Reducing the risk of SIDS

It's not known why some babies die suddenly and for no apparent reason from sudden infant death syndrome (SIDS)  or cot death.¹

In Australia there were 61² deaths in 2013, for which SIDS was recorded as the cause of death.

While the exact cause of SIDS is unknown it's thought to be the result of a combination of factors.

Experts believe SIDS occurs at a particular stage in a baby’s development, and that it affects babies who are vulnerable to certain environmental stresses.

This vulnerability may be caused by being born prematurely or having a low birthweight, or because of other reasons not yet identified. 

Environmental stresses could include tobacco smoke, getting tangled in bedding, a minor illness or a breathing obstruction. There's also an association between co-sleeping (sleeping with your baby on a bed, sofa or chair) and SIDS.

Babies who die of SIDS are thought to have problems in the way they respond to these stresses and how they regulate their heart rate, breathing and temperature.

Although the cause of SIDS isn't fully understood, there are a number of things you can do to reduce the risk. SIDS is rare, so don't let worrying about it stop you enjoying your baby's first few months. Follow the advice below to reduce the risks as much as possible.

How to reduce the risk of SIDS

• Place your baby on their back to sleep, in a cot in the same room as you for the first six months. 
• Don't smoke during pregnancy or breastfeeding and don't let anyone smoke in the same room as your baby. 
• Don't share a bed with your baby if you've been drinking alcohol, if you take drugs or you're a smoker. 
• Never sleep with your baby on a sofa or armchair. 
• Don't let your baby get too hot or cold. 
• Keep your baby's head uncovered. Their blanket should be tucked in no higher than their shoulders. 
• Place your baby in the "feet to foot" position (with their feet at the end of the cot or Moses basket). 

Place your baby on their back to sleep

Place your baby on their back to sleep from the very beginning, for both day and night sleeps. This will reduce the risk of cot death. 
It's not as safe for babies to sleep on their side or tummy as on their back. 
Once your baby is old enough to roll over, there's no need to worry if they turn on to their tummy or side while sleeping.

The risks of co-sleeping

The safest place for your baby to sleep for the first six months is in a cot in the same room as you. It's especially important not to share a bed with your baby if you or your partner:

• are smokers (no matter where or when you smoke and even if you never smoke in bed) 
• have recently drunk alcohol 
• have taken medication or drugs that make you sleep more heavily 

The risks of co-sleeping are also increased if your baby:

• was premature (born before 37 weeks), or 
• had a low birth weight (less than 2.5kg or 5.5lb) 

As well as a higher risk of SIDS, there's also a risk you might roll over in your sleep and suffocate your baby. Or your baby could get caught between the wall and the bed, or roll out of an adult bed and be injured.

Never sleep with a baby on a sofa or armchair

It's lovely to have your baby with you for a cuddle or a feed, but sleeping with your baby on a sofa or armchair is linked to a higher risk of SIDS. It's safest to put your baby back in their cot before you go to sleep.

Don't let anyone smoke in the same room as your baby

Babies exposed to cigarette smoke before and after birth are at an increased risk of SIDS. Don't let anyone smoke in the house, including visitors. 

Ask anyone who needs to smoke to go outside. Don't take your baby into smoky places. If you're a smoker, sharing a bed with your baby increases the risk of cot death.

Find help and support if you'd like to quit smoking.

Don't let your baby get too hot or too cold

Overheating can increase the risk of SIDS. Babies can overheat because of too much bedding or clothing, or because the room is too hot. 

• When you check your baby, make sure they're not too hot. If your baby is sweating or their tummy feels hot to the touch, take off some of the bedding. Don't worry if their hands or feet feel cool – this is normal. 
• It's easier to adjust for the temperature by using layers of lightweight blankets. Remember, a folded blanket counts as two blankets. Lightweight, well-fitting baby sleeping bags are a good choice, too.   
• Babies don't need hot rooms. All-night heating is rarely necessary. Keep the room at a temperature that's comfortable for you at night – about 18^c is ideal. 
• If it's very warm, your baby may not need any bedclothes other than a sheet. 
• Even in winter, most babies who are unwell or feverish don't need extra clothes. 
• Babies should never sleep with a hot water bottle or electric blanket, next to a radiator, heater or fire, or in direct sunshine. 
• Babies lose excess heat through their heads, so make sure their heads can't be covered by bedclothes while they're asleep. 
• Remove hats and extra clothing as soon as you come indoors or enter a warm car, bus or train, even if it means waking your baby. 

Don't let your baby's head become covered

Babies whose heads are covered with bedding are at an increased risk of SIDS. To prevent your baby wriggling down under the covers, place them in the "feet to foot" position. This means their feet are at the end of the crib, cot or Moses basket.

How to put your baby in the 'feet to foot' position

• Tuck the covers in securely under your baby's arms so they can't slip over their head. Use one or more layers of lightweight blankets. 
• Use a baby mattress that's firm, flat, well-fitting and clean, and waterproof on the outside. Cover the mattress with a single sheet. 
• Don't use duvets, quilts, baby nests, wedges, bedding rolls or pillows. 

Feeding, dummies and SIDS

Breastfeeding your baby reduces the risk of SIDS. 

It's possible using a dummy at the start of a sleep also reduces the risk of SIDS. However, the evidence is not strong and not all experts agree that dummies should be promoted. 

If you do use a dummy, don't start until breastfeeding is well established. This is usually when they're around one month old. Stop giving them the dummy when they're between 6 and 12 months old.

If your baby is unwell, seek medical help promptly

Babies often have minor illnesses, which you don't need to worry about. Give your baby plenty of fluids to drink and don't let them get too hot. If your baby sleeps a lot, wake them up regularly for a drink.

It can be difficult to judge whether an illness is more serious and needs urgent medical attention. 

1 Contains public sector information licensed under the Open Government Licence v3.0.

2 3303.0 - Causes of Death, Australia, 2015