Sudden Infant Death Syndrome: Beyond Back to Sleep

Lilian White, MD
January 12, 2026

An estimated 1,400 infants die in the United States each year due to sudden infant death syndrome (SIDS). SIDS is also the leading cause of death in infants 1 to 12 months of age at a rate of nearly 5 per 10,000 births in the United States. The 1992 Back to Sleep campaign was associated with an impressive 39% reduction in SIDS; in the 10 years following the campaign’s launch, rates of SIDS have remained relatively stable since then. A 2025 AFP article reviewed risk and protective factors for the prevention of SIDS.

There are both modifiable and nonmodifiable risk factors for SIDS. Nonmodifiable risk factors include preterm birth, low birth weight (< 2,500 g), poverty, male sex, and lack of prenatal care. Preterm birth increases the risk of SIDS by about 4´ compared with infants who are born full term. Male infants are more than 20% likely to die of SIDS than female infants, perhaps due to X-linked factors and differences in serotonergic receptors in the brain. Race does not appear to contribute to the risk of SIDS after controlling for socioeconomic factors.

Modifiable risk factors for SIDS include being younger than 12 weeks of age, maternal alcohol use disorder or smoking (maternal or household), sleep-surface sharing, and prone or side sleeping position. Car seats and strollers are not recommended for purposeful sleep because their inclined surfaces may increase the risk of SIDS, but allowing children to finish sleeping if they fall asleep while in the car, on a walk in a stroller, etc., is reasonable.

Infants younger than 12 months of age should be placed on their backs to sleep alone on a firm, unshared, flat sleeping surface, per the Safe to Sleep campaign. Several other protective factors may be recommended to reduce the risk of SIDS. Breastfeeding, room sharing (but not bed sharing), use of pacifiers at sleep onset, and preventing overheating have been shown to be helpful. Infants who are exclusively breastfed for the first 6 months of life appear to benefit the most; however, any amount of breastfeeding is beneficial. Room sharing is encouraged for the first 6 months of life and reduces the risk of SIDS by 50%.

Although pacifiers are protective when used at sleep onset, it is imperative to discourage parents from attaching the pacifier (via string) to the infant during sleep because this may present a choking hazard. The benefit of pacifiers appears to persist despite infants expelling them during the night.

Overheating may be prevented by avoiding excessive bedding and instead using swaddles or wearable blankets and avoiding hats indoors. Swaddling does not appear to reduce the risk of SIDS, but it may be helpful to promote supine positioning during sleep until the infant is able to roll over. Blankets are typically not recommended because of the risk of excess material obstructing the infant’s airway. Instead, it is recommended that snug bedding be used (eg, a fitted sheet) without additional items in the bed (eg, toys, crib bumpers).

It is not well known whether commercially available cardiorespiratory home monitors reduce the risk of SIDS in healthy or at-risk infants.