As a parent, you probably already know that putting your baby to sleep on her back is crucial to decrease the risk of Sudden Infant Death Syndrome, otherwise known as SIDS. In fact, the "Back to Sleep" campaign, started years ago by the National Institute of Child Health & Development, has been so successful that it reduced the number of SIDS cases in the U.S. by more than half in the decade following its introduction. But since that time, the rates have stalled—and a new study conducted by the San Diego SIDS/Sudden Unexplained Death in Childhood Research Project provides clues about why this is.

Study Specifics

The study examined 568 SIDS deaths recorded in San Diego between 1991 and 2008, and took a closer look at the risk factors noted in the children's death scene investigations and autopsies. The research provides a picture of risk factors over time: before the back-to-sleep era, during its inception and launch in 1994, and in the 14 years since the program was initiated.

Risk Factors

Although the specific types of risk factors—variables such as age, gender, maternal smoking, alcohol and drug use, and bed-sharing, to name a few—remained the same over the time period, the contribution of some of those factors increased as the rates of stomach sleeping decreased.

Surprisingly, although the back-to-sleep campaign was successful in reducing this specific risk factor, the number of risk factors experienced by each infant remained steady over time, with the majority of infants subject to at least three separate risk factors. Dr. Fern Hauck, MD, MS, Professor of Family Medicine and Public Health Sciences at the University of Virginia, and co-author of 14 Ways to Protect Your Baby from SIDS, says that the new study "highlights the need to focus on several risk factors in preventing SIDS, not only placing babies on their back."

The study has not changed the most important recommendation to help parents protect their infant from SIDS—always placing the baby on her back to sleep for each and every sleep. But that alone might not be enough. Hauck also cautions that parents need to be aware of the other key risk reduction practices, including but not limited to:

  • Sleeping solo. Put your child down to sleep in a nearby, but separate place. Avoid bed sharing—Hauck commented that bed sharing increased among the infants who died from SIDS over the time period, as stomach sleeping decreased. The study revealed that the increase was especially marked among younger infants, which Hauck states is "a time of greater vulnerability." Instead, give your little one his own crib or bassinet in your room. If you want to be closer to baby, put him to sleep in a bedside co-sleeper. This keeps him within arms reach while avoiding the hazards of sleeping side-by-side in your family bed.
  • Breastfeed. Nursing not only provides your baby with essential immunological defense against illness, research has shown that it helps prevent SIDS as well. If you're unable to breastfeed, exclusive pumping is another great option for getting your little one the health benefits breast milk provides.
  • Stop smoking. Step away from the cigarettes! Aside from the obvious health risks associated with puffing away (such as cancer and emphysema) smoking both during and after pregnancy can put a serious strain on your baby's little lungs. While the study did not find any increase or decrease in the rate of maternal smoking over time, it was often found to be a factor among the babies who died.
  • Back-to-sleep. Despite general awareness of the back-to-sleep campaign, parents didn't always make sure their babies slept tummy-up. Hauck notes that while many moms and dads are aware of recommendations to avoid the stomach sleep position, the study shows that almost half the infants who died—49 percent—were still placed in that position. An additional 17 percent of babies were placed in the side position, which also increases the risk for SIDS.
  • Sleep safely. Use a firm mattress in baby's bed and steer clear of soft bedding and objects in the crib, including bumper pads. Too many pillows, blankets and furry friends sleeping with your little one can cause suffocation.
  • Keep cool. Don't wrap your little one in blankets and warm sleep suits. If you're concerned your baby isn't warm enough, feel the back of his neck—not his hands or feet, which can feel cool even when he's very warm. If he's too cold, opt for a breathable but cozy sleep suit.
  • Provide a pacifier. Offer your child a pacifier at bedtime. When your child's old enough, you'll be able to break the binky habit—right now, it can help prevent sleep danger.

The study notes that SIDS "is a disease, and these risk factors are not causative of SIDS in and of themselves." But Dr. Hauck notes that a key point of the study was the finding that only 5 percent of the infants did not have at least one extrinsic risk factor—"something parents can control, such as sleep position, soft bedding, and bed sharing." Hauck says this "tells us that SIDS is largely preventable."

Some intrinsic risk factors—such as premature infants, boys, and African-American babies—can't be prevented. But even if you can't avoid every risk, staying informed and taking steps to prevent as many hazards as you can will be beneficial for your baby in the long run.