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Sudden Infant Death Syndrome

  • The recommendations apply to children up to 1 year old.
  • The supine sleep position is advised whenever the infant is put down for sleep, particularly for preterm infants. Preterm infants should be placed in the supine position for sleep as soon as is safely possible in the neonatal intensive care unit.
  • The supine position does not increase the risk of choking or aspiration among infants, even among those with gastroesophageal reflux.
  • Once the child can roll from supine to prone, the child can sleep in any position that he or she chooses.
  • The recommended sleeping surface is a firm mattress covered with a fitted sheet. Infants should sleep on these firm surfaces and should not be permitted to sleep on beds. Infants who fall asleep in sitting devices such as a car seat should be transferred to a crib, particularly when they are younger than 4 months.
  • The parent or provider should not attempt to fix broken parts of a crib, as these defects are associated with a higher risk for SIDS.
  • Soft materials should not be used in the sleep environment of infants, even if they are covered by a sheet.
  • Room-sharing without bed-sharing is recommended. This practice may reduce the risk for SIDS by as much as 50%. Devices promoted to make bed-sharing safe are not recommended.
  • Bed-sharing is particularly high risk when the infant is younger than 3 months, a parent is a smoker or may have an altered level of consciousness, or the sleeping surface is very soft.
  • There is no evidence that bumper pads reduce the risk for injury to young infants, and these devices are not recommended because of the potential for entrapment or strangulation.
  • Breast-feeding reduces the risk for SIDS and should be continued for at least the first 6 months of life.
  • Pacifiers appear to reduce the risk for SIDS, although the mechanism of this effect is unclear. The protective effect persists throughout the sleep period, even if the pacifier falls out of the infant's mouth. The pacifier does not need to be reinserted if it falls out, and the infant should not be forced to take the pacifier.
  • The pacifier should not be introduced until the pattern of breast-feeding is firmly established, at approximately 3 to 4 weeks. There is insufficient evidence that finger-sucking is protective against SIDS.
  • Although infants should not be over bundled, there is insufficient evidence to support the use of fans to prevent SIDS.
  • Routine immunizations may have a protective effect against SIDS.
  • Commercial devices, including cardiorespiratory monitors and positioning devices, promoted to prevent SIDS should be avoided.
  • Supervised tummy time is recommended on a daily basis to facilitate development, which may reduce the risk for SIDS.
  • Public education efforts need to continue to alert caregivers about ways to reduce the risk for SIDS. These efforts are most critical in communities in which SIDS is more common, including African American and American Indian/Alaskan Native communities.
Factors that can increase the risk of SIDS include:
Overheated, age (peak 2-4 months), male, black and indigenous groups, no pacifier at sleep onset, prematurity, prone or side sleep position, recent fever, exposure to tobacco smoke, soft bedding or sleep surface, face covered by bedding, sharing bed with family, sleeping in own room, colder season without central heating, maternal drugs (smoking, alcohol, illegal drug use (opiates)), inadequate prenatal care, low income, young mother, low education, single mom, increased parity, short birth interval, intrauterine hypoxia, fetal growth retardation



CMAJ 174(13):1862 june20,2006

American Academy of Pediatrics (AAP) 2011 National Conference and Exhibition. Presented October 17, 2011.

Pediatrics. Published online October 17, 2011. Policy Abstract, Report Abstract

Related Link

The American Academy of Pediatrics provides a downloadable A Parent's Guide to Safe Sleep that may be used for patient education.

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