Risk Factors: at a glance
| Risk Factor | Factors increasing risk further | Advice to parents |
| Prone/side sleeping position |
| Always place an infant to sleep on their backs at the start of every sleep period. |
| Co-sleeping (beds, sofas or armchairs) |
| Avoid sleeping with baby on a sofa, avoid bedsharing where alcohol/drugs/cigarettes have been consumed by either party, ideally baby should sleep in their own cot or moses basket.
If bedsharing is required, signpost to the Safe Sleep Guidance on Lullaby Trust7. |
| Temperature and overwrapping |
| Check room temperature is not too hot and that clothing and bedding is appropriate.
Babies should not wear hats to sleep either during day or night. Signpost to the Lullaby Trusts guide8. |
| Soft sleeping surfaces/loose bedding |
| Remove pillows, duvets and quilts.
The sleeping surface should be firm enough that it does not indent/conform to the shape of the babys head. Place baby feet-to-foot of cot to prevent them wriggling down under covers. There is no established link between SIDS and products such as nests or pods, specifically marketed for infant sleep. They are, however, not recommended for use by The Lullaby Trust. |
| Second-hand mattresses | (The mechanism is unclear but thought to be related to bacterial carriage and allergens) | Avoid second-hand mattress use (risk has not been found to be significant if it is from the same home and used previously, e.g. for a sibling).
Covering it with a waterproof mattress protector will help keep it clean and dry. |
| Poor antenatal care | (Later initiation and fewer appointments potentially increase likelihood of pre-term birth and IUGR) | Encourage timely booking and attendance at all antenatal appointments. |
| Maternal smoking during pregnancy
Household smokers after birth | (Increases likelihood of pre-term delivery, low birth weight and IUGR)
(Greater susceptibility to bacterial and viral infections9) | Offer smoking cessation advice to parents |
| Drug and alcohol use |
Substance misuse is related to other SIDS risk factors such as low SES, poor antenatal care, low birth weight, infant neglect. (Impair parental decision-making around babys safety) | Offer drug and alcohol liaison services to parents.
Complete a referral. Strongly encourage parents to make alternative care arrangements for baby for the whole night if they plan to drink or use drugs. |
| Other maternal factors, e.g. young age, increased parity, short inter-pregnancy interval, twin pregnancy, low SES, previous safeguarding concerns, family history of SUDIC | (Likely to be due to increased risk-taking behaviour, poor engagement with healthcare services, mental ill-health, increased likelihood of child being in a neglectful environment10) | Encourage engagement with midwifery and health visiting teams and GP. |
Learning bite
There is evidence to show that where parents are able to understand the mechanisms of risk (e.g. accidental suffocation whilst sleeping in an armchair) that they are more likely to trust the message and adhere to the advice10.