After the “back to sleep” campaign in the 1990s, there has been a major reduction in the incidence of sudden infant death syndrome (SIDS). Even though prone sleeping position has been proved to be an important risk factor for SIDS, the exact pathophysiological mechanism leading to death, is still not completely understood. In this paper we look at the riskfactors for SIDS after the “back to Sleep” campaign. We evaluate the literature, and try to summarize the information about the most relevant riskfactors.
Prone sleeping is still an important isolated riskfactor for SIDS. According to the literature exposure to tobacco-smoke increases the SIDS- risk significantly. The incidence of SIDS could be reduced by two thirds if parents did not smoke. Co-sleeping is an independent riskfactor for SIDS when the infant is younger than 8 weeks. When the infant is older than 8 weeks, the literature is not conclusive. Infection is not an independent riskfactor, but may contribute to SIDS in vulnerable infants. Use of pacifiers and breastfeeding have been suggested to have a possible protective effect. Use of pacifiers slightly reduces the SIDS-risk, but it is controversial whether this should be recommended as a possible method to reduce the SIDS- ratio. The studies concerning breastfeeding are not conclusive.
We quote the current recommendations from the American Society of Pediatrics concerning prevention of SIDS.
Further investigations are still needed to find the exact mechanism leading to SIDS. The Norwegian government has decided that from the first of November 2010, all families who experience sudden and unexpected death of an infant or child under the age of 4 years, should be offered a deathscene investigation. This may contribute to further knowledge, and may also stimulate to new studies concerning riskfactors and mechanisms leading to SIDS.