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Sudden Unexpected Deaths in Infancy (including SIDS)

SIDS; sudden; infant; death; syndrome; tummy; sleeping; overheating; cigarette; safe; safety; smoke; breastfeeding; immunisation; medicines; breathing; clothing; rug; sweating; cotton; doona; quilt; bumpers; pillows; electric; blanket; bedclothes; mattress; waterbed; beanbag; smoking; tobacco; sleepingbag; bag; dummy; dummies; pacifier; sofa; lounge; chair; unexplained; SUDI; infancy; plagiocephaly; head; shape; lamb; wool; sheep; skin; hat; beanie; hood;

Contents

Many parents worry a lot about the chance that their baby might die from SIDS (Sudden Infant Death Syndrome). SIDS means that babies die suddenly, without warning, while they are asleep and where no cause can be found.

  • SIDS is now very rare. In South Australia in 2009 only 2 babies died from SIDS out of around 20,000 births. SIDS is no longer the most common cause of deaths of babies between 1 month and 12 months.
  • Between 1989 and 2009, deaths from SIDS in Australia declined by 85%, 78 in 2009. The decline is strongly linked to a public health campaign which promoted the importance of safe sleeping practices (such as placing babies to sleep on their back).

However Sudden Unexpected Deaths in Infancy (SUDI) have not decreased recently. These include sudden unexpected deaths from medical problems (illnesses or conditions that a baby may have been born with) and injuries. But the most common causes of SUDI are fatal sleep accidents. Fatal sleep accidents have not decreased in recent years. 

Much of the information in this topic comes from the SIDS and Kids publication 'Sudden Unexpected Deaths in Infancy (SUDI) - Frequently asked questions'

What you can do

  • Put baby down on the back to sleep from birth. 
  • Sleep baby with head and face uncovered
  • Avoid exposing babies to cigarette smoke before birth and after.
  • Sleep baby in a safe cot and in a safe environment.
  • Sleep baby in its own cot or bassinette in the same room as the parents for the first 6 - 12 months.

What not to do

The things which make it more likely a baby will die from a sudden unexpected death (SIDS or a fatal sleep accident) are:

  • sleeping a baby on the tummy or side
  • sleeping a baby on a soft surface, eg a soft mattress, pillow, bean bag or water bed
  • sharing a bed with a parent or other person
  • sleeping a baby on a sofa (with or without a parent)
  • loose bedding and puffy bedding
  • sleeping baby with face or head covered
  • exposing babies to tobacco smoke before birth or after
  • sleeping a baby in an unsafe cot or in an unsafe environment.

Sleeping on the back from birth

Sleeping on the back is safest for babies.

  • Putting babies to sleep on their back has been the most important reason why the number of babies dying suddenly and unexpectedly has gone down dramatically all around the world.
  • The chance of babies dying is higher if they sleep on their tummies or sides.
    • Many babies who are put on their sides for sleep roll over onto their tummies while they are asleep. Putting a baby to sleep on her side is not always safe.
  • Healthy babies placed to sleep on the back are less likely to choke on vomit than babies sleeping on their tummies. Sleeping a baby on its back protects its airway.
  • Some babies with rare medical problems might have to sleep on their side or tummy, but only do this if your baby's doctor advises you to do so in writing. 
  • Older babies will move around the cot and roll over. Settle them to sleep on their back, but let them find the position they feel most comfortable in for sleep. Remember that older babies still need a safe cot and safe sleep environment.

Being on the tummy while awake

  • It is quite safe to put a baby down on his tummy on a firm surface (eg. on a blanket on the floor) while he is awake. This helps babies to learn how to lift their heads, use their arms and explore the world.
  • Make sure that there is an adult with the baby all the time while he is on his tummy.
  • Always turn babies onto their back if they fall asleep.

Sleeping with your baby

 Sharing a sleep surface (such as the parents' bed or a sofa) with a baby has lead to the death of some babies.

It is recommended that babies sleep in a cot in the same room as their parents for the first 6 to 12 months of life, as this has been shown to lower the risk of SIDS.

There appears to be no increased risk of SIDS or fatal sleep accidents when a baby shares a sleep surface during feeding, cuddling and playing providing the baby is returned to a cot or a safe sleeping surface before the parent goes to sleep.

The risk is higher if parents smoke, have drunk alcohol or used drugs which cause them to sleep more heavily.

There is more about this in the SIDS and Kids Information Statement 'Sleeping with a baby' 
http://www.sidsandkids.org/wp-content/uploads/Sleeping-with-Baby.pdf

Keep your baby's face and head uncovered when sleeping

Make sure that your baby's face and head are not covered when she is asleep.

  • The best way to do this is to use a baby sleeping bag which is made so that the baby cannot slip inside the bag and become completely covered.
    • The sleeping bag should have fitted neck and arm holes and should not have a hood.
    • Make sure that your baby has enough clothes on under the sleeping bag so that you do not need to use any other bedding (no sheets or blankets).
  • If you use blankets, make up the cot so that your baby's head cannot slide under the bedclothes. A good way of doing this is by making up the cot so that your baby's feet are at the end of the cot.
  • If she does manage to wriggle under the bedclothes, and you do not have a baby sleeping bag, you could try dressing her in warm clothing and putting her down without a rug or sheet.
  • If your baby is wearing a beanie or other hat outdoors, remove it when you go indoors, or into a warm car, bus or train, even if this means that your baby may wake.
  • Babies can be firmly wrapped for sleeping. See the topic Wrapping babies

What is unsafe

  • Do not use a loose cover such as a doona (quilt).
  • Keep fluffy toys, pillows, sheep skins and cot bumpers out of the cot when your baby is asleep. Babies do not need pillows to sleep comfortably.
  • Keep pets such as cats out of your baby's cot.

Tobacco smoke

Avoid exposing a baby to tobacco smoke before birth and after.

  • Babies who are exposed to the toxins in tobacco smoke during pregnancy or after birth are more likely to die of SIDS, and the risk increases if a baby sleeps in the same bed as a parent who is a smoker. These risks remain even if parents smoke outside, away from their baby.
  • To reduce the risk of SIDS don't let anyone smoke near your baby - not in the house, the car or anywhere else that your baby spends time. (It is now illegal in South Australia to smoke in a car if there are children in the car.)
  • In South Australia the Quitline is 13 18 48.
  • Remember - tobacco smoke goes on causing health problems for older children too.

A safe cot and a safe environment

Cots, bassinettes, prams, etc and environments that are unsafe increase the risk of sudden unexpected infant death. For example:

  • A baby's face might get caught between a mattress that does not fit and the side of a cot.
  • A baby's head or limb might get trapped between bars that are too far apart or too close.
  • Knobs or exposed bolts may get hooked onto a baby's clothing around the neck.
  • A bassinette or a pram may tip.

Make sure that cots meet the Australian Standard for Cots (AS 2172).

For much more information about safe cots, bassinettes, prams, etc and sleep environments, have a look at the topics  Cots, Prams and strollers and Safe sleep for babies and toddlers.

Have your baby sleep in a cot next to your bed

  • Research done in New Zealand and the UK has shown that sleeping a baby in the same room, but not in the same bed, with parents for the first 6 to 12 months is protective.
  • This is thought to be because parents can see the baby and easily check to see that the baby is safe.
  • Sharing a room with other children is not protective, probably because children do not know if a baby is safe.
  • Recent evidence from the UK indicates that sharing the same room during a baby's daytime sleeps is also protective.

Dummies and SIDS

Research suggests that using a dummy (pacifier) may have a protective effect against SIDS. But the evidence about other ways of protecting a baby (eg sleeping on the back, with face uncovered, smoke free) is clear.

  • Breastfeeding: it is recommended that dummies only be used after the first 6 weeks for breastfed babies, as dummies may interfere with breastfeeding in those early weeks. Bottle fed babies could have a dummy earlier.
  • Ear infections: using a dummy may increase the risk of ear infections.

Parents will need to work out for themselves whether their baby uses a dummy. SIDS and Kids does not make any recommendations about dummy use at the moment.

  •  It is unclear why use of a dummy might be protective. It seems that dummies are most protective when babies sleep on their tummies, however it is much more important to have babies sleeping on their back.
  • It seems that the time to use a dummy is when the baby is going to sleep. If the baby spits it out during sleep, there does not seem to be any value in putting it back. It is not at all clear why this is so.

See Sids and Kids 'Pacifier/dummy use' for more information.

Head shape

  • If babies always sleep in the same position, the back of their head may become flattened (called 'plagiocephaly').
    • This does not affect brain growth, and for most babies, the shape of the head becomes rounder as babies get older and move their heads around more during sleep.
  • To reduce this, settle babies to sleep on their backs, but turn their heads to the right for some sleeps and to the left for other sleeps, until they are old enough to move around and change their sleeping positions by themselves.
  • For more information, have a look at the topic Baby's head shape.
  • If you are concerned about the shape of your baby's head, ask your doctor to check it.

Breastfeeding

  • Breastfeeding is best for babies, but research has not shown that it helps protect babies from SIDS.

Immunisation

  • Immunisation does not increase the risk of SIDS.

Medicines

It has not been proven that medicines given to babies for colic, reflux or other health problems make it more likely a baby will die from SIDS.

  • However, many medicines are not recommended for young babies, in order to avoid any risk that the medicine could be a cause. Check what is written on the packaging.
  • Use only medicines that your doctor suggests for your baby and follow the directions on the bottle carefully.
  • Medicines to help baby sleep are not generally a good idea for babies under one year, unless a doctor advises you to use them.

Resources

South Australia

Australia

References

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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