Sudden Infant Death Syndrome and Safe Sleep

Sudden Infant Death Syndrome (SIDS) is the unexpected and unexplained death of a seemingly healthy baby, usually under one year of age, during sleep. Creating a safe sleep environment—specifically by avoiding soft bedding and overly warm rooms—is the most fundamental way to minimise this risk. Assoc. Prof. Dr. Rüya Çolak, Paediatrics and Neonatology Specialist at BHT CLINIC İstanbul TEMA Hospital, emphasises that parents can drastically reduce this risk through simple yet life-saving precautions.

At a Glance

SIDS most commonly occurs during sleep in babies between 2 and 5 months old.
It is vital to always place your baby on their back to sleep until they can roll over independently.
Pillows, toys, thick quilts, or soft blankets should never be kept in the cot.
Breastfeeding reduces the risk of sudden infant death by approximately 50 percent.
The room temperature should be kept between 22-26°C, and the baby should not be overdressed to the point of sweating.
For the first 6 months to a year, your baby should sleep in the same room as you, but in a separate cot.

What is Sudden Infant Death Syndrome (SIDS)?

In the medical world, Sudden Infant Death Syndrome is a term used to describe the death of a baby under one year of age where the exact cause remains unexplained, even after a thorough autopsy, death scene investigation, and detailed clinical history review. It usually happens silently during nighttime or daytime naps. While this is an incredibly distressing thought for any parent, we know that the risk can be significantly managed through practical physical and environmental precautions.

Looking at the statistics, SIDS occurs in about 91 out of every 100,000 births globally; in Türkiye, this rate is around 168 per 100,000 births. The vast majority of cases happen between the 2nd and 5th months, a period of rapid development. Experts note that this timeframe coincides with a critical stage in the development of the brainstem, which controls the baby's breathing and heart rate.

Causes of Sudden Infant Death and SIDS Risk Factors

While there is no single cause for SIDS, medical professionals often explain it using the "Triple-Risk Model." According to this model, the risk increases when a baby in a developmentally vulnerable period encounters an environmental stressor (such as being placed on their stomach or experiencing a lack of fresh air). We can group these risks under three main headings.

Risks During Pregnancy

A baby's development in the womb directly affects their postnatal health. A mother's use of smoking, alcohol, or recreational drugs during pregnancy negatively impacts the baby's brain development and oxygen levels. Exposure to tobacco smoke—not just during pregnancy but also after birth—ranks among the highest risk factors for SIDS. Additionally, inadequate maternal nutrition or a lack of proper medical care during pregnancy can also elevate the risk.

If a baby is born prematurely or has a low birth weight, the centres in the brain that regulate breathing and heart rhythm may not be fully mature. This makes it harder for the baby to tolerate short pauses in breathing (apnoea) during sleep. Similarly, severe respiratory infections can make breathing difficult, creating an indirect risk. For detailed information on infections commonly seen, especially during the winter months, you can review our article titled What is RSV Virus?.

Environmental factors are the areas where parents can intervene and make the biggest difference. The surface your baby sleeps on plays a life-saving role. A soft mattress, the use of pillows, or plush toys in the cot can cover the baby's face, causing them to rebreathe their own exhaled air (carbon dioxide). Exposing the baby to excessive heat, dressing them too warmly, and bed-sharing with parents are also common, yet dangerous, practices linked to sudden infant death.

Are There Any Symptoms? What Conditions Can Mimic SIDS?

The most defining and challenging aspect of Sudden Infant Death Syndrome is that it gives no prior warning signs. Before falling asleep, the baby appears completely healthy, showing no signs of pain or distress. Therefore, since there are no symptoms to watch out for, the primary focus must be on strictly applying preventive measures.

However, some underlying structural conditions can present a similar picture to SIDS. Congenital heart rhythm disorders or structural heart diseases, in particular, can create sudden life-threatening risks in infants. To rule out such suspicions and thoroughly evaluate the heart, we safely protect your baby's health using modern methods like echocardiography and ECG, performed by our Cardiology department.

How to Create a Safe Sleep Environment for Babies?

Assoc. Prof. Dr. Rüya Çolak underlines that to protect babies from this syndrome, their sleep environment must meet specific standards. Safe sleep for babies is not just a preference; it is a medical necessity.

The Back-to-Sleep Position

The World Health Organization (WHO), the American Academy of Pediatrics, and all leading child health authorities recommend that babies must always be placed on their backs to sleep. Sleeping on the stomach or side increases the risk of the baby's airway becoming blocked. Until your baby gains the ability to roll over on their own (usually around 5-6 months), they should be placed on their back every time they go to sleep.

Choosing a Mattress and the Danger of Soft Surfaces

It is crucial that the mattress your baby sleeps on is firm and flat. Soft mattresses, memory foam, or waterbeds are not suitable for infants. Soft materials like pillows, plush toys, thick quilts, or cot bumpers must never be kept on the bed. Nothing should be draped over the baby; if a blanket is used, it should be thin, tucked in tightly around the edges of the mattress, and reach no higher than the baby's shoulders. Safe baby sleeping bags are an excellent alternative to loose blankets.

Sleeping in the Same Room, But a Different Bed

It is recommended that mothers and babies sleep in the same room for the first 6 months, and ideally for the first year. Room-sharing makes it easier for the mother to notice the baby's sounds and movements. However, you must absolutely avoid sharing the same bed. Fatal accidents can occur, such as a parent unknowingly rolling onto the baby during sleep or the baby falling out of bed. The baby should sleep in their own cot placed right next to the parents' bed.

Room Temperature and Ideal Clothing

It is highly important not to expose the baby to excessive heat and to keep the room temperature between 22-26°C. Babies only need one more layer of clothing than an adult would wear to be comfortable. Excessive sweating can cause the baby to fall into a very deep sleep, making it harder for them to wake up and thereby increasing the SIDS risk. Furthermore, full swaddling is not recommended as it makes it difficult for the child to adjust their position and increases the risk of hip dysplasia. If the baby needs to feel secure, a half-swaddle that leaves the legs free can be chosen.

The Protective Effect of Breastfeeding and Pacifier Use

In addition to the countless benefits of breastfeeding on an infant's health, its protective effect against SIDS has been scientifically proven. Breast milk strengthens the baby's immune system, providing protection against respiratory infections. Assoc. Prof. Dr. Rüya Çolak notes that receiving breast milk reduces the rate of sudden infant death syndrome by 50 percent.

The use of a pacifier (dummy) also has a protective effect, thanks to its mechanism that helps keep the airway open. While pacifier use is not highly recommended for the first 3-4 weeks—until the breastfeeding routine is fully established—it can be used when settling down to sleep from the 1st month onwards. Offering a pacifier just before sleep is particularly advised. However, if the pacifier falls out of the baby's mouth after they have fallen asleep, there is no need to wake or force the baby to put it back in.

When to Seek Emergency Help?

If signs of respiratory distress are observed in a baby, medical help must be sought without delay. The following situations require immediate intervention:

The baby stops breathing for more than 20 seconds.
A bluish tint (cyanosis) appears on their lips, tongue, or face.
There are deep retractions in the chest while breathing, or the baby makes grunting sounds.
The baby does not respond to stimulation and appears extremely lethargic or floppy.

In such cases, you should immediately call the 112 Emergency Call Centre (the national emergency number in Türkiye) or visit the emergency department of the nearest hospital.

The Process and Newborn Care at BHT CLINIC

At the Paediatrics and Child Health department of BHT CLINIC İstanbul Tema Hospital, all stages of your baby's development are meticulously monitored from birth. With our neonatal intensive care unit and our 24/7 emergency service, we are by your side at all times for your baby's health. During routine check-ups, our specialist physicians provide parents with comprehensive education on safe sleep habits, nutrition, and general care. All the evaluations and regular follow-ups you need for your baby's healthy development are carried out in the safe environment of our hospital. To get more detailed information and to plan your baby's routine check-ups, you can book an appointment.

Frequently Asked Questions

Until what age should babies be placed on their backs to sleep?

Babies should always be placed on their backs until they have mastered the ability to roll over in both directions (from back to tummy, and tummy to back) on their own. This skill usually develops between 5 and 6 months, but medical authorities recommend placing the baby on their back to sleep for the entire first year.

What should I do if my baby rolls onto their tummy while sleeping?

If your baby has reached the muscle development to comfortably roll over on their own, you do not need to constantly correct their position during sleep. However, you must always place them in their cot on their back when they first go to sleep.

Sleeping in the same bed can lead to a parent unknowingly rolling over onto the baby during sleep, causing them to suffocate. Additionally, adult mattresses are too soft for babies, and materials like pillows and heavy quilts create a suffocation risk.

Does using a pacifier reduce breast milk supply?

If pacifier use is introduced before the baby has fully learned to breastfeed, it can lead to nipple confusion or breast refusal. Therefore, it is recommended to introduce a pacifier only after the breastfeeding routine is well established, usually around 3-4 weeks of age.

How should the temperature of the baby's room be set?

The ideal room temperature should be between 22 and 26°C. To check if your baby is cold or sweating, you can feel the back of their neck or their chest, rather than their hands. Dressing them in just one more layer than what you are wearing is perfectly sufficient.

This article is for informational purposes only; please consult your physician for diagnosis and treatment.

Beware of Soft Bedding: Sudden Infant Death Syndrome (SIDS) and Safe Sleep