SIDS/Co-Sleeping
Goals:
1. To have the residents identify risks factors for SIDS
2. To have residents understand the reasoning behind the AAP
recommendations to reduce the risk of SIDS & sleep related deaths
Board Question: PREP 2009, #169
During the health supervision visit of a term newborn boy, his mother relates that a
cousin’s child died of age 4 months from sudden infant death syndrome. She asks
what she can do to prevent such an occurrence in her son. Of the following, the
single MOST important preventative measure is to:
A. Avoid use a pacifier
B. Cosleep in the parental bed for close observation
C. Ensure side sleep position to prevent aspiration
D. Ensure supine sleep positioning
E. Use home apnea & bradycardia monitoring
ABP Board Content Specification:
 Know the risk factors for sudden infant death syndrome
Epidemiology:
 Despite a major decrease in the incidence of SIDS since the AAP released
their recommendation that infants sleep on their back, this decline has
plateau.
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Other causes of unexpected death that occur during sleeping (suffocation,
asphyxia, entrapment, & other) have increased since 2005
Comparison of US rates of SIDS according to maternal race & ethnic origin in
1996 & 2006
The National Infant Sleep Position survey of nearly 19,000 people found that
the percentage of participants who reported bed-sharing increased from
6.5% in 1993 to 13.5% in 2010. Co-sleeping rates rose until 2000 and then
held steady among white study participants, and the practice increased
among black and Hispanic participants from 1993 to 2010, according to a
study in JAMA Pediatrics.
Definitions:
 Sudden infant death syndrome (SIDS) = cause assigned to infant deaths that
cannot be explained after a through case investigation, including a scene
investigation, autopsy, and review of the history.
 Sudden unexplained infant death (SUID) = term used to describe any sudden
and unexpected death, whether explained or unexplained (including SIDS)
that occurs during infancy. Can be attributed to:
o Suffocation
o Asphyxia
o Entrapment
o Infection
o Ingestions
o Metabolic diseases
o Arrhythmia associated cardiac channelopathies
o Trauma
Age at death:
 90% of SIDS cases occur before 6 months.
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Peaks between 1 and 4 months
10% of SIDS cases occurred in 1st month of life
AAP Recommendations 2011
See attached for explanation of recommendations & technical report for more
complete information for reference
 Developed to reduce the risk of SIDS, sleep-related suffocation, asphyxia, and
entrapment
 Level A Recommendations: (good/consistent scientific evidence)
o Back to sleep for every sleep
o Use of a firm sleep surface
o Room-sharing without bed-sharing is recommended (decreases risk
by 50%)
o Keep soft objects & loose bedding out of the crib
o Pregnant women should receive regular prenatal care
o Avoid smoke exposure during pregnancy & after birth
o Breastfeeding is recommended
o Consider offering a pacifier at nap time & bedtime
o Avoid overheating
o Do not use home cardiorespiratory monitors as a strategy for
reducing the risk of SIDS
 Level B Recommendations: (limited/inconsistent scientific evidence)
o Infants should be immunized in accordance with recommendations of
the AAP & CDC
o Avoid commercial devices marketed to reduce the risk of SIDS
o Supervised, awake tummy time is recommended to facilitate
development & to minimize development of positional plagiocephaly
Risk Factors for SIDS:
 Infant co-sleeping
o Odds ratio of 2.88 with bed sharing
 Prone/Side sleep positions
o Prone: Odds ratio 2.3-13.1
o Side: Odds ratio 2.0, if found on side after placed side: odds ratio 8.7
 Parental obesity
 Sleeping on soft surface (ie- waterbed)
 Overheating
 Tobacco smoke, especially in the setting of co-sleeping
o Odds ratio with 1 parent smoker = 2.3, 2 parent smokers =17.7
Protective Factors for SIDS:
 Breastfeeding or expressed breast milk
o Odds ratio of 0.41-0.64
 Pacifier use
o Decreases risk of SIDS by 50-60%
Type of Sleep Environment: Sleep Environmental Risks for Younger & Older
Children (Pediatrics, July 14, 2014- Attached)
 Review of data from 24 states from 2004-2012 from National Center for the
Review & Prevention of Child Deaths Case Reporting System (database of
death reports from state child death review teams).
 Reviewed 8207 deaths:
o Younger victims (<4 months): 73.8% were bed sharing (P <.001) &
51.5% sleeping in adult bed/on a person
o Older victims (4 months -364 days): 39.4% had an object in sleep
environment, & 18.4% changed from side/back to prone
 Objects included: blanket, pillow, bumper pads, hard furniture,
stuffed toys , nonstuffed toys, clothing, small soft fabric items,
cord, bag
o Median age of death: 2 months
o Significantly higher percentage of young infants were placed side
sleeping or prone (37.3 vs 28.7 in older group)
o Almost half (49.2%) of all deaths occurred in adult bed or person with
higher percentage in younger group (51.6% vs 43.8%)
o Most children were without complex chronic conditions = 98.8%
 However, significantly higher death rate in higher age group if
CCC was present
 Conclusions:
o Infants 0-3 months were more likely to die while sleeping on the same
surface (usually an adult bed) or on a person
o Infants 4 months- 364 days were more likely to die found prone with
objects such as blankets & stuffed animals in the sleep area
Board Q #169: Answer=D