Official recommendations for reducing the risk of SIDS are provided on the ‘SIDS and Safety’ page for parents. Here we provide information on the evidence behind the recommendations. There are many published sources explaining the risks associated with Sudden Infant Death Syndrome (SIDS) and other infant sleep-related deaths, and the reasons for current SIDS-reduction recommendations. Although individual elements of SIDS reduction strategies are debated, the key guidelines are very similar. Peer reviewed and published discussions of the evidence from around the world are provided below.
The key review of evidence for UK recommendations is not published or peer-reviewed, however information is available in the form of a factfile on the Lullaby Trust website. Specific new guidelines on SIDS and co-sleeping were issued for the UK by NICE (National Inst. for Health and Care Excellence) in 2014, and updated in 2021. The guidance from all UK authorities should have now been updated to reflect these recommendations.
▸ Lullaby Trust (2019) Evidence Base.
▸ Mitchell et al (2011) Scientific consensus forum to review the evidence underpinning the recommendations of the Australian SIDS and Kids Safe Sleeping Health Promotion Programme – October 2010
▸ American Academy of Pediatrics (2016) SIDS and Other Sleep Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment
▸ The US CDC (Centres for Disease Control) provides useful information on SIDS in the US
The article below from the New England Journal of Medicine provides an overview of the major advances in explaining how SIDS deaths occur. (N Engl J Med 2009, 361:795-805).
▸ Kinney & Thach (2009) The Sudden Infant Death Syndrome
Safety issues relating to bed-sharing
All parents need information on bed-sharing, whether or not they intend to do it, as parents sometimes fall asleep with their babies when they don’t mean to – especially during night-time feeds – and if they can plan ahead, many risks can be ameliorated. In addition to information regarding SIDS risks when bed-sharing, it is also important that parents are informed about how to reduce the chance of accidents.
Parents need information with which to make informed decisions, and should be encouraged to weigh up any potential risks and benefits of bed-sharing in light of their own individual circumstances. Such information includes information on
- factors known to increase the risk of SIDS in the bed-sharing environment: including parental smoking (particularly maternal smoking in pregnancy), young maternal age, infant prematurity and low birthweight;
- aspects of adult beds that could be modified with infant safety in mind: e.g. gaps between bed and wall or other furniture, proximity of baby to pillows, type of bedding used, height of bed;
- parental behaviour prior to bed-sharing such as consumption of alcohol, drugs or medication affecting arousal and awareness, and the presence of other children in the bed.
Safety issues relating to cot-sleeping
Although cots are generally regarded as safe places for babies, particularly since the introduction of British Standards regulating their design, accidents can still happen, and babies still die with no explained cause while asleep in a cot.
Accidents may involve smothering, strangulation, entrapment of limbs, falls, and accidents due to manufacturing or assembly defects. Because they are considered safe environments, parents may leave babies in cots for long periods of time, increasing risk of injury. When infants are allowed to play with objects in their cots injuries may also occur. The consumer website Which? contains safety information for cot sleeping as does NHS Choices.