Child Care Health Program
Sudden Infant Death Syndrome (SIDS) Risk Reduction

By Keri Wagenaar, MPH, Executive Director of the SIDS Foundation of Washington

Most child care providers would agree that having an infant in their care die of SIDS (Sudden Infant Death Syndrome) is one of the worst things they can imagine. The bad news is that SIDS remains the leading cause of death in infants from one month to one year of age. For every 1,000 babies born in Washington , one will die from SIDS. But there is good news also. Much research has been done on factors that increase a baby’s risk of dying of SIDS. We now know that following the latest risk reduction steps will dramatically decrease the likelihood that you will ever have to deal with a SIDS death. It is important to remember that following these steps will not prevent all SIDS deaths, because we still do not know the cause of SIDS. But the steps do significantly reduce the risk of SIDS, and they do save lives every day.

The most well-known SIDS risk reduction recommendation is “Back to Sleep.” Since 1994, when the American Academy of Pediatrics began recommending that babies sleep on their backs, the rate of SIDS in the United States has dropped by half. It is crucial that babies sleep on their back for every single nap or nighttime sleep. SIDS has happened in our state when parents or providers placed a baby on the tummy “just this once” thinking it would help the baby sleep better. Some parents may fear that their baby will choke if she sleeps on her back. Doctors used to think that could happen, but we now know that this is not the case. In fact, there have been no deaths due to choking since the Back to Sleep recommendation was made over ten years ago.

If you are already placing all infants in your care on their backs to sleep, that’s a wonderful first step in reducing their risk of SIDS. But it is not enough. There are other recommendations that need to be followed to keep babies alive. One important one is overheating. Babies are not as good as adults at regulating their body temperature and we know from investigations of SIDS deaths that getting too hot raises a baby’s chances of falling victim to SIDS. Make sure babies’ faces, heads and hands always remain uncovered. Do not place many layers of clothing and/or blankets on the baby, and do not allow the room where babies are sleeping to become too warm. The room temperature should be between 65 and 70 degrees. If a baby arrives at your center asleep and has been bundled for travel outside, remove the baby’s coat, hat, and any other extra layers before placing him in a crib to sleep.

Speaking of putting baby in a crib, what makes a safe sleep environment for baby? A safe crib is a boring crib: Just a safety-approved crib with a firm mattress and tight-fitting sheet. No bumper pads, no pillows, no stuffed animals, no blankets. All of these items raise the risk not only of SIDS but of accidental suffocation. The best choice is to not have any blankets in the crib. If a parent insists on a blanket for their child, it should be a very lightweight blanket and the baby should be “feet to foot.” Place the baby’s feet right at the foot of the crib, put the blanket no higher than baby’s chest, and tuck it in on the sides and bottom. This reduces the risk of the blanket covering the baby’s face. Babies should not nap in car seats or swings and should never sleep on couches, recliners or adult beds.

You may have heard in the news recently about pacifiers being recommended for SIDS risk reduction. This is a new recommendation based on research that has shown that falling asleep with a pacifier reduces the risk of SIDS. This is of course a personal decision, but if a parent uses a pacifier for their baby, offer it to the infant when placing her for sleep. If she spits it out after she falls asleep, there is no need to repeatedly reinsert the pacifier. Pacifiers should not be attached to babies’ clothing with strings or ribbons.

Remember tummy time when babies are awake and supervised. You may have heard, “Back to sleep, tummy to play.” It is very important for infants to get daily time on their tummies to develop their muscles and prevent a flat head. Just be sure that you are watching the baby at all times, and return them to the crib if they should fall asleep.

The SIDS Foundation of Washington is a nonprofit organization based in Seattle serving the state of Washington. We would be happy to send materials to you for display in your child care or to share with parents. You can call Keri at the SIDS Foundation of Washington with any questions about SIDS, and you can also give our contact information to parents. We never charge for any of our services, and you can call toll-free at 1-800-533-0376 or email ExecDirector@SIDSofWA.org. Remember, if you follow the risk reduction steps outlined above, you will greatly reduce the likelihood of SIDS happening to an infant in your care. Together we will save babies’ lives.