There's more to cutting the risk of sudden infant death syndrome (SIDS) than putting babies to sleep on their backs.

The public health campaign “Back to Sleep,” geared toward putting infants to sleep on their backs, helped reduce the rate of SIDS by more than 50%.

But now, a new study published in Pediatrics also shows that SIDS rates have stabilized in recent years, so there's more work to be done. There are about 2,500 SIDS deaths per year in the U.S.

In the new study, "the vast majority" of the babies who died from SIDS still had a sleep-related risk factor, "so just following the [American Academy of Pediatrics] guidelines for infant sleeping could have a dramatic impact on deaths,” says researcher Henry F. Krous, MD, who directs the San Diego Sudden Infant Death Syndrome Research Project at Rady Children’s Hospital.

Those guidelines:

    Always put babies to sleep on their backs -- not on their stomachs or sides.
    Cribs should have a tightly fitted mattress and no other bedding (no pillows, blankets, bumper pads, or soft toys).
    Avoid over-bundling or covering the infant’s head.
    Don't share your bed with your baby. Infants should not sleep on adult mattresses.

“The impetus for bed sharing is usually to make nighttime nursing easier, but there are cribs available that are placed right next to the bed to allow proximity without the risk,” Krous says.

The researchers conclude that while these risk factors do not cause SIDS by themselves, avoiding them can keep vulnerable babies alive.

 
Babies, Sleep, and SIDS

About 90% of SIDS deaths occur between the second and sixth months of life, Krous explains.

Certain babies are at higher risk, including boys, premature babies, infants exposed to cigarettes or alcohol while in the womb, or having a certain genetic condition related to their brain chemistry.

In the San Diego study, as the percentage of SIDS deaths related to sleep position dropped, bed-sharing deaths accounted for a greater percentage of SIDS deaths.

The combination of risk factors may matter. More than half (57%) of the babies who died of SIDS in the San Diego study had at least three risk factors.
Safer Bed, Safer Baby

Preventing avoidable risk factors could further cut SIDS deaths.

“If caregivers are unable to meet all ideal sleep conditions, this study suggests that meeting as many as possible will still be beneficial,” the researchers conclude.

“As successful as the ‘Back to Sleep’ campaign has been, it hasn’t reached everyone,” says study co-author Felicia L. Trachtenberg, PhD, of the New England Research Institute. “And as more babies are sleeping on their backs, other risk factors have become more prominent.”

The study appears in the March 26 issue of Pediatrics.