Sudden Infant Death Syndrome (SIDS) is the sudden and unexplained death of an infant where no cause is found after detailed post mortem. Around 250 babies and toddlers still die every year of SIDS in the UK.

Since the launch of the Back to Sleep Campaign in England and Wales in 1991, the number of SIDS deaths has fallen by around 85%.

The death of a baby is a devastating loss for a family, and we need to do all that we can to prevent this.

What is SIDS Syndrome?

Sudden Infant Death 'Sudden Infant Death’ is the term used to describe the sudden and unexpected death of a baby that is initially unexplained. The usual medical term is ‘Sudden Unexpected Death in Infancy’ (SUDI) or Sudden Unexpected Death in Childhood (SUDC), if the baby was over 12 months old.

A thorough post-mortem examination will reveal a specific cause of death in less than half of all sudden infant deaths. Causes may include accidents, infection, congenital abnormality or metabolic disorder. For the deaths that remain unexplained (SIDS), researchers think there are likely to be undiscovered causes. For many it is likely that a combination of factors affecting a baby at a vulnerable stage of development.

How can the risk of SIDS be reduced?

Research has shown that several maternal and infant care factors are more commonly associated with babies who die of SIDS than those who survive. There is no advice that guarantees the prevention of SIDS but parents should be informed that by following the advice below, it is possible to lower the chance of this tragedy occurring. The following factors are associated with a decreased risk of SIDS:

• Babies should be consistently placed on their back as part of their sleep routine.
• Mother does not smoke during or after pregnancy and baby lives in a smoke free home.
• Babies sleep in safe sleeping environments in their own cots.
• Babies are vaccinated.
• Babies that are breastfed (this should be encouraged where possible).
• The use of a dummy for settling the baby to sleep and only once breastfeeding has been established.

Safe sleeping environments

• Babies are safest sleeping on their backs, in their own cots, feet to the end, in their parent’s room for the first 6 months.
• keep the baby in a cot in your room for the first 6 months, but not in your bed
• Babies head should be uncovered.
• The ideal room temperature for a baby to sleep is 16-20°c.
• Blankets or sheets are tucked in underneath arms, nothing should cover the baby’s head while they are sleeping. Baby sleeping bags should fit the baby snuggling around the shoulder so they can not slip down inside it.
• Babies should sleep on a firm, flat mattress that is clean and in good condition and has a water proof layer that can be wiped down and kept clean.
• Having a clear cot (no bumpers, no soft toys and nothing to keep baby in one place such as wedges or straps).

Unsafe sleeping environments

• Sleeping or co sleeping on sofas or armchairs.
• Sleeping in car seats, unless they are out and about.
• Parent’s/carers sharing a bed with their baby especially if they have been drinking alcohol, taking drugs or are smokers; or the baby was premature (37 weeks or less) or had a low birth weight (2.5kg or 5.5lbs or less)
• Using quilts or pillows.
• Exposing babies to cigarette smoke

Some parents will continue to choose to share a bed with their baby, it is important they are informed of how to minimise risk and how to co-sleep more safely.

The Lullaby Trust website has more guidance for co bedding of twins or multiple babies.

Also, once a baby can roll from back to front and back again, on their own, they can be left to find their own position to sleep.

Overheating can increase the risk of SIDS

• Babies should not be too hot or too cold.
• Hats and extra clothing should be removed as soon as a baby comes indoors or enters a warm car/bus/train, even if it means waking the baby.
• Babies lose excess heat from their heads. They do not need to wear hats indoors or in bed.
• If it is very warm a baby may not need any bedclothes other than a sheet.
• Check a baby’s tummy to see if they are too hot. Don’t worry if a baby’s hands or feet feel cool, that’s normal.
• Even in winter, most babies who are unwell or feverish do not need extra clothes.
• Changes of temperature can be controlled using lightweight blankets, not quilts or duvets.
• Babies should never sleep with a hot water bottle or electric blanket, next to a radiator, heater or fire, or in direct sunshine.

Questions consider for during professionals home (especially for under 6months) to visits

• Where did the baby sleep last night? Ask to see.
• Are there any smokers in the house? Does smoking take place inside? Medway Stop Smoking Service could help parents quit.
• Does the parent take medication or use drugs or alcohol?
• Was the baby born prematurely? (Premature babies have a higher rate of SIDS)
• What temperature is the room where the baby sleeps?

Using a dummy

Regular use of a dummy/pacifier/soother has been found in several studies to be associated with a lower risk of SIDS. Although it is not clear how.

Some additional advice about dummies if a parent chooses to use one:

• Parents should wait until the baby is 4 weeks old and feeding is well established.
• Parents should not force their baby to take a dummy or put it back in if the baby spits it out.
• A dummy should not be attached to a neck cord.
• Nothing sweet should be put on the dummy.
• The dummy should not be offered during awake time.
• Using an orthodontic dummy is best as it adapts to the shape of the baby’s mouth.
• If a dummy is used as part of a baby’s sleep routine it should be given for every sleep period.
• A dummy should be gently withdrawn between the ages of 6 to 12 months to avoid any potential adverse effects.

Swaddling and slings

If a parent decides to adopt swaddling it should be done consistently for every day and night sleep. The material used should be thin and the baby should not be swaddled above their shoulders.

Swaddled babies should still be placed to sleep on their back. The swaddle should not be to tight and the baby’s temperature should be checked to ensure they do not get to hot.

The safest baby carriers keep the baby in an upright position where a parent can always see their baby’s face and ensure their airways are free.

When using slings parents should be aware of the risk of falls, entrapment or suffocation. Further advice on the safe use of slings can be found on the ROSPA website.

The impact on a professional and supporting parents

Professionals working with a family where a child has died need to recognise the impact it also has on them, which may include questioning themselves or worrying about working with the bereaved family.

Professionals should not avoid contact. Where there is contact professionals should keep contact brief, offer condolences and use the baby’s name. Families should be offered support (as appropriate to the service) and ensure the family has access to support e.g. literature or website such at the Lullaby Trust.

Professionals should avoid clichéd expressions e.g. “time is a great healer” or ask the parents to repeat their story. Comparisons to other cases should not be made and professionals should avoid becoming defensive of their own or colleague’s practice.

Care of next infant

Parents who have suffered bereavement will understandably be anxious about the possibility of another sudden infant death.

In Medway parents are offered support from the CONI programme (Care of next infant). The CONI scheme provides specialist advice, information and support to health professionals who, in turn, support bereaved families with their subsequent babies and help them enjoy the first year of their baby’s life.

This guidance should be read in conjunction with the Kent and Medway Safeguarding Procedures. Occasionally advice from health professionals may differ from that given above for reasons that are particular to an individual baby. This factsheet has been created in reference to The Lullaby Trust.