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Risk and Protective Factors
for SIDS/SUID
Epidemiology:
• Leading cause of infant mortality between
1 month and 1 year of life
• < 1 per 1,000 live births in United States
• 2–3 times higher risk for African Americans and
American Indians / Alaskan Natives
Maternal Risk Factors:
• Smoking, drug use, and alcohol during pregnancy
• Poor prenatal care
• Mothers younger than 20 years of age
Infant Risk Factors:
• Prematurity
• Low birth weight
• Smoke exposure following birth
• Face-down or side laying position for sleep
Sleep position is the strongest modifiable risk factor for SIDS. The
risk of side sleeping is associated with the potential to roll into a
face-down position. Infant positioners have also been associated
with several cases of infant deaths.
Sleep Environment Precautions:
• Avoid soft sleep surfaces / loose bedding accessories
Use of blankets, quilts, and pillows increases the risk of SIDS
by as much as five, independent of sleep position. Avoid air
mattresses and sheepskins. The Canadian Pediatric Society (CPS)
has recommended that caution be used with crib bumper pads
due to the increased risk of suffocation. Per AAP, always place
infants face up in a crib or bassinet with a firm surface that is
certified for infant use.
• Use car seats and other sitting devices for sitting only
The use of car seats or other sitting devices (strollers, swings,
or infant carrier) has been associated with some sleep-related
deaths. AAP recommends avoiding car seats for routine sleep
outside travel situations.
• Share a room rather than a bed
The greatest risk of bed sharing is for infants younger than 3
months of age, or for infants of mothers who smoke. Risks also
increase for those in which a bed-sharer consumes alcohol or
sleeps with an infant on a couch or sofa. Multiple bed-sharers
increase the risk for SIDS. Avoid bed sharing with other children
or pets, or with anyone taking sleep medications / opiates
• Avoid overheating
The risk of SIDS increases with the amount of clothing and
blankets used and with increased room temperature. The infant
should be dressed lightly for sleep and the room temperature
adequate for a lightly dressed adult. If the infant is in a sleeper,
no more than one blanket should be used.
• Swaddling
Evidence is unclear as to whether swaddling is a risk factor or a
protective factor for infants. Swaddling tends to keep an infant
in a safe (face-up) or unsafe (face-down) position. If swaddling,
always place in face-up position.
Protective Factors:
• Breastfeeding
Breastfeeding is recommended for possible effects on reducing
the risk of SIDS.
• Pacifier usage
There is some evidence that pacifier use decreases SIDS risk.
Recommend delay of pacifier usage until breastfeeding is well
established — at approximately one month of age. Never attach
the pacifier to a strap or cord due to strangulation risks. Use to
place the infant to sleep but do not replace once asleep.
• Immunizations
SIDS is not associated with DTaP or other vaccines and may
actually be protective.
Contributors: Richard Harruff M.D, King County Medical Examiner; Whitney Taylor,
King County Child Death Review Coordinator; Lois Schipper and Rebecca Benson,
King County Child Death Review Committee members, Tatiana Kaehler, Violence
and Injury Prevention Associate
July/August 2016
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