SIDS and Sleep Safety Measures for Babies

Every mother strives to ensure the welfare of her child at any cost. But taking care of an infant is a tough job. Even the most normal mundane things might pose a grave danger to a sensitive new-born. One such safety issue is SIDS. Read on to discover facts about SIDS which may help avoid the known causes, and thus prevent it,

What is SIDS?

Sudden Infant Death Syndrome, as the name indicates, is the sudden, unanticipated death of an infant during sleep. SIDS in babies can occur in a normally healthy baby due to unexplained reasons. One of the possibilities associated with SIDS is the sudden defect in any portion of the brain that might lead to a breathing difficulty. There are external factors that can cause SIDS as well. This makes it necessary to double check the safety of infants while they are asleep.

Causes of SIDS In Babies:

A definite cause for SIDS continues to be a mystery. The good news is that in recent times, we have seen a significant drop in the number of instances where a baby dies from SIDS. This is mainly because of increase in the awareness of the condition and the widespread emphasis and incorporation of sleep safety in infants. However, SIDS continues to be a cause of death in infants as it mostly occurs due to a combination of issues that are hard to predict and isolate. Learning all you can about SIDS is sure to help avoid any risks.

One thing that we know for sure is that it is not just physiological factors that lead to SIDS but also external factors like sleep conditions that increase vulnerability.

1. Portions of the Brain are Still Immature

Normally, the brain is mature at the time of birth and can control basic involuntary functions. It develops further in the first few months after birth. In some babies, however, parts of the brain are still not fully formed when the baby is born. This is likely to occur in babies who are born premature or those that are born as a part of multiple births (i.e. in twins, triplets, etc.).

Very low birth weight is another risk factor. In such cases, chances are that the baby’s brain has little control over the autonomic nervous system. This means that the brain cannot regulate and take full control over the baby’s breathing. This puts the baby at risk during sleeping, and the arousal response of the baby is hampered. The natural tendency of the body to respond when some abnormality takes place in the body is a very important aspect, especially in infants.

For example, if the baby is having trouble breathing because of the position of the face against the baby’s bed, in a normal condition this would arouse the baby from sleep, and he would automatically move his head such that he can breathe normally again. But in babies with underdeveloped portions in the brain, this effect is sometimes not achieved. This could lead to SIDS.

2. Respiratory illness and infections

Some cases of cold and respiratory tract infection can lead to trouble in breathing. These issues increase when the baby is asleep.

3. Abnormal preventive reflex responses

For obvious reasons, the respiratory system of the body should not contain any excess fluid (it can lead to suffocation and sometimes death). Whenever fluid comes in contact with mucosal surface of the respiratory system, a preventive reflex is triggered, which causes the person to either swallow, or try and cough up the fluid out through the throat or nose. This is known as laryngeal reflex. These responses help clear out the fluid from the airway that could cause trouble in breathing. If the baby is born with certain parts of the brain still underdeveloped, these responses might not be triggered. This can lead to sleep apnea and in the worst case, SIDS.

4. Excess heat

Babies sleep well in warm conditions. But if it gets too warm, the baby’s body might not be able to handle it. Hyperthermia or overheating can occur mainly due to wrong choice of clothes. Too many clothes might increase the body temperature of the baby and increase the risk of SIDS. Higher temperatures would result in elevated metabolism levels and this, in turn, can lead to poor control over breathing.

5. Wrong sleeping position

Have you heard people reiterate the fact that infants should be made to sleep on their backs? When a baby sleeps on his tummy, it has a detrimental effect on his normal breathing. It also increases the chances of his face pressing against the mattress and thus blocking the normal breathing. When the baby is made to lie on his side, chances of him rolling on to his tummy increase. So, always lay the baby on his back to reduce these risks. This especially needs to be done for those babies who still do not know to roll from on their tummy to onto their back and vice versa.

To summarise, allowing the baby enough room to avoid a rise in temperatures, dressing aptly for the weather, and putting the baby to sleep on his back can help reduce the risks of SIDS greatly.

Which Babies are at a Higher Risk for SIDS?

• Male babies have been observed to be more at risk of SIDS than female babies of the same age, though no clear reason has been identified for this.
• This is a condition that has been most commonly seen to occur in infants. Most of the cases have been observed in babies between 2-4 months of age. This is because younger children have less control over their movements and are susceptible to suffocation by bed-clothes etc.
• Another observation is that winters record higher number of SIDS related deaths than summers, largely because extra blankets and clothes are used to keep the baby warm.

• If the baby’s siblings or other babies in the family have died of SIDS, the baby would be considered slightly more vulnerable. So, extra precaution needs to be taken.
• Babies born ahead of schedule, several weeks before the due date, and with low birth weight would be at higher risk as they may be underdeveloped.
• If there is a smoker in the house, exposure to cigarette smoke can make the baby more prone to SIDS as the baby will be exposed to passive smoking.
• Babies born to very young mothers, especially those below 20 years, are at higher risk. While there is no reason identified for this, it may be owing to the lack of maturity in the mother and her inability to care for a baby.
• Unhealthy mothers with very little to no prenatal care, unhealthy lifestyle choices, consumption of alcohol and drugs, can result in mothers giving birth to babies who are more at risk of SIDS than other normal babies.

Signs of Sudden Infant Death Syndrome in Newborns

SIDS is a condition that tends to occur suddenly. The baby doesn’t even cry during the process. This means that you might not be warned by any alarming signs and symptoms. Thus, it is even more difficult to know when SIDS occurs and what action you can take to prevent it. In general, if your baby often has trouble breathing, or if your baby has a very bad gag reflex and spits up a lot after every feed, it would be wise to get a doctor’s opinion. This would rule out any underlying health condition that can increase the risk of SIDS. Some babies might contract a respiratory illness a few days before SIDS. But in most cases, the baby is reported to have been healthy and active when awake.

How to Reduce Baby’s Risk of SIDS and Other Sleep-Related Dangers?

Though the causes remain difficult to comprehend we can indeed reduce SIDS in babies by trying and avoiding all the associated risk factors.

1. Correct sleeping posture

Start with correcting the baby’s sleep posture. The American Academy of Pediatrics along with the National Child Care and health organisations came up with the Back to Sleep campaign in the year 2003. This was mainly to emphasise the importance of putting the baby on their back to sleep. This was a campaign designed to increase talk about SIDS and to educate parents about infant sleep safety.

Be it a day time nap or a slumber at night, sleeping on the back, also known as the supine position is the safest posture for your infant. Preterm babies who are still under neonatal care should also be placed in this posture as they tend to be at higher risk of SIDS.

2. Rectify the bedding and other sleep conditions

Most sleep related issues occur mainly due to wrong sleep environments offered to the baby. Making yourself aware of child sleep safety recommendations would be the first step to reducing the risks of SIDS and sleep related dangers.

Educate yourself by learning from example. There are numerous tragic stories of SIDS that come as warning tales to parents worldwide. These help parents understand how even the tiniest detail in the baby’s sleep safety plays a crucial role.

How to Keep Your Sleeping Baby Safe

So how exactly do you make sure that your baby is safe when he is sleeping? Even if you stay up all night looking at your baby it would be tough to tell when SIDS occurs as it shows no external signs. So here are some ways to make sure that the baby is safe when he is sleeping:

1. Keep baby in the same room

In the first year of birth, making your baby sleep in the same room where you sleep would be the safest option. You can choose a crib of your choice and place it near your bed at a position where you can monitor the baby if you must, at night. This is particularly important at least for the first 6 months.

2. Do not rely on baby monitors

You might feel that you can still monitor the baby when he is in his nursery with a baby monitor. Baby monitors are great, but you cannot rely on a baby monitor for SIDS prevention. These could be used for older babies once they enter their second year, but in the first year, the safest option is to place your baby’s crib in your room.

3. Do not rely on cardiorespiratory monitors

We know that SIDS mainly occurs due to obstruction in breathing. But this doesn’t mean that cardiorespiratory monitors, or breathing monitors in general, or even those marked SIDS baby monitors can be trusted. There is no proof to show that these can accurately warn the parent before SIDS.

4. Choose the right clothing

When you put your baby to sleep at night, clothe him aptly so that he feels warm and comfortable. Unless you stay in a cold region with extremely harsh winter, too many layers of clothing can lead to the baby feeling excessively hot. Breathable clothing that avoids suffocation, and has the right number of layers to shield the baby from the cold would be the right choice. Also, avoid clothes with a hood, drawstrings, etc. when your baby is sleeping in his crib. Do not allow your baby to sleep with his bib on.

5. Offer a pacifier

If your infant accepts a pacifier, then offer him one right when he is put to sleep. Avoid those that come with straps to be wrapped around the baby’s neck. A normal pacifier is observed to prevent the risks of SIDS to a good extent.

Recommendations for Infant Sleep Safety

The collective records of SIDS cases have helped American Academy of Pediatrics offer the best recommendation for sleep safety. This is continuously updated as new findings are recorded related to SIDS. Here’s a gist of the recommendations:

• Put the baby on his back to prevent SIDS baby rolling over in sleep.
• Avoid bedding that is too soft and plush.
• Keep your baby in the same room where you sleep.
• Prevent the exposure of the baby to smoke, drugs, and alcohol.
• Give the baby a pacifier.
• Do not skip the recommended vaccinations.
• Do not rely on home SIDS monitors.

What Moms Can Do to Protect a Baby From SIDS

SIDS is not too common, and reducing the risk factors can bring down the chances of SIDS a great deal. But as a mother, you would want nothing but the absolute safety of your child. Here are a few things you could do to avoid SIDS in babies:

1. Never leave the baby alone during tummy time

Tummy time is essential to help strengthen the baby’s muscles. But supervised tummy time is the key. The duration of tummy time should be set based on the baby’s age and depending on whether he likes being on his tummy. No matter how long he is on his tummy, you should be around to monitor him continuously. Also, make sure that he is on his tummy only when he is wide awake and active and not when he is tired and sleepy.

2. Consult a doctor whenever baby exhibits signs of cold or respiratory illnesses

Even a mild cold can get quite severe in infants in their vulnerable months. Do consult your baby’s paediatrician when the baby shows any signs of respiratory troubles.

3. Lifestyle changes

Avoid smoking when you are pregnant and even after delivery. Use of alcohol and other drugs can also cause trouble for the baby after birth, especially if you are breastfeeding. Do not allow anyone to smoke anywhere near the baby. Avoid allowing the baby to sleep near anyone who has consumed alcohol.

4. Breastfeeding and SIDS

It is a common observation that babies who are breastfed right from birth are more immune to SIDS. Skin-to-skin contact is critical in the first few months after birth. Exclusive breastfeeding for the baby in the first 6 months can enhance the health and immunity of the baby. This can also promote a better development of all parts of the brain in the premature babies.

Safe Sleep Environment for Babies

Some of the physical factors that lead to SIDS cannot be avoided, but the external factors, including an unsafe sleep environment, can be corrected. This can reduce the risks of SIDS a great deal. Here are some tips to ensure a safe sleeping environment for the babies in the first few months:

1. Choose the right crib

Pick a crib that meets all safety standards and requirements. It should be strong enough to hold the baby’s weight. When you choose a cradle, choose one that has a railing high enough to prevent falls during sleep. Age-appropriate cradles and cribs would be the best options.

2. Choose the right baby sleep mattress

The firmness of the mattress needs to be just right. Again, this needs to be chosen based on the baby’s weight. A mattress approved for safe use in cribs should be chosen, and the size should fit perfectly in the crib. Avoid choosing those that would leave gaps or would measure extra, creating wall folds at the ends of the crib. The mattress should be firm enough to hold its shape under the weight of the baby.

3. Avoid pillows, cushions, and blankets

For the first few months, it is best to avoid pillows and cushions in the crib especially when the baby is sleeping at night. Fancy pillows, soft toys and fuzzy blankets might all look great in a crib. But these are the items that pose the highest threat to the safety of the baby. They tend to press against the baby’s face or neck and block the passage of air, thus leading to obstruction in breathing. A simple mattress with a top sheet or a protective sheet is all that a crib needs especially in the first few months.

4. Cautiously swaddle your baby

Swaddling means wrapping your baby in a garment or cloth. Swaddling your baby is a great way to help him sleep better. But when you have swaddled you baby place him on his back in the crib. Also, make sure that all the ends are snugly tucked in.

5. Crib checklist

Here are some points to keep in mind when you set you infant’s crib:

• Crib bumper pads do more harm than good for infants – these are suffocation hazards.
• Crib specific mattresses should be selected. Preferably one that doesn’t sag and one that doesn’t leave gaps at the edges.
• Sturdy construction of the crib would make it safer. Something made of solid wood with durable posts and frame would be the safest.
• Steer clear of cribs that smell of paint or plastic ones that carry any strong synthetic smell.
• Choose a brand that is popular for adhering to baby safety standards; one that has no history of crib recalls.
• Keep cribs away from windows/blinds/blind cords. Blind cords are strangulation hazards.
• The crib shouldn’t be close to any electric outlets or power cords.
• If you have twins, choose the right sized cribs and place them securely against a wall to promote safer sleep and to prevent SIDS.

6. Avoid co-sleeping

Co-sleeping is said to increase the risk of SIDS to a large extent. Sharing the bed with the baby is a big NO especially if you smoke or have consumed alcohol or drugs.

7. Regulate the temperature of the room

Choose a well-ventilated room for your baby to rest and play in. Ensure that your heating system is working fine and set the temperature to warm while making sure that it doesn’t get too hot at night, especially if your thermostat is faulty. It should not get too cold either. The right ambient temperature plays a vital role in influencing the sleep quality of the infant.

A safe sleep environment thus requires a careful choice of crib, mattress, furnishing, and placement as well. Avoid putting your baby to sleep on the couch or a chair.

Quick Tips for Safer Sleep for Babies

• Remove top sheets and furnishings that come with ribbons
• Avoid mattress covers and furnishings that are fuzzy and made of fur. Choose a breathable soft material which is lint-free to ensure that the baby doesn’t breathe in any tiny particles that might cause breathing difficulties.
• Assure that the crib mobile is securely fastened and placed at a height where the baby can’t reach.
• Remove bottles and sippy-cups from the crib once the baby has finished feeding.
• Do not place the mattress directly next to a window or in a corner where there is direct sunlight.
• Do not let the baby sleep with a hat on.
• Feet-to-foot position, where the baby’s feet touch the foot of the crib, is the safest. This prevents the baby from squirming under the top sheet.

Once you keep in mind these factors, precautions and educate yourself about SIDS, you can rest a little easier knowing you have equipped yourself with the required knowledge over the issue. Do not hesitate to reach out to a doctor for advice because your baby’s health and well-being are of paramount importance.

Read this article in Arabic: متلازمة الوفاة الفجائية للرضّع