Sudden infant death syndrome (SIDS) describes a sudden unexplained death in an infant under 1 year of age. Other causes (e.g., infections) must be excluded before a diagnosis is made. It is sometimes referred to as “cot death”. It most often occurs within the first six months of life.
Risk Factors
Risk factors for SIDS include:
- Prematurity
- Low birth weight
- Smoking during pregnancy
- Male baby (only slightly increased risk)
- Young maternal age (<20 years)
Breastfeeding is protective against SIDS.
Minimising the Risk
Measures to reduce the risk of SIDS include:
- Having the baby in their own sleeping space with a firm, flat mattress
- Sleeping on their back
- Keep their head uncovered
- Place their feet at the foot of the bed to prevent them from sliding down and under the blanket
- Keep the cot clear of toys and loose blankets
- Avoid overheating (not overdressing the baby)
- Maintain a comfortable room temperature (16-20ºC)
- Avoid smoking or handling the baby after smoking (smoke stays on clothes)
- Avoid co-sleeping on a sofa or chair
Planned co-sleeping in a bed is common. Measures that reduce the risk when co-sleeping include:
- Use a firm, flat mattress
- Avoid alcohol, drugs or sedating medications
- Avoid co-sleeping with smokers
- Keep pillows, duvets, loose bedding or other obstructions away from the baby
- Avoid other children or pets in the bed
Using a dummy during sleep may lower the risk. Breastfeeding should be established before introducing a dummy. The dummy does not need to be put back in if it falls out during sleep.
TOM TIP: Discussing SIDS is a common OSCE station, requiring you to counsel a parent who is worried about sudden infant death. They may be worried because a previous infant has been affected or they know someone else who has been affected. Empathise and be understanding of their anxiety, and give them advice in a way that does not imply blame and is non-judgemental. For example, don’t say, “It probably happened because you smoked and slept in the same bed”. Discuss things that “increase the risk”, but not “cause” it. Positively frame ideas: “there are things we can do to reduce the risk and make it much less likely to happen”.
Support
Support can come from:
- Charities (e.g., The Lullaby Trust, Teddy’s Wish, Sands and Petals)
- Bereavement services and counselling
- Care of Next Infant (CONI)
The CONI programme supports parents with their next infant after a sudden infant death. It provides extra support, home visits, resuscitation training, and access to equipment, such as movement monitors, for reassurance.
Last updated May 2025
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