Crib death (SIDS): what is it and what can be done to prevent it?

Cot death or SIDS: what is it?

Sudden Infant Death Syndrome ( SIDS ) is the sudden death of a child under the age of 12 months due to unknown and unexplained causes , even after an autopsy. It usually occurs during sleep and affects apparently healthy children .

Although it is among the leading causes of death under one year of age, it is most common between 2 and 4 months of age and becomes rarer after 6 months .

How frequent is it in Italy?

Cot death is a rare condition. According to data from the Ministry of Health, the percentage of SIDS in Italy seems to have dropped from 1-1.5% to 0.5% , thanks to the greater attention paid to placing infants to sleep on their backs.

Cot death tends to affect more boys  (60%) than girls (40%) and appears to be more common in winter .

Preventing cot death: all the rules for safe sleep

In 2022 , the American Society of Pediatrics (AAP) updated guidelines to reduce the risk of SIDS. The prevention rules are divided into first, second and third level recommendations . Let’s see them together.

Top level recommendations

First of all, it is important to create a safe sleeping environment for the infant  and then:

• always put the baby to sleep in the supine position, i.e. on the back and not on the stomach ( even in the case of gastroesophageal reflux or colds);
• use a semi-firm mattress (into which the child’s head cannot sink if he rolls over on his side or on his stomach). Furthermore, the surface must be  flat and not inclined by more than 10 degrees . Greater inclinations allow the child to lift his head and turn into a lateral or prone position more easily, increasing the risk of suffocation;
• keep the child in the same room as the parents and close to them (cosleeping)  but in a separate bed, possibly for the first 6 months of life and ideally up to one year of age;
• avoid using soft objects on the surface where the baby sleeps (pillows, bumpers, soft toys or cuddly toys). Blankets and sheets should be tucked tightly under the mattress so that they cannot move over the child’s face or head. To protect the infant from the cold, it is best to add a layer of clothing or use a sleeping bag .
• do not use the cap indoors (except in the first hours of life or in newborn intensive care) to avoid the risk of overheating. For the same reason, it’s important to avoid covering your baby too much while sleeping .

Other factors that help reduce the risk are:

• breastfeed at least for the first 6 months (up to the year and even beyond, if mother and child so desire), especially in the case of preterm birth and low birth weight ;
• do not expose the baby to smoke, alcohol or drugs , both during pregnancy and after birth;
• carry out the recommended childhood vaccinations ;
• offer the pacifier at bedtime, after breastfeeding has been well established;
• do not use home cardiorespiratory monitors as a substitute for current recommendations;
• get the baby used to moments of play on the tummy (the so-called “tummy time”) starting from 7 weeks of life for increasing periods of time (up to 15-30 minutes a day) under parental supervision. This position favors the development of the child and prevents plagiocephaly , a deformation of the head that appears flattened due to too much time spent in the supine position.

Second level recommendations

The AAP advises against the use of commercial devices that are incompatible with safe sleep recommendations.

Third level recommendations

Swaddling the newborn is not an effective strategy to prevent SIDS. Also, when the baby makes its first attempts to roll over (generally between 3 and 4 months, although some babies can start earlier), the swaddling could increase the risk of suffocation and therefore should no longer be used.

SIDS: questions and answers

My baby rolls over in his sleep: what should I do?

Once the infant has learned to turn from supine to prone and vice versa, it can be left in the position it assumes during sleep. However, when placing him in his crib or cot, it is important to continue placing him on his stomach until one year of age and to ensure a risk-free sleeping environment.

My baby fell asleep in the baby carrier or on the sofa: is it dangerous?

In some situations, it may happen that the infant falls asleep on a surface that does not comply with the recommendations for safe sleep. In this case, the advice is not to leave it unsupervised  and to transfer it to a suitable surface as soon as possible .

What if he falls asleep in the bed while I’m breastfeeding him?

It would be best to move him to his bed after feeding . While  sharing a bedroom with parents is recommended, bed-sharing increases the risk of SIDS , especially if:

• one of the two parents is a smoker , has taken alcohol or psychoactive drugs ;
• the child is less than 4 months old ;
• the birth took place before the deadline ;
• the mattress is not semi-firm or there are quilts and other soft items .

For this reason, try not to fall asleep with him by your side, especially if you are on a risky surface (such as a sofa or an armchair) . If you are very tired and afraid of falling asleep, it is still preferable to breastfeed the baby in bed, freeing the surface from pillows, blankets and spaces at risk of entrapment (between the bed and the wall or between the mattress and the headboard), suffocation or falling.

My little one falls asleep with the pacifier, but loses it in his sleep. Do I have to put it back in his mouth?

No, it is not necessary to reintroduce the hickey once it is lost. Also, if the baby doesn’t want the pacifier he shouldn’t be forced to take it .