Orthodox SIDS Prevention Advice

Fallacy: To reduce the risk of SIDS, breastfeed your baby.

Breastfeeding does not reduce the risk of SIDS, as the following statistics demonstrate:

The breastfeeding rate in New Zealand has risen during recent decades and is very high by international standards (over 90% of newborns and 55% of babies aged six months). Yet up to 1995 the New Zealand SIDS rate was the highest in the world.

In the United States, only 60% of newborns and 21% of babies aged six months are breastfed. Yet in 1996 the US SIDS rate (0.75 deaths per 1000 live births) was less than half the New Zealand rate (1.8/1000).

The United Kingdom has a low breastfeeding rate (66% of newborns, falling to 21% of babies aged six months), yet the United Kingdom SIDS rate is low (in 1999 only 0.57/1000).

While breastfeeding is good practice for nutrition and various health reasons, it is not relevant to SIDS prevention.

Fact (but only a partial solution): To reduce the risk of SIDS, sleep your baby face up.

Face-up sleeping decreases the risk of SIDS on mattresses which are not wrapped with a BabeSafe mattress cover, but it is only a partial solution.

The reason why face-up sleeping reduces the SIDS risk is simple: the gases which cause SIDS (phosphines generated from phosphorus, arsines generated from arsenic, and stibines generated from antimony) are all more dense than air. They diffuse away from a baby's mattress towards the floor, so a baby sleeping face up is less likely to ingest them. However, the protection afforded by face-up sleeping is limited.

Face-up sleeping is not very effective in preventing SIDS in cribs which have enclosed sides, as these can cause gases to be trapped around a baby. It is not very effective against the danger of phosphine, as this gas is only slightly more dense than air. Any phosphine generated in a baby's mattress is likely to be present in the air which a baby breathes, even if the baby is sleeping face up.

Face-up sleeping does not eliminate the risk of SIDS. The risk is eliminated by separating the baby from the source of toxic gas using a gas-impermeable film which does not contain phosphorus, arsenic or antimony (and does not pose a risk of suffocation).

If a baby's mattress is correctly wrapped and the correct bedding used, sleeping position is irrelevant to SIDS prevention.

Fallacy: To reduce the risk of SIDS, don't smoke during pregnancy or around your baby.

Smoking does not cause SIDS, as recent history shows:

Smoking was very common in Britain in the 1930s and 1940s, yet SIDS was virtually non-existent. Smoking is prevalent in present day Russia, yet SIDS is rare in that region.

No cause-and-effect relationship between smoking and SIDS has ever been established. In fact, they are simply socio-economic parallels. Smoking is more common among poorer people - and so is SIDS. But it does not follow that smoking is therefore a SIDS risk factor.

It is indisputable that along with having a higher rate of smoking, poorer people are also more likely to re-use mattresses. And it is also indisputable that SIDS occurs much more frequently on re-used mattresses. A 1989 mattress collection facilitated by British coroners showed that of some 150 SIDS babies, about 95% had died on previously used mattresses. (Remember also, once your baby uses a new mattress, it becomes more used each day, increasing the risk. Buying a new mattress is not a good enough preventive.)

It is not smoking but the re-use of mattresses which causes the high SIDS rate among lower socio-economic families.

Fallacy: To reduce the risk of SIDS, don't co-sleep with your baby if you smoke or smoked during pregnancy. Sleep the baby in a bassinet alongside your bed.

The risk posed by co-sleeping does not come from smoking - it comes from the mattress. Adults' mattresses frequently contain the same chemicals and fungi as babies' mattresses and therefore can generate the same toxic gases. Thus all co-sleeping results in a SIDS risk if the parents' mattress is not correctly wrapped for SIDS prevention. Placing a baby to sleep in a separate bassinet, co-sleeper, or crib alongside the parents' bed does not protect a baby against SIDS unless the baby's mattress is wrapped in a BabeSafe mattress cover.

Misleading statement: Keep baby's face clear at all times and place baby with feet to the foot of the crib.

Keeping a baby's face clear may reduce the risk of SIDS on mattresses which are not wrapped for SIDS prevention, but the protection afforded is very limited.

Sleeping a baby with feet to the foot of the crib provides no protection against SIDS. Any area on an unwrapped mattress where a baby sleeps is a potential source of toxic gas, since that is the area which becomes warm and moist (promoting the fungal activity which can cause gas generation).

Misleading statement: Use a firm, clean fitting mattress, with no gap between the mattress and crib sides.

While this advice may reduce the risk of injury in cribs, it is irrelevant to SIDS prevention.

Any unwrapped mattress which contains the chemicals phosphorus, arsenic and/or antimony can pose a SIDS risk. The risk can arise regardless of whether such a mattress is firm or soft, regardless of whether it is clean or soiled, and regardless of whether or not it fits the sides of the crib closely.

Misleading statement: Tuck in bedding securely.

Tucking in bedding securely may reduce slightly the risk of injury in cribs, but it increases the risk of SIDS on unwrapped mattresses. This is because tight tucking in can lead to increased temperature in a baby's crib; and an increase in temperature of even a few degrees can cause the rate of gas generation to increase tenfold or more.

Blankets must not be tucked in so securely that a baby cannot release the bedding for ventilation.

Misleading statement: Don't put baby on a waterbed.

Certainly, waterbeds which are not wrapped for SIDS prevention can pose a crib death risk. This is for two reasons:

First, waterbeds are frequently made of PVC (polyvinyl chloride), a soft plastic which often contains phosphorus and antimony (which can generate phosphine and stibine gases).

Secondly, waterbeds are frequently kept heated, which can cause increased fungal growth and hence increased gas generation. However, if a waterbed is correctly wrapped for SIDS prevention, sleeping a baby on the bed poses no SIDS risk.

Misleading statement: Soft toys and bumpers are not recommended.

The presence of soft toys in a crib is irrelevant to SIDS prevention. There is risk when animals stuffed with poly-fill are placed in the crib. When babies play with these toys they become soiled and will generate the same toxic gases if they are not laundered frequently.

Furthermore, if a baby's mattress is correctly wrapped for SIDS prevention, bumper pads pose no SIDS risk. In fact, they are to be recommended, as they reduce the risk of injury. Bumper pads should not be placed around all sides of a crib, because they greatly impede ventilation. If bumper pads are used, they should be positioned across the head of the crib and part way down the sides.

Fact: Pillows, loose quilts and duvets are not recommended.

Pillows, loose quilts and duvets can pose a very slight risk of suffocation or asphyxiation.

These items also pose a SIDS risk. This is because they almost invariably incorporate a fill which contains phosphorus and antimony. They also tend to be washed less frequently than other items of bedding, resulting in a greater likelihood of fungal activity.

Thus pillows, loose quilts and duvets can introduce a SIDS risk on wrapped mattresses and can increase the SIDS risk on unwrapped mattresses. Pillows, loose quilts and duvets should not be present in a baby's crib.