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Every parents silent stressor: SIDS and ASSB

Updated: Jun 9, 2022

A topic so difficult to talk about that we often just stress about it in silence. This might be a tough post to read. None of us want to see the words "baby" or "infant" in the same sentence as "death". It's enough to make us shudder .

I remember not wanting to hear or even read up on it, because I couldn't stomach the thought of SIDS. But, I have since learned that information is power and being informed on the facts around SIDS (and ASSB) actually made me feel more at ease and more prepared.

Here is what I really want you to take away from this article:
Firstly: You, as a responsive and responsible caregiver are not a danger to your baby. In fact, you are the biggest protective factor they have, and guess what? They know it!
Secondly, it may put your mind at ease to know: The prevalence of SIDS is extremely low and really only a risk for a very small percentage of babies.
Lastly: The prevalence of ASSB is on the decline with parents being more informed on safe sleep practices. And by you being informed, you can prevent it as well!

What is SIDS and ASSB?

Because both of these tend to happen during sleep, there is a lot of confusion between SIDS and ASSB. I would like you to read through the information below so you can make informed decisions about your baby's sleep and safety.

SIDS: Sudden Infant Death Syndrome

When an infant under a year old dies suddenly and no cause of death can be found, it is considered a SIDS death. This means: it's not suffocation, there are no underlying medical conditions or known health problems, no accidents or birth defects. SIDS usually happens during sleep, and is linked to babies not being easily aroused. So I like to remind parents that waking through the night is not only normal, it is necessary. It serves a protective function. We WANT our babies to be easily roused in the first couple of months after birth.

I want to make it clear that current research indicates that true SIDS only happen in a very small group of vulnerable babies who already have an underlying risk (a very specific health issue). Recently there has been a breakthrough in research that found that one of these possible underlying causes could be found in a biomarker. "They found the activity of the enzyme Butyrylcholinesterase (BChE) was significantly lower in babies who died of SIDS compared to living infants and other non-SIDS infant deaths. BChE plays a major role in the brain’s arousal pathway" read more here .

Ninety percent of SIDS happen before 6months (most between 1 and 4 months) and these numbers drop tremendously after 9 months (only 2%). The USA and New Zealand has the highest statistic of SIDS deaths per capita, and even there it amounts to 0.27 per 1000 babies (or roughly 1 in 3700).

Now, just because there is no known cause doesn't mean there are no factors that can increase (or decrease) your baby's risk.

These are the biggest risk factors contributing to SIDS:

According to Wiessinger, West, Smith and Pitman (Sweet Sleep) "at least three-quarters of SIDS deaths involve smoking, stomach sleep and formula feeding."

Smoking - during pregnancy, after birth and in the home. This is by far the biggest risk factor contributing to SIDS and depending on the study can increase the risk of SIDS by 2-10 times!! The risk depends on how much exposure to smoke there is/was.

Prone sleeping position (belly sleeping) - In the 1990's the "Back to sleep" campaign was launched and between 1990-2005 we saw a 40% decrease in SIDS. It turns out that babies tend to sleep too soundly on their stomachs (not as easily roused), sleeping tummy down may also compress their chest, which could restrict breathing. (note: This does not refer to babies sleeping chest to chest on their mother and it also only refers to babies who cannot roll front to back or back to front)

Leaving baby to sleep unattended - This refers to leaving your baby physically alone to sleep in a separate space than you, but also refers to caregivers who are cognitively impaired (use of alcohol, drugs or medications that inhibit your ability to care for your child). This is why rooming-in is advised for the first 6-12 months of your baby's life.

Formula feeding - It's not only that breastfeeding decreases the risk of SIDS, but formula feeding actually increases the risk by 56%. The risk is "dose dependent" meaning the more formula, the higher the risk. Obviously the priority when caring for a baby is that he or she be fed! So, please feed your baby. Even if it is formula or mixed feeding.

There is a difference between CAUSE and RISK. You can decrease your baby's risk of SIDS dramatically by not smoking; having your baby sleep on their back (when not in your arms); keeping your baby in close proximity and breast feeding.

This cot is not safe

ASSB: Accidental strangulation or suffocation in Bed:

SUID is a term that was coined in the mid 1990's, which include infant deaths caused by SIDS, ASSB (Accidental strangulation and suffocation in Bed), poisoning or overdose, cardiac problems, infections and "other" or "unknown" causes.

For the purposes of this post, I'm going to focus on ASSB, because this is where we, as parents, have some control and the ability to prevent an accidental "cot death" as it was known years ago. This includes: suffocation (smothering), strangulation and entrapment.

How do we prevent ASSB's and set up a safe sleep environment?

Preventing breathing hazards are mostly common sense, and chances are you're already doing most of them!

All families are unique and have different needs. What works for one might not work for the other, but I always recommend that you set all possible sleep spaces up for safety, even if you don't plan on using it. This includes: your baby's cot, bassinet, pram and YOUR BED.

Avoiding suffocation:

Keep the sleep space free of any loose blankets, throws, pillows, stuffed toys, bumpers and wedges. Consider your baby's clothing as well: for example, avoid putting your baby down for sleep in a hoodie top as it can go over their face.

Avoid strangulation:

Keep the sleep space free of anything that dangles and/or tangles. No cords or ties near the cot (including the cords on blinds, lights, monitors, etc.). Also, no clothing with draw strings or bibs around their neck.

Avoid entrapment:

Ensure that there are no spaces or gaps where your baby can become trapped or wedged. This includes the slots of your baby's cot (read more here) as well as spaces between the mattress and the cot/bassinet OR spaces between your bed and the wall/bedside table/etc.

Other safety factors to consider: No smoking in the house or around your baby; keep your baby at close proximity to you for at least the first 6-12 months; be mindful of the use of substances (including alcohol and medications that could inhibit your functioning); Don't hang anything heavy above the cot, like shelves, framed artwork, mirrors or banners that can come loose, etc.

How safe bedsharing plays into all of this:

It angers and confuses me when I read about safe sleep guidelines and they add bedsharing to the list of "things to avoid", as safe bedsharing has been proven (over decades worth of research) to be a massively effective protective factor against both SIDS and ASSB. The problem comes in when bedsharing (as with solitary sleep) is not done safely.

The other confusing factor that comes into play is the synonymous use of the terms: bedsharing and co-sleeping. Co-sleeping refers to an infant and ANY adult sleeping together on ANY surface. This is a huge suffocation and entrapment risk, because it includes sleeping on a chair, sofa or unsafe bed and also doesn't specify the safety factors around the adult.

According to professors Helen Ball and James McKenna 60-75% of breastfeeding mothers will end up bedsharing with their baby, whether they plan to or not. So it's imperative that we inform parents on how to do so safely.

Furthermore, bedsharing and sleeping within close proximity adds a protective layer and research shows that there are a whole host of benefits to safe bedsharing for both baby and mother, including: reduction of infant stress hormones, reduction in irregularities in infant breathing; Increase in the production of endorphins; it supports breastfeeding (which is also a protective factor) and it helps balance baby's body temperature.

When it comes to bedsharing safely, we want to follow the "Safe Sleep 7":

You need to be:

1. A non-smoker

2. Sober / unimpaired

3. Breastfeeding (for at least the first 4 months)

Your baby needs to be:

4. Full-term and healthy

5. Kept on his back when not breastfeeding

6. Un-swaddled, in light pajamas

You both need to be:

7. On a safe sleep surface

I hope you feel more confident, informed and at ease knowing more about this topic.




Sweet sleep (Wiessinger, West, Smith and Pitman)

Safe infant sleep (James J. Mckenna)

Mother-infant cosleeping, breastfeeding and sudden infant death syndrome: what biological anthropology has discovered about normal infant sleep and pediatric sleep medicine. (J.J McKenna; H.L Ball; L.T Gettler. 2007); SIDS and other sleep related deaths (R.Y Moon. 2011); Cigarette smoking as a risk factor for SIDS: a population based study (B. Haglund; S. Cnattingius. 1990)

Cot death: cause and prevention - experiences in New Zealand 1995-2004 (T.J. Sprott. 2004); CDC infant death scene investigation. 2012

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