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Sudden Infant Death Syndrome: Common Questions and Answers

Hillary J. Darrow, MD
Kayla A. Carman, DO
Vernon Wheeler, MD

American Family Physician. 2025;111(2):164-170.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Sudden unexpected infant death is an umbrella term that describes death that occurs in infants younger than 12 months that does not have an immediately obvious cause. Sudden infant death syndrome (SIDS) is diagnosed when there is no other explanation for the death after a detailed investigation. Despite a decrease in the incidence of SIDS after instituting the Back to Sleep campaign in 1992, sudden unexpected infant death remains a leading cause of infant death, and rates have plateaued. Although there has been a decrease in the incidence of SIDS, these numbers likely reflect improved investigations because rates of sudden unexpected infant death have remained stable. Recommended risk reduction strategies include promotion of a supine sleep position, safe sleep surfaces, room sharing, breast milk feeding, and pacifier use. Families should be counseled to avoid sharing sleep surfaces, overheating, loose bedding and inclined surfaces, and parental use of tobacco or alcohol. Infant swaddling without hats is recommended until they are attempting to roll over, after which appropriate clothing or wearable blankets can be worn. Family physicians should prioritize early education and consistent messaging to promote SIDS risk reduction.

Approximately 3,400 infants die of sudden unexpected infant death in the United States annually, and 1,400 of these deaths are diagnosed as sudden infant death syndrome (SIDS).1 SIDS requires a full investigation without alternative findings, whereas sudden unexpected infant death is a larger category of unexplained infant deaths that includes SIDS. Although talking about infant death can be difficult for families and physicians, early introduction and consistent messaging allow parents to reduce the risk of SIDS.2 This article reviews common questions about SIDS and presents evidence-based answers.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments
Surface sharing increases the risk of SIDS and should be avoided; however, room sharing is protective and should be encouraged.2,3,6,12 BPopulation-based, case-control study; case-control study; and clinical guidelines
Avoid the use of loose bedding or bedding accessories (eg, pillows, blankets, mattress toppers, crib bumpers) on the infant's sleep surface because they are associated with an increased risk of SIDS.2,3,6 BCase-control study and clinical guidelines
Exclusively feeding with breast milk is recommended in infants up to 6 months of age for the reduction of SIDS; however, even if infants are not exclusively fed breast milk, any amount is protective and should be encouraged.3,16,18 BCase-control study of 333 SIDS deaths and 998 age-matched controls and clinical guidelines
Infants younger than 12 months should be placed in the supine position while sleeping to reduce the risk of SIDS.3,6,13 BCohort studies and clinical guidelines
Avoid the use of inclined infant sitting and carrying products (eg, car seats, strollers, swings) for purposeful sleep, especially if unsupervised.3,21 BRetrospective review of 47 deaths reported to the US Consumer Product Safety Commission and clinical guidelines

SIDS = sudden infant death syndrome.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

HILLARY J. DARROW, MD, is family medicine obstetrics staff at the Family Medicine Residency Program at Fort Eisenhower Army Medical Center in Georgia. At the time this article was written, she was adjunct faculty at the Family Medicine Residency Program at Carl R. Darnall Army Medical Center, Fort Cavazos, Texas.

KAYLA A. CARMAN, DO, is adjunct faculty at the Family Medicine Residency Program at Carl R. Darnall Army Medical Center.

VERNON WHEELER, MD, FAAFP, is the research director and Family Medicine Obstetrics faculty member at the Family Medicine Residency Program at Carl R. Darnall Army Medical Center; an assistant professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Maryland; and a clinical assistant professor at Texas A&M Health Science Center College of Medicine, Temple.

Address correspondence to Hillary J. Darrow, MD, at culli1hj@cmich.edu.

Author disclosure: No relevant financial relationships.

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