[Skip to Navigation]
February 2017

Risk Factors, Protective Factors, and Current Recommendations to Reduce Sudden Infant Death Syndrome: A Review

Author Affiliations
  • 1Division of General Pediatrics and Community Health, Goldberg Center for Community Pediatric Health, Children’s National Medical Center, Washington, DC
  • 2Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
  • 3Division of General Pediatrics, University of Virginia School of Medicine, Charlottesville
JAMA Pediatr. 2017;171(2):175-180. doi:10.1001/jamapediatrics.2016.3345

Importance  Sudden infant death syndrome remains the leading cause of death in infants aged 1 month to 1 year in the United States.

Observations  While its exact cause is unknown, sudden infant death syndrome is believed to be multifactorial, ie, occurs in infants with underlying biological vulnerability who experience an exogenous stressor, such as prone/side sleeping or soft bedding, during a critical developmental period. Much genetic and physiologic evidence points to impaired arousal responses to hypercarbia and hypoxia, which ultimately leads to asphyxia. Known risk factors for infants include prone and side sleeping, soft bedding, bed sharing, inappropriate sleep surfaces (including sofas), exposure to tobacco smoke, and prematurity; protective factors include breastfeeding, pacifier use, room sharing, and immunizations.

Conclusions and Relevance  Despite our improved understanding of the physiologic mechanisms that cause sudden infant death, the mainstay of risk reduction continues to be a safe sleep environment, as most infants who die suddenly and unexpectedly do so in unsafe sleep environments.

Add or change institution