Measures to promote a safe sleeping environment and to reduce the risk of all sleep-related infant deaths including Sudden Infant Death Syndrome (SIDS)

Conclusion: Strong indications for effectiveness

Effective measures to prevent Sudden Infant Death Syndrome (SIDS) are:
- Sleeping on the back.
- Avoiding overheating and head covering in infants.
- Avoiding contact with smoking
- Breastfeeding
- Avoiding sedatives in children
- Avoiding alcohol and illicit drug use during pregnancy and after the infant’s birth.
- Use of pacifiers

Recommendations (for research & practice)

The effects of infant care practices on the incidence of SIDS are practicable and ethical. Continuous monitoring of SIDS cases and controls is recommended to assess the uptake and effectiveness of preventive measures. Continuous case-control monitoring would also ensure that new initiatives in baby care could be tested at the earliest possible stage.

Recommendations for practice include the following advice for parents, carers and health professionals:
- a baby should be placed to sleep on his/ her back rather than stomach or side
- a baby should be placed to sleep in a safe sleeping environment. This includes the use of a safety-approved crib, portable crib, play yard, or bassinet. Put the baby to sleep on a firm, flat mattress with no pillow or toys and only a fitted sheet under him/ her. Pillows, quilts, comforters, sheepskins, and other soft surfaces are hazardous when placed under the infant or in the sleeping environment.
- blankets should not be used. In cold conditions, the baby should be clothed in warmer clothing such as footed pyjamas or a cotton one-piece under a wearable blanket or sleep sack.
- bed sharing with a baby is not recommended. A baby should be placed in his/her own crib/bed. Room-sharing without bed-sharing is recommended.
- smoking during pregnancy, in the pregnant woman’s environment, and in the infant’s environment should be avoided.
- the use of alcohol or ilicit drugs during pregnancy and after the infant’s birth should be avoided.
- breastfeeding is recommended.
- giving the baby medicines that induces dullness or sleepiness is not recommended..
- offering the baby a pacifier when he/she is placed to sleep is acceptable.
The measures mentioned above do not indicate an exclusive course of treatment or serve as a
standard of medical care. Variations, taking into account individual circumstances, may be

Review Date: 12/06/2012
Version: 1.1
Status: Publish

Articles (reviews) and reports were included that were published between 1990 and 2011, in English and Dutch. The outcomes of the study were reviewed by the Dutch Consumer Safety Institute.

Strategy: An online literature search was performed by a researcher of the Consumer Safety Institute and after this a more thorough search was performed by the documentation centre of CSI (Catalog CenV, Pubmed, Injury lit, Google, Websites, 'Grey' literature). Results of each search were compared on differences and potential missed studies were added. First the titles and then abstracts were scanned in order to include relevant studies. In the case of insufficient information obtained from abstracts the full text articles were obtained. Relevant articles were scrutinized and background documents were created. In addition, relevant references of included articles were checked on new and relevant articles (i.e., snowball search).

The outcomes of the study were reviewed by an expert in the field of child safety in the summer of 2012.

Background documents

Where should infants sleep? A comparison of risk for suffocation of infants sleeping in cribs, adult beds, and other sleeping locations (version 1.0)
N.J. Scheers, G.W. Rutherford, J.S. Kemp (2003)

Sleeping prone and the risk of sudden infant death syndrome (version 1.0)
Warren G. Guntheroth, Philip S. Spiers (1992)

Sleeping position for infants and cot death in the Netherlands 1985-91 (version 1.0)
Guus A. de Jonge, Ruud J.F. Burgmeijer, Adele C. Engelberts ...[et al.] (1993)

Sudden unexplained infant death in 20 regions in Europe : case control study (version 1.0)
R.G. Carpenter, L.M. Irgens, P.S. Blair ...[et al.] (2004)

SIDS and other sleep-related infant deaths : expansion of recommendations for a safe infant sleeping environment (version 1.0)
Rachel Y. Moon ; Task Force on Sudden Infant Death Syndome (2011)