appointment.

Keep your baby's well-check appointments at the clinic. Be sure to bring your baby to all routine appointments. Let us know about steps you are taking to reduce the chance of SIDS and be sure to ask us about any concerns or questions that you might have. 

Dealing with a Loss

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Unfortunately, we cannot predict a baby's death from SIDS, nor can we resuscitate a baby with SIDS. Even when a parent follows all of the recommendations to prevent SIDS, it may still happen. 

Losing a baby to SIDS is an enormously painful experience. Each family member may deal with this loss in a different way, which may put a strain on marriages and relationships. Struggling with feelings of guilt is common. 

It is important to obtain support during this traumatic time from family, friends, and counselors. Many people find that it is useful to seek help from trained professionals and support groups. 

All Kaiser Permanente medical offices have counselors who specialize in grief. Please don't hesitate to ask for the support you need. We are here to help.