Intended for healthcare professionals

Clinical Review

Sudden infant death syndrome and advice for safe sleeping

BMJ 2015; 350 doi: (Published 28 April 2015) Cite this as: BMJ 2015;350:h1989
  1. Rosemary S C Horne, professor12,
  2. Fern R Hauck, professor3,
  3. Rachel Y Moon, professor4
  1. 1The Ritchie Centre, Monash Institute of Medical Research and Prince Henry’s Institute, Melbourne, Victoria, Australia
  2. 2Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
  3. 3University of Virginia School of Medicine, Charlottesville, VA, USA
  4. 4George Washington University School of Medicine and Health Sciences, Washington, DC, USA
  1. Correspondence to: R S C Horne rosemary.horne{at}

The bottom line

  • Sudden infant death syndrome (SIDS) remains the leading cause of death between 1 month and 1 year of age

  • Placing infants in the prone position (on their stomach) to sleep and exposure to maternal smoking are major risk factors for SIDS

  • Infants born preterm are at four times the risk compared with infants born at term

  • The safest place for infants to sleep is in the parental bedroom in their own cot and in close proximity to parents to allow for feeding and comforting; sleeping on a sofa or couch with an infant is extremely dangerous

  • Bed sharing with infants is a risk factor for SIDS—infants are at highest risk if younger than 3 months or if the parents smoke, use illicit drugs, or consume alcohol

  • Breast feeding decreases the risk of SIDS and therefore mothers should be encouraged to breast feed for this reason and other health benefits

Sudden infant death syndrome (SIDS) is currently defined as “the sudden and unexpected death of an infant under 1 year of age, with the onset of the lethal episode apparently occurring during sleep, that remains unexplained after a thorough investigation including performance of a complete autopsy and review of the circumstances of death.”1 Before this 2004 definition a diagnosis of SIDS did not require a death scene investigation or to have occurred during sleep, and therefore the definition for SIDS varies in the studies cited in this review.

Sources and selection criteria

We searched PubMed for articles in English published between 1980 and January 2015 using the search terms “sudden infant death syndrome”, “SIDS”, and “cot death”. To date most studies have used a case-control design and there are no randomised controlled trials. The information in this review results primarily from the literature arising from these case-control studies and from the policy statements and …

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