Sudden Infant Death Syndrome (SIDS) tragically claims the lives of over 3,500 infants in the U.S. every year. As parents and caregivers, understanding how to reduce the risk of SIDS is critical. In this blog, I’ll share key protective factors against SIDS, with a focus on infants under 12 months.
First, let’s establish the baseline: a baby sleeping Alone, on their Back, in a Crib (ABC’s of safe sleep) with no blankets, positioners, or stuffed toys. The protective factors outlined below are relevant only when these conditions are met.
It’s important to note that failing to follow certain protective factors doesn’t increase the risk of SIDS, but missing these factors means you won’t benefit from their protective effects. Mental well-being of the caregiver is also essential—over-exhaustion can lead to unsafe sleep practices, which may increase the risk of SIDS. Ideally, each caregiver should get at least four hours of uninterrupted sleep in a 24-hour period to avoid dangerous sleep deprivation.
Please see the below image for a visual reference.
Protective Factors Against SIDS
- Breastfeeding (≈45% Protective)
Breastfeeding has been found to be a protective factor against SIDS. Breastfed infants tend to have more frequent wake periods due to breatmilk being less calorific when compared to formula. This, in turn decreases the likelihood of them sleeping too deeply. Studies suggest that this increased arousal reduces the risk of SIDS because breastfed babies spend less time in the deep sleep stages where SIDS may occur.
Importantly, the American Academy of Pediatrics (AAP) does not distinguish between exclusive breastfeeding and pumped milk in their studies. Therefore, any form of breastfeeding is likely to offer this protective benefit. - Room Sharing (≈45% Protective)
Keeping your baby in the same room, but not in the same bed—provides an estimated 45% reduction in SIDS risk. The AAP suggests that room sharing facilitates easier monitoring and feeding. Additionally, the noise generated by caregivers during sleep can help keep babies from entering dangerously deep sleep stages.
While room sharing can be challenging due to infants being noisy sleepers, it’s important to find a balance that works for you and your family. Just remember, room sharing is not the same as bed sharing, which should be avoided for the first two years of life. - Pacifier Use (≈90% Protective)
Offering a pacifier/dummy is now known to be the protective factor that offers the highest rate of protection, doubling the ≈45% to 90% protection when also following the ABC’s. The pacifiers are also the only safe item that can be in your infants crib/cot and anecdotally, we had dozens in ours (saved getting up at night to find and sterilise them)
Although the exact reason pacifiers are so effective is still under study, Cozzi et al have suggested that the sucking motion of the pacifier could possibly prevent the ‘vacuum motion’ that is expected to cause SIDS by pulling the tongue back into the pharynx and blocking the airway.
Other theories, such as those by P Pujar and N Gokhale, indicate that pacifier use encourages babies to sleep on their backs and keeps them aroused when the pacifier falls out. sucking on a pacifier also increases production of saliva which causes baby to swallow more often.
It has also been proven that using a pacifier slightly raises the carbon dioxide levels in the babies body which act as a stimulant and lower the babies arousal threshold in addition to increasing the production of the gastrin and somatostatin, which are thought to also have protective benefits.
Mental Well-being of Caregivers: A Crucial Factor
- While breastfeeding, room sharing, and pacifier use offer protective benefits, it’s vital to acknowledge the mental well-being of caregivers. Over-exhaustion can lead to dangerous situations, like unintentionally falling asleep with the baby in an unsafe environment (such as a couch or adult bed). For this reason, it’s recommended that caregivers aim for at least four hours of uninterrupted sleep in every 24-hour period to prevent severe sleep deprivation.
Final Thoughts
- The risk of your baby passing from true SIDS—when all other risk factors like unsafe sleep practices are ruled out—is statistically very low. The chance is even lower than them being struck by a meteor. However, it’s crucial to follow the ABCs of safe sleep (Alone, Back, Crib) as your baseline for safety.
- Protective factors like breastfeeding, room sharing, and pacifier use significantly lower the already slim risk of SIDS. These factors do not stack, meaning that while each offers its own benefit, combining them doesn’t multiply the protective effect—but they do provide essential layers of security for your baby.
- Remember, your baby wasn’t born used to being held, wrapped in a blanket, or snuggling with a teddy bear. Their safety is worth far more than the temporary frustration of adjusting to these safe sleep practices.
Stay Tuned
In future posts, I’ll dive deeper into each protective factor and explore specific risk factors to avoid, such as overheating, soft bedding, and exposure to second-hand smoke. For now, the most important thing to keep in mind, is that the possibility of your baby passing from true SIDS (Unexplained and unrelated to unsafe sleep practices) is less than it is them being hit by a meteor, so always follow the ABC’s of safe sleep and use that as your base, your only option.
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