Q. We have a 4 month old baby boy that tends to sleep on his belly. I have 2 boys who never actively turned around like he does. The other day while surfing the internet for this problem, i came across this article on Sudden infant death syndrome (SIDS) and it got me and my husband worried. WHAT IS THE CAUSE OF SIDS AND WHAT IS SIDS PREVENTION ?

Ans.

Hello and Welcome to AskHealthMD

I appreciate your concern and i want you to know that i am here to help

  • I tend to address all of your concerns regarding SIDS. I shall also elaborate SIDS PREVENTION so that you have all the necessary knowledge tools based on the latest evidence that would help you to take all the necessary steps in keeping your child safe and healthy.
  • The exact cause of SIDS is not entirely known. However there are a number of logical explanations. the most plausible being that in SIDS, the baby has a poorly developed arousal / respiratory center in the brain.
  • The infant sleep position has an important role in this regard. If they sleep on their bellies, then they are more prone to SIDS as in this position they are more likely to inhale the oxygen-depleted air again.
  • Oxygen-depleted air means that the limited space for breathing created by the interface between the baby’s mouth/nose with the bed/bed sheet is deprived of oxygen by inhaling repetitively in that congested space. 
  • Side sleeping position is also discouraged especially if the baby does not have the skills to roll out of the belly position which he assumes much easily when he is lying in a side position rather than the back.
  • Lying face first on a soft/ fluffy surface such as a waterbed is much worse than on a firm even surface as the soft surface is more likely to obstruct the airway than the firm one. Blankets, pillows, improperly fitting mattresses are also to be avoided as they are commonly used with the baby. If you are worried about the baby getting cold then the baby can swaddled in a receiving blanket or a sleep sack.  
  • The congested space due to the belly/ face first position and weather can lead to overheating which further increases the risk of SIDS. Generally, babies should not be so wrapped and compacted with blankets etc that overheating occurs.
  • Low birth weight,Preterm babies and twins/ triplets are much more prone to SIDS. The reason is the same that their centers of breathing and arousal are not fully developed to appreciate the environmental changes that would normally lead to a reflex response, maintaining proper oxygenation.
  • A respiratory tract infection or a cold in the susceptible age period of SIDS can compound the risk as it contributes by exacerbating the respiratory distress.
  • Similarly, infants who are exposed to smoke at this young age, whether its cigarette smoke or any other smoke e.g fossil fuel, car fuel emissions etc are also much more likely to develop respiratory distress predisposing to SIDS by the same rationale.
  • Mothers younger than 20 years age, using alcohol and other recreational drugs and smoking increase the risk of SIDS.
  • The highest risk of SIDS and its peak incidence is between 2 to 4 months age. However, precautions should be taken till the baby is 1 year old as the possibility is present till the baby is 1 years old.
  • Pacifiers lower the risk of SIDS. The explanation for this intervention is that they prevent the baby from falling into an extremely deep sleep, They can be initiated after 1 month age. Do not initiate it before one month age if the baby is breastfeeding. If the pacifier falls out of your baby’s mouth while he or she is sleeping, don’t pop it back in.
  • Proper immunization and breastfeeding up to 6 months at least has shown to lower the risk of SIDS.
  • Once the baby can roll over by himself , independently, at round about 6 months age then the risk of SIDS is greatly reduced as it can rescue itself from most stressful positions by rolling away and the respiratory centers are also much more mature.
  • Sleeping with the baby in the same bed is also discouraged as the mother could potentially roll over the baby inadvertently and may obstruct the baby’s airway especially if she is too tired herself. A crib clamped or attached to the bed is the safest way to prevent this catastrophe. Sharing the bed with both parents, siblings and pets is discouraged.

 

Hope this helps to ease you anxiety regarding SIDS and helps you in taking the proper precautions needed to prevent it.

Wishing you best of health

Thanks

Dr. Muhammad Sareer Khalil