At 3AM, SIDS Guidelines Are Tough To Follow

By Julianna LeMieux — Aug 18, 2016
Sudden Infant Death Syndrome is when an infant under 1 year dies, for the most part, when sleeping. There are a handful of recommendations given to new parents to prevent it, mostly regarding the baby's sleeping environment. A new study shows that, although these recommendations are (mostly) adhered to at bedtime, it's a different story as the night wears on.
shutterstock_168745607 Can you find the three things wrong with this picture? Answer at the end of the article.

Open any parenting magazine, and you will  see hundreds of products to help parents keep their babies safe. And, it works. New parents are jumping on every opportunity—logical or not — to keep their babies safe. Unfortunately, they are being manipulated into buying products that are, for the most part, completely unnecessary. There are expensive (over $400.00) car seats that are no safer than any other car seat and baby bottle sterilizers with extremely high heat that do the same thing as good old boiling water.

But, a new report out in Pediatrics suggests that, although new parents may be knocking it out of the park with safety during the day, they are letting it slip at nighttime.

The most important safety concern when night falls, and one of the worst nightmares of any new parent, is Sudden Infant Death Syndrome (SIDS). SIDS is defined as the sudden death of an infant less than 1 year of age that cannot be explained. SIDS can occur during both day and nighttime sleep, but, happens more frequently during the night.

SIDS is now categorized under the larger umbrella of "Sudden Uncategorized Infant Deaths" (SUID) which can be broken down into three groups: 1) SIDS;  2) unknown cause; 3) accidental suffocation and strangulation in bed. (1)

The chart below is quite revealing. The SIDS rate started to fall precipitously in the early 1990s. This is a result of the release of the American Academy of Pediatrics safe sleep recommendations in 1992, which catalyzed the "Back to Sleep" campaign (now known as the "Safe to Sleep" campaign.)

Sudden Infant Death Syndrome (SIDS) rates declined considerably from 130.3 deaths per 100,000 live births in 1990 to 55.7 deaths per 100,000 live births in 2001. Unknown Cause infant mortality rates have remained unchanged from 1990 to 2010. In 2011, the Unknown Cause mortality rate in infants was 22 deaths per 100,000 live births. Accidental Suffocation and Strangulation in Bed (ASSB) mortality rates remained unchanged until the late 1990s. Rates started to increase beginning in 1998 and reached the highest rate at 17.8 deaths per 100,000 live births in 2008. The total combined Sudden Unexpected Infant Death rate (which includes SIDS, Unknown Cause, and ASSB) declined considerably following the American Academy of Pediatrics safe sleep recommendations released in 1992 the initiation of the Back to Sleep campaign in 1994, and the release of the Sudden Unexplained Infant Death Investigation Reporting Form in 1996. However, the total combined Sudden Unexpected Infant Death rate has not decreased significantly since 1999. (sudden unexpected infant death rates in the United States from 1990 through 2014.)

Even with the decrease, however, about 1,500 infants died of SIDS in 2014, making it the leading cause of death in infants 1 to 12 months old in the United States. (1)

The cause of SIDS remains a true mystery. Current research is focused on trying to hone in on genetic or physiological causes. However, even though we do not know the cause of SIDS, there are well established methods that can be taken to minimize the risk.

The recommendations by the CDC are:

  • Always place babies on their backs to sleep.
  • Use a firm sleep surface, such as a mattress in a safety-approved crib, covered by a fitted sheet.
  • Have the baby share your room, not your bed. Your baby should not sleep in an adult bed, on a couch, or on a chair, and especially not with you or anyone else.
  • Keep soft objects, such as pillows and loose bedding out of your baby’s sleep area.
  • Do not smoke during pregnancy, and do not smoke or allow smoking around your baby.

In order to obtain an accurate estimate of how well parents are adhering to those recommendations, a group from Penn State College of Medicine videotaped 142 children for one night at ages 1 month, 3 month and 6 months old to observe their sleep habits. All parents had consented to the video taping.

One of the findings was that babies started out the night, for the most part, in a safe sleeping environment, face up. The primary exception was that a large percentage (roughly 90%) of babies started out the night with a loose or non-approved item in their sleeping environment, typically loose bedding, bumper pads, pillows or stuffed animals.Slide1

But, as the night wore on, and babies awoke (as they do) many of the parents changed the baby's sleeping environment, and the majority of the time, it ended up being less safe.

In all three age groups, when the baby was moved to the second location there was:

  • an increase in the use of a non-approved surface (for the most part - an adult bed)
  • less adherence to placing the baby on its back
  • an increase in sharing their sleep environment with another person

This study clearly shows that parents were conscientious when the night started out. (1) But after a nighttime feeding or diaper change, adherence to the SIDS recommendations relaxed, and babies were moved to a less safe environment.

And, we get it. I have had three babies and understand that exhaustion is real and it's hard to make good decisions at 3 AM. But, perhaps these data will highlight those middle of the night choices and, after a night feeding, a new parent will make sure to put their baby back into the crib, face up, without the stuffed animal. Because, there are so few steps that we can take to minimize the risk of SIDS. We have to try, tired or not, to do everything that we can.


Answer to the question on the top photo:

  1. A stuffed animal is in the baby's sleep environment
  2. The baby is not on its back
  3. There is a blanket on the sleeping baby




(1) This is with the exception of having the non-approved items in the crib. I know that stuffed animals are cute, but, they should not be in the crib. And, instead of a blanket, you can buy a sleep sack - a safer alternative that will keep a baby just as warm.


More information on the current research on SIDS can be found at: