Question
What are risk factors for Sudden Unexplained Infant Deaths (SUID)?
Answer
There are many risk factors for SIDS.
- Prematurity and/or low birth rate
- Maternal smoking during pregnancy
- Second-hand smoke
- Sleeping space other than a crib
- Sharing a bed with others
- Quality of supervision at time of death
- Obesity, fatigue, or drug/alcohol use by person supervising or sleeping with child
- Infants sleeping on their stomachs
- Soft sleep surfaces
- Loose bedding, toys, or other objects in crib
- Faulty design of crib or beds
- Overheating
If the baby is born premature or is born with a low birth rate then that baby is at higher risk for SUID. If the mother smokes during pregnancy or is around secondhand smoke then that is a great risk factor. Smoking during pregnancy or exposure to smoke during pregnancy can often cause a baby to be born at a low birth rate. If you are doing home visits or have a prenatal program such as an Early Headstart where you are working with pregnant mothers, talk to them about that. If they are smoking or if their spouse or significant other or anybody in the family or the household is smoking, encourage them to not do that because it is putting that unborn baby at risk.
Using a sleeping space other than a crib is a risk factor. Very often people will put the babies to sleep on a bed or a couch or something soft and that is highly dangerous. If the infant is sharing a bed with other children or with other adults, that is a risk factor. That is where it often becomes what they call a rollover death. If the infant is in the bed and the adult goes to sleep and suddenly rolls over, they might not feel the baby. This is sometimes categorized as SIDS when they do the death report.
The quality of supervision at the time of death is a risk factor. Related is obesity, fatigue, or drug and alcohol use by a person who is supervising or sleeping with the child. Regarding obesity, if you are a large person and you roll over on a tiny little infant you will not know it. Even in the childcare environment, if the person who is charged with watching the babies while they sleep is exhausted herself, that can be a risk factor. You might just say, oh, I am going to close my eyes just for a second, but you cannot do that. Or if the person is under the influence of drugs or alcohol, then their decision-making skills are not going to be top-notch, so that is a risk factor for SIDS.
Another risk factor is infants sleeping on their stomachs. In 1994 the Back to Sleep campaign was started, which encouraged putting infants to sleep on their back. Most people do that now. You still have some people who believe that the infant will throw up or something else might happen if you put the child to sleep on their back, but that is simply not true. Unless there is a medical reason the infant should not sleep on their backs, they should be put to sleep on their backs. One of the greatest risk factors is if the parent is putting the infant asleep on their back at home, then they bring them to child care and if the caregiver puts that infant to sleep on its stomach, then it just intensifies the risk. Always put the infants to sleep on their back.
Soft sleep surfaces are also a risk factor, whether it is a chair, a couch, or an adult bed, especially a feather bed or water bed. Beanbag chairs would be one of the worst places you could have a baby to sleep. Loose bedding or toys or other objects in the crib are other risk factors. If the sheet on the bed is not tight-fitting and comes up on the corner, then the baby, as he is moving around, can get that bedding around him which can cause suffocation. Toys, pillows, and bumper do not belong in the infant's crib.
Faulty design of the crib or the beds, which could include loose hardware or cutouts, can allow the baby to get his head caught. It is dangerous. Another one that people do not think of is overheating. I do not know why people think that babies get cold but they are just like we are. With the baby, if he is just sleeping in footed pajamas and he is all covered up, he is all cozy and comfortable. You do not need to put blankets on him or three layers of clothing or anything else. That is even true when you have them out for a walk or you are going in the store or anything like that.
This Ask the Expert is an edited excerpt from the course, Safe and Healthy Sleep for Infants and Young Children, in partnership with Region 9 Head Start Association, presented by Charlotte Hendricks, PhD.
