SIDS: Every New Parent’s Greatest Fear

healthy babyDear Mr. Dad: A few years ago, my sister’s three-month old infant died from Sudden Infant Death Syndrome. My baby is now the same age, and I’m in a panic worrying that the same thing will happen to him. I’m not even sure I understand what SIDS is and what the risk factors are. More importantly, is there anything my wife and I can do keep my son from suffocating to death?

A: In the U.S., around 4,000 babies die from Sudden Infant Death Syndrome every year—that’s about one death per thousand births. That makes SIDS the most common cause of death of children between one week and one year old. Before we get to risk factors and how to reduce them, we need to clear up a big misconception: SIDS is not “suffocating to death.” According to First Candle (, SIDS is “the sudden, unexpected death of an apparently healthy baby under one year of age,” whose death remains unexplained even after an autopsy.

Unfortunately, despite millions of dollars spent on research, there’s no consensus on what causes SIDS. However, many experts believe that the most likely culprit is the baby’s failure to wake up when a breathing problem (such as sleep apnea) happens during sleep. There aren’t any medical tests than can reliably identify high-risk babies. But here are some of the known risk factors.

  • Certain types of brain abnormalities increase SIDS risk.
  • SIDS is most common in babies two to four months old. Ninety percent of deaths happen to babies under six months.
  • SIDS takes more boys than girls. Multiple-birth babies and preemies are also at higher risk.
  • African American and American Indian babies are more likely than white babies to die of SIDS.
  • It’s more common in cold weather when respiratory infections are more likely.
  • It’s more common in families where one or both parents smoke, share a bed with their baby, put the baby to sleep on his or her stomach, overdress the baby, or cover him or her with fluffy bedding.

Despite all those risk factors, SIDS remains unexplained, which means that most babies who succumb to it don’t fall into any of the above categories. There’s no surefire way to prevent SIDS. But there are a number of proven ways to reduce the risks.

  • Put your baby to sleep on his back. Until about 1994, doctors thought that babies who slept on their back would choke on their vomit if they spit up. It turns out that babies are smart enough to turn their heads. SIDS deaths are more than 40% lower now than before the recommendations changed.
  • Don’t smoke and don’t let anyone who does near your baby. Babies exposed to cigarette smoke (even before birth) are at high risk for SIDS. According to the CDC, chemicals in cigarette smoke may interfere with babies’ ability to regulate their breathing.
  • Don’t overdress the baby. A number of studies show that overheated babies can fall into a deep sleep that’s hard to wake from.
  • Put the baby to sleep on a firm mattress: no pillows, fluffy blankets, plush sofas, waterbeds, shag carpets, or beanbags.
  • Give your baby a pacifier at bedtime. A number of studies show that pacifier use greatly reduces SIDS risk. That may be because it helps keep airways open or because pacifier-sucking babies may sleep less deeply. But does it really matter why?
  • Encourage your wife to breastfeed. Research shows that breastfed babies are 60% less likely than formula-fed ones to die from SIDS. They also tend to be lighter sleepers. Plus, breastmilk strengthens the baby’s immune system, which is always a good thing.
  • Don’t panic. SIDS is a devastating, horrible experience for any parent, but try to remember that 999 out of 1,000 babies don’t die of it.

Photo credit: Vicente

Germs: Cleanliness is Next to Sickliness

Dear Mr. Dad: With all the talk about bird flu and swine flu I’m in a panic about germs. I’m putting antibacterial soaps all over my house and hand sanitizers in the car and my kids’ backpacks. Is there anything else I can do?

A: The most important thing you can do right now is relax. There are a number of ways to reduce the risk that you or your children will get the flu (or come in contact with other dangerous germs), and antibacterial soaps and hand sanitizers are at the bottom of the list: Get a flu shots every year, stay away from people who are sick, cover mouth and nose when coughing or sneezing, wash hands thoroughly with soap and water (skip the antibacterial stuff, though—more on that in a minute), keep your hands away from your eyes, nose, or mouth (that’s the way most germs get into our body), get plenty of sleep, and eat right.
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Pacifiers, sippy cups, and bottles might not be as harmless as you’d think

When manufacturers stopped making pacifiers that could break apart and a lot of people switched from glass bottles to plastic (BPA-free, of course), we thought the big dangers were gone. Maybe not.

Proving my theory that babies and toddlers are constantly searching for new ways to scare the hell out of their parents, a new study comes out showing that an average of 2,270 children under three are treated in hospital emergency rooms every year for injuries involving pacifiers, bottles and sippy cups (the majority are one-year olds).  According to the study, which looked at ER data for the past 20 years, two thirds of the accidents involved bottles and 86 of the injuries involved falling down. In 14.3% of cases, the culprit was the seemingly harmless sippy cup.

Binkies, bottles and sippy cups: Handle with care

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Hittin’ the Road, Baby

Dear Mr. Dad: We just had a baby and are eager to introduce her to my parents. But they live quite far away and are too old to travel. How soon is it safe to fly with an infant?

A: Unfortunately, there is no hard and fast rule. Some experts advise waiting until the baby is at least six weeks old before flying, largely because airplanes are essentially giant, germ-filled tubes. Others say that if the baby is healthy, there’s no need to wait. Ultimately—assuming there are no health issues—you should hold off until you feel comfortable with the whole idea of traveling with an infant.

Personally, I think that four to six months is a great age to introduce babies to flying. They’re generally pretty happy to be held for hours at a time (once they start crawling, all bets are off), they sleep a lot, and don’t need a ton of stuff yet (especially if you’re breastfeeding).

Before booking your flight, have your pediatrician clear your baby for take-off. If she was born prematurely or has any respiratory conditions, she may be grounded for a while because of the low-oxygen environment in the pressurized cabins. Also, if your baby is sick, you’ll probably want to postpone the trip.

Next, check with the airline. Some have policies against newborns flying until they reach a certain age, such as 7 days old. Most airlines allow babies to fly as a “lap child” (meaning they fly free but don’t have a seat and need to stay in your lap) until age two. However, the FAA recommends buying a seat for all infants and bringing your FAA-approved car seat on board so your baby can be strapped in (rather than on your lap) because that is the safest place. (If you hold your baby, put the seat belt around your waist, and hold the baby outside of it).

A warning: Traveling with an infant is infinitely more complex than traveling solo. A delayed flight or sitting on the runway for an extra two hours may have been annoying before, but with a baby, it can be torture. Here are some tips to smooth out some of the potential bumps:

  • Pack at least one diaper for every hour of travel, plus a few extras (there’s no such thing as too many diapers).
  • If your baby is formula-fed, bring twice as much as you think you’ll need. The TSA’s 3-ounce restriction for liquids doesn’t apply to infant formula or pumped breast milk (as long as you are traveling with your baby) so you should be able to carry-on as much as you’d like. But get there extra early, in case you have to educate the screeners.
  • During flight, if your baby is in pain–especially during take-off and landing—it’s probably due to changes in ear pressure. Breastfeeding or sucking on a bottle or pacifier might help.
  • The air on planes is dry so feed your baby often to avoid dehydration.
  • Bring lots of extra clothes in case of diapers leaking, spit-up, or worse (bring some for the baby too) and a changing pad (airplane lavatories often have a tiny changing table, but it’s often easier to do it at your seat).
  • Skip the early boarding. Send one parent ahead to set things up while the other waits until the last possible second to bring the baby on board.
  • Find out the airline’s policy about gate checking strollers and car seats. Most won’t charge you, but that could change at any moment.

Pacifier Addiction

Dear Mr. Dad: My son loves his pacifier, but he’s almost three and my wife says it’s time for him to give it up. But when I try to take it away he doesn’t sleep and cries hysterically. What’s wrong with a pacifier?

A: The day-to-day life of a toddler can be a lot more stressful than we realize. New activities all the time, constant field trips and errands, new friends, a transition to preschool—and then someone comes along and tries to take away the one thing in life he can always count on: the binky. It sounds like your son’s pacifiers have become “transitional objects”—something (as opposed to some person) he uses to soothe himself and relieve stress. If so, it might be wise to let him keep using it until he develops other coping mechanisms.

Besides relieving a child’s stress and giving him a sense of comfort and security, there are other benefits associated with pacifier use. One of the biggest is that pacifier use seems to reduce the risk of Sudden Infant Death Syndrome (SIDS). The connection is so strong that the American Academy of Pediatrics actually endorses pacifier use. According to the AAP, most children break the pacifier habit on their own between ages 2 and 4. In addition, some parents (and researchers) believe that taking away the pacifier too soon may forcethe child to find a different comfort measure, like sucking her thumb or shirt sleeves, pulling her own hair, or carrying around a blankie.

That said, there are plenty of folks who believe that pacifiers shouldn’t be used after a baby’s first birthday. There’s a lot of disagreement about this, but in fairness, here are some of their reasons:

  • With a pacifier in his mouth, your son may talk less and may have problems with pronunciation. Taken to an extreme level, binky use could damage his tongue and lip muscles, which in turn could delay his language development and might even cause a lisp.
  • For young babies, dependence on a pacifier for sleep means they’ll wake up and need your help finding it if the thing falls out of their mouth at night.
  • Newborns may have trouble learning to breastfeed properly if they get a pacifier before breastfeeding is well established.
  • Although no one can say exactly why, some studies link pacifiers to increased risk of ear infections.
  • Prolonged pacifier use might cause buck teeth. This isn’t an issue for baby teeth—they move back into position after a few pacifier-free months—but it could be a problem with adult teeth, which typically appear around 4-6 years. The American Dental Association and the American Academy of Pediatric Dentistry discourage pacifiers after age four.

The best way to settle this is to ask your son’s pediatrician and dentist (if he’s doesn’t have one, he should). If you decide to give up the pacifier, here are some strategies to try:

  • Give them away (tell your son he’s giving them to babies who need pacifiers, or have him leave them under his pillow for the pacifier fairy).
  • Exchange them for a toy.
  • Cold turkey—just throw them away (for example, after his 3rd birthday when he’s officially a “big boy”).
  • Ease the transition away from the pacifier habit by offering a reward for achieving a specified number of pacifier-free days or for giving it up completely.
  • Rely on peer pressure. Surround your son with other (pacifier-free) children and he may decide he doesn’t want to be the only “baby” using a pacifier.