Sudden infant death syndrome (SIDS) is the sudden and unexplained death of a baby younger than 1 year old. Most SIDS deaths are associated with sleep, which is why it's sometimes still called "crib death."
A lack of answers is part of what makes SIDS so frightening. SIDS is the leading cause of death among infants 1 month to 1 year old, and remains unpredictable despite years of research.
Even so, the risk of SIDS can be greatly reduced. Most important: Babies younger than 1 year old should be placed on their backs to sleep — never on their stomachs or on their sides. Sleeping on the stomach or side increases the risk for SIDS.
Most SIDS deaths happen in babies between 1 and 4 months old, and cases rise during cold weather.
Babies might have a higher risk of SIDS if:
Doctors diagnose most health problems based on the symptoms they cause. But SIDS is diagnosed after all other possible causes of death have been ruled out. This review helps tell true SIDS deaths from those due to accidents, abuse, and previously undiagnosed conditions, such as heart problems.
SIDS is more likely in babies placed on their stomachs to sleep than babies sleeping on their backs. Babies also should not be placed on their sides to sleep. A baby can easily roll from a side position onto the belly during sleep.
Some researchers believe that stomach sleeping may block the airway. Stomach sleeping can increase "rebreathing" — when babies breathe in their own exhaled air — particularly if the baby is sleeping on a soft mattress or with bedding, stuffed toys, or a pillow near their face. As the baby rebreathes exhaled air, the oxygen level in the body drops and the level of carbon dioxide rises.
Infants who die from SIDS may have a problem with the part of the brain that helps control breathing and waking during sleep. If a baby is breathing stale air and not getting enough oxygen, the brain usually triggers the baby to wake up and cry to get more oxygen. If the brain is not picking up this signal, oxygen levels will fall and carbon dioxide levels will rise.
In response, the AAP's (American Academy of Pediatrics) "Back to Sleep" campaign recommended that all healthy infants younger than 1 year old be placed on their backs to sleep.
Babies should be placed on their backs until 12 months of age. Older infants may not stay on their backs all night long, and that's OK. Once babies consistently roll over from front to back and back to front, it's fine for them to be in the sleep position they choose. Do not use positioners, wedges, and other devices that claim to reduce the risk of SIDS.
Some parents might worry about "flat head syndrome" (positional plagiocephaly). This is when babies develop a flat spot on the back of their heads from spending too much time lying on their backs. Since the "Back to Sleep" campaign, this has become more common. But it's easily treatable by changing a baby's position in the crib and allowing for more supervised "tummy time" while babies are awake.
Some parents may worry that babies put to sleep on their backs could choke on spit-up or vomit. There's no increased risk of choking for healthy infants or most babies with gastroesophageal reflux (GER) who sleep on their backs. Doctors may recommend that babies with some types of rare airway problems sleep on their stomachs.
Parents should talk to their child's doctor if they have questions about the best sleeping position for their baby.
Since the AAP's recommendation, the rate of SIDS has dropped greatly. Still, it is the leading cause of death in young infants. The Safe Sleep campaign reminds parents and caregivers to put infants to sleep on their backs and provide a safe sleep environment.
Here's how parents can help reduce the risk of SIDS and other sleep-related deaths:
For parents and families who have experienced a SIDS death, many groups, including First Candle, can provide grief counseling, support, and referrals.
Reviewed by: Elana Pearl Ben-Joseph, MD
Date Reviewed: Jul 1, 2022