Sleep-Death Risks Vary by Baby's Age

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Harvard Medical School
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Sleep-Death Risks Vary by Baby's Age

News Review from Harvard Medical School

July 14, 2014

News Review From Harvard Medical School -- Sleep-Death Risks Vary by Baby's Age

Sleep-related deaths of younger babies occur most often when they are sharing a bed, a new study finds. But older babies are more likely than younger ones to die when there are pillows, toys or other objects in bed with them. Doctors advise parents to place babies on their backs to sleep. This can help to prevent SIDS and other sleep-related deaths. This new study looked at how a baby's environment, as well as sleeping position, affects the risk of death. The study focused on 8,200 sleep-related deaths. Nearly 70% of the babies were sharing a bed at the time of death. About one-third were sleeping with an object, such as a pillow or toy. Researchers looked separately at deaths of babies younger and older than 4 months of age. Younger babies were twice as likely to be sharing a bed at the time of death. They were also more likely to be sleeping in an adult bed or on a person. Older babies were more likely to have objects in bed with them. They also were more likely to die after rolling from back or side onto their stomachs. The journal Pediatrics published the study. HealthDay News wrote about it July 14.


By Henry H. Bernstein, D.O., M.H.C.M.
Harvard Medical School


What Is the Doctor's Reaction?

Babies sleep a lot. Where they sleep matters. How they are put to sleep matters.  

Unsafe sleep practices put babies at risk for sudden infant death syndrome (SIDS) and other sleep-related injuries. Some factors linked with greater risk include:

  • Sleeping in something other than a crib
  • Bed sharing
  • Being placed on soft bedding
  • Having objects, such as bumper pads, in the sleep area
  • Sleeping facedown

Researchers wondered whether these risk factors are different between younger and older babies. They reviewed data from the National Center for the Review and Prevention of Child Deaths. The details included more than 8,200 sleep-related baby deaths in 24 states. They occurred between 2004 and 2012.

Researchers published their results this week in the journal Pediatrics. They found out that risk factors for dying did depend on the age of the infant.

  • Younger babies (0 to 3 months) who died were more likely to be sharing a place other than a crib. For example, they may have been lying on an adult bed or on a person. About 7 out of 10 babies (70%) were bed sharing at the time of death.
  • Older babies (4 months to 364 days) who died were more likely to be sleeping facedown. They rolled into things near them in their sleep area, such as heavy blankets or stuffed animals.

Differences also were found based on gender and ethnic group. Sleep-related baby deaths occurred most commonly in males (58%) and non-Hispanic white infants (45%).

The results of this study remind parents and pediatricians that risk factors for sleep-related deaths do differ by the age of the infant. Younger babies should be not bed sharing. Older babies should be put to sleep on their backs and in their own cribs. This will help lower the risk of SIDS and other sleep-related injuries.


What Changes Can I Make Now?

The cause of SIDS is not clear.  So be sure to follow the American Academy of Pediatrics' (AAP) advice to help prevent baby injury or death. Put the baby to sleep on its back. Put the baby in a safe sleeping place, not near things that the baby could get tangled up in.

Important ideas to keep in mind include:

  • Put your baby to sleep on his or her back.  The AAP recommends babies sleep only on their backs. Never on the side. Never facedown on the tummy. This helps protect babies from being smothered or dying from SIDS.
  • Share your room, but not the bed. The AAP recommends parents share a room if they want, but not a bed. Parents can roll onto babies. The baby can get tangled in the blankets.
  • Place your baby on a firm sleep surface. Never put your baby to sleep on a chair, sofa, waterbed or cushion. Car seats and other sitting devices also are not routinely recommended spots for sleep.
  • Keep the crib clear of any objects. Pillows, heavy blankets, stuffed animals, crib bumpers and toys can smother or choke your baby. Cover the mattress with a fitted sheet.
  • Do not overheat your baby.  Use clothing that keeps baby warm without covering the head. Do not dress your baby in extra layers.
  • Do not use special products that are marketed to lower the risk of SIDS. Heart monitors, wedges, positioners and special mattresses have not been proven to lower the risk of SIDS.

Consider these key thoughts, too.

  • Breastfeed your baby. This lowers the risk of SIDS.
  • Sucking on a pacifier also may lower the risk of SIDS.
  • Keep your home and car smoke-free. Avoid smoking during pregnancy or after birth. Stay away from smokers and places where people smoke.
  • Let your baby play on her tummy only when she is awake and you can watch her closely.
  • Stay up to date with all of your baby's vaccines. 
  • Make sure all caregivers, not just the parents, know how to prevent SIDS and other sleep-related injuries.


What Can I Expect Looking to the Future?

Parents should expect the pediatrician to explain proper sleep position and safe sleep practices for their babies. We need more education for parents about where and how babies should sleep. Parents need to know the dangers of some risk factors are based on their baby's age.

Last updated July 14, 2014

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