When can I stop worrying about SIDS?

As a parent, you’re going to worry. You’ll worry about concrete things like whether your baby has gotten enough to eat or if your toddler is warm enough without a jacket. You’ll worry about abstract things like if your child is happy or whether they’ll always “do the right thing.” And you’re going to worry about sleep. Especially when they are a newborn, you’re going to worry about sleep. It’s kind of ironic but some the biggest worries during the newborn stage are likely to occur when your baby isn’t crying and is actually sleeping peacefully.

Meet our expert Jamie Engelman Certified Pediatric Sleep Consultant, Founder of Oh Baby Consulting

Sudden Infant Death Syndrome (SIDS) is a terrifying reality that impacts over a thousand American families per year. While SIDS is the leading cause of death in babies under 1 year of age, most SIDS deaths (90%) occur in babies under 6 months of age.

Will I always have to worry about SIDS?

SIDS only occurs in babies 12 months or younger. But that doesn’t mean it’s time to throw safe sleep practices to the curb after your baby’s first birthday. There are many things parents can do to help prevent SIDS both during the highest-risk period and beyond.

Before your baby turns 1, you can reduce the risk of SIDS by:

1. Room sharing for the first 4-6 months

The AAP currently recommends room-sharing for the first 6 months as a preventative measure for SIDS. When your baby has their own sleep space but is also close by, you can quickly and easily attend to their nighttime needs and may not be as tempted to bring them into your bed in the middle of the night. However, new research has come out indicating that while the risk for SIDS decreases significantly at 4 months, the rate of unsafe sleep practices and less nighttime sleep when room-sharing past 4 months actually increases.

2. Placing your baby on their back to sleep

Back when we were infants, we likely were placed on our stomachs to sleep and your mom or grandmother may even encourage you to put your baby down in this position. But in 1994, the American Academy of Pediatrics launched their “Back to Sleep” campaign after research found that if infants were placed on their stomachs, their risk of dying from SIDS increased two-fold.

After 6-months old, babies are typically able to lift their heads, roll over, or wake up more easily, and the risk of SIDS decreases dramatically.
However, 10% of SIDS happens between 6 and 12 months of age and safe sleep recommendations should be followed up to a baby first birthday. By the time a baby turns 12 months old, the risk of sudden death is negligible.

When babies are placed on their tummies, there is more risk for their airways to be blocked if they wind up face-down in the mattress. With very immature motor function and weak head, neck, and trunk muscles, it is difficult for young infants to turn their head and clear their airway. That’s why I hold firmly to the motto, “Back to sleep…tummy to play!”

3. Ensuring a firm, flat sleep surface

Infants should be placed on a firm, flat sleep surface covered only by a tightly fitted sheet. I know it can seem boring and even uncomfortable to envision your new little bundle sleeping in a bare crib on a rigid mattress, but softer materials (like memory foam) can result in indents or small pockets that can increase the risk of a phenomenon known as carbon dioxide re-breathing. As your baby breathes in oxygen, they breathe out carbon dioxide. If their face is too close to a small pocket (or even another piece of fabric), that little space can begin to fill with exhaled carbon dioxide instead of oxygen.

4. Not using loose bedding, soft object, or crib bumpers

Everyone loves adorning a baby’s nursery with adorable décor, and cribs are no exception. But please make sure that when it comes time to place your baby into it for sleep, there is nothing else in there with them. With fluffy bedding, blankets, bumpers, and even plush toys, the risk for entrapment, obstructed airways, and suffocation rises greatly.

5. Avoiding the use of commercial devices inconsistent with safe sleep recommendations

As you know, the safest place for babies to sleep is on a firm, flat mattress in an approved crib, bassinet, or play yard. These spaces have gone through the rigorous testing needed to be deemed safe for unsupervised sleep. It can be tempting to want to rely on loungers, positioners, swings, wedges, or co-sleeping to keep your baby snoozing just a bit longer, but these devices and apparatuses are not designed with infant sleep-safety in mind and should only be used during supervised awake periods.

If your baby sleeps best when snugly confined (as most newborns do) consider using the gently weighted Zen Swaddle. When used safely and correctly (an easy feat with the Zen Swaddle), swaddling is a very effective tool for promoting longer periods of sleep in newborns.

6. Asking for sleep help

When you’re in the throes of exhaustion, it can be very easy to rely on any variety of the devices and apparatuses that promise to help your baby sleep well. It’s tempting to bring your baby into bed with you at 3 a.m. when they just won’t fall asleep after a feeding or strap them into a swing because you know it can buy you an extra hour or two before they wake up again. Unfortunately, you now know that these are not safe sleep practices, and as parents we have enough to worry about to spend time fretting about our babies’ safety when they’re sleeping. It is possible for your child to sleep well and safely and sleep coaches (like me) help families do this every day. You are not alone.

After your baby turns 1 years old, continue to: 

1. Place them on their backs to sleep

“Back is best” still applies. When your baby eventually rolls from back to tummy on their own (usually around 4-5 months), many pediatricians and sleep experts agree that it is okay to leave them in this position to sleep as long as they are no longer swaddled (please check with your own pediatrician).

2. Stick to firm sleep surfaces

Ensuring that your baby is sleeping on a flat, firm mattress will keep them safe in any sleeping position—whether their tummy sleepers, side sleepers, or always rolling around. You should also continue to avoid sleeping in swings, loungers, etc.

3. Keep the crib clear

The AAP recommends that cribs stay bare for at least the 12 months of life (and many experts recommend beyond). If you’re concerned about your baby being cold while sleeping, consider using the Zen Sack as an alternative to lose blankets.

Other SIDS Resources

American Academy of Pediatrics: SIDS and Other Sleep-Related Infant Deaths

Zerotothree.Org: How to Prevent SIDS

Healthychildren.Org: Can SIDS Be Prevented?

Centers for Disease Control and Prevention: SIDS and Vaccines

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• How to Get Your Newborn to Sleep

• When Do Babies Sleep Through the Night? And What Might Be Preventing It?
  

• Ask the Experts: Co-sleeping