18. SIDS Prevention, and Why I Disagree with the AAP’s Policy on Room Sharing

Sudden infant death syndrome (SIDS) is a frequent cause of death for infants in the first year of life. Despite progress made under the “Back to Sleep” campaign that began in the mid-nineties, more than 2000 babies still die from SIDS annually in the United States. Fortunately, there are numerous steps parents can take to avoid these unthinkable tragedies.

1. Always place your baby on his/her back at naptime or bedtime; never allow a newborn to sleep on the side or stomach. At around four months of age (or even before this time), your baby may start rolling over on his own, meaning you can no longer control his sleep position. Parents often wonder whether they should readjust a sleeping baby’s position after he’s rolled over onto his stomach, but constantly repositioning a baby throughout the night is impractical. Luckily, the risk of SIDS is already declining by the time a baby is rolling over. Furthermore, babies who can get themselves into a prone position can usually get themselves out (rolling back to belly is generally harder than rolling belly to back).

2. Practicing “tummy time” from day one of life will help improve your baby’s core strength and rolling abilities. Over the course of the day (five minutes here, 10 minutes there), try to achieve one full hour of tummy time while your baby is awake.

3. Don’t cosleep with your baby. For cultural, nursing, and bonding reasons, some parents prefer to sleep in the same bed with their infants, which is understandable; but scientific evidence clearly shows that cosleeping increases the risk of SIDS. In fact, aside from sleeping in a prone position, cosleeping is the single most important risk factor for SIDS. In my own practice, I’ve lost healthy babies over the years due to parents inadvertently rolling onto and suffocating their children. These occurrences are both tragic and preventable.

Bedside sleepers are marketed as safe sleeping spaces for infants, but there is no safety data supporting their use. Similarly, devices like car seats (especially when unbuckled), strollers, and swings are not great places for babies to sleep because shifts in head position can lead to airway obstruction.

Falling asleep while holding a baby in a couch or armchair is a particularly dangerous situation. Babies in my practice have fractured their skulls after rolling out of hospital beds. Mothers who have just had C-sections or are drowsy from recent anesthesia should never be left alone holding infants.

4. Room sharing is a controversial topic. Currently, the AAP recommends room sharing (i.e. having a baby sleep in a bassinette or crib inside the parents’ room) until one year of age. Many pediatricians, including myself, think this is ridiculous. Like snoring husbands, newborns are noisy creatures. When they aren’t burping, sighing, cooing, or hiccupping, they’re breathing—and a newborn’s breathing can be noisy. Just ask any parent who is room sharing. Getting a baby into his own room early is one of the most important things a family can do to achieve a good night’s sleep. When is the ideal time to make this transition? The risk of SIDS is highest between two and four months of age, so I usually recommend transitioning at about four months. Full disclosure—with my own children, we stopped room sharing at about two weeks of age.

Because SIDS is generally a silent event, room sharing will not necessarily prevent a SIDS death from occurring.

5. Feel free to use pacifiers—they decrease the risk of SIDS. Sucking on a pacifier helps prevent babies from drifting into deeper sleep states in which cardiac arrhythmias are more likely to occur.

If your baby likes the pacifier, you will eventually need to wean it. When is the best time to wean a pacifier? When you find yourself running into the baby’s room all night long to reinsert the pacifier! At this point, the binky has become more of a hindrance than a sleep aid. What is the best way to wean a baby off pacifiers? Throw them out (the pacifiers, not the child), and never buy another one. Your baby may be angry for a few days, but she’ll soon rise to the occasion and adjust.

6. Don’t use bumpers—they can suffocate a baby. For similar reasons, avoid fluffy blankies, pillows, stuffed animals, etc. A shirt and footy pajamas are all you need for a snug night’s sleep. Some parents like to use sleep sacs, and these generally seem to be safe. If you must use a swaddle, be sure NOT to swaddle your baby with straight legs, as this can increase the risk of hip dysplasia. Also keep in mind that your baby will soon be rolling over. Like pacifiers, swaddling is a temporary sleep aid that will need to be discontinued.

7. Avoid overheating your baby. Keep the baby’s room around 72 degrees Fahrenheit. Dress your baby comfortably—not too hot, not too cold. Here is a good rule of thumb: count the number of layers you’re wearing, and dress the baby in one extra layer. For instance, if you’re wearing a T-shirt, dress your baby in a T-shirt, followed by a thin blanket. Placing a finger in the folds of a baby’s neck is a great way to check his temperature.

8. Don’t smoke, anytime, anywhere. Even outside, chemicals from cigarette smoke infiltrate clothing and potentially affect the health of your family members (i.e. third-hand exposure).

9. Don’t drink alcohol, especially if you’re nursing.

10. DO breast feed.