Prevention of cot death

Cot deaths or Sudden infant death syndrome (SIDS) is rare especially after six months of age when the babies are little more physically mobile.

In spite of the small risks, cot death is a devastating occurrence and rates can be reduced by simple preventive and precautionary measures.

Preventive strategies for cot deaths include (1-7) –

  • Changing the sleeping position – Sleeping on the stomach has been associated with crib deaths. It is supposed that sleeping on the front leads to pressure on the jaws and obstruction in breathing.

    Babies should always be laid to sleep on their back, with their feet touching the foot of the cot.

  • Bedding, sheets or blankets – many cases of crib deaths occur due to suffocation in bedding.

    Sheets or thin blankets should be preferred and they should not come higher than the baby’s shoulders. This will prevent wriggling under the covers.

    In addition, the covers should be securely tucked in so they cannot slip over the baby’s head during sleep.

  • Firm mattress and crib – Babies should be made to sleep on a firm mattress with no heavy blankets, quilts, sheepskin, duvets etc. The cot, bassinet, portable crib, or play yard should meet current safety standards.

    Cribs with broken or missing parts, or drop-side rails should be avoided. Babies should not be allowed to sleep or nap on an armchair, sofa, water bed, pillow or cushion.

  • Separate cot – The safest place for the baby to sleep is in a crib or cot in a room with the parents for the first six months.

    The baby should never be brought to the adult bed. This prevents accidents.

    For example, one parent may roll over the baby in their sleep suffocating the baby.

    Sharing bed with a baby is especially dangerous if one or both parents are smoking, drinking alcohol or taking medication that makes the drowsy, or if they are feeling very tired.

    In addition, the baby may fall off the bed or get injured getting caught between the wall and the bed.

  • Tummy time – when awake the baby should be allowed time on their stomach. This helps them practice holding their head and encourages development. It must be ensured that the baby does not fall asleep on its tummy.
  • Avoidance of tobacco smoke – Mothers should not smoke or be exposed to cigarette smoke during pregnancy. Babies should be kept in a smoke free environment right from birth.
  • Controlling room temperature – Overheating of the babies with bed clothes, bedding or room heaters has been known to raise risk of SIDS. This should be avoided.

    The room temperature needs to be comfortable for the baby. The aim should be to keep the baby's room temperature between 16 and 20°C (61-68°F).

    In addition babies should never sleep with a hot water bottle or electric blanket or close to a radiator, heater or fireplace.

  • Getting help for minor ailments – Parents need to consult their health care providers in case of minor ailments in the baby like wheezing, breathing difficulty, fever, rash, etc. The baby might appear sick, refuse feeds and refuse to respond normally.
  • Breast feeding has been found to reduce risk of crib deaths. Mothers are advised to breast feed as long as they can.
  • Parents should avoid commercial devices marketed to reduce the risk of SIDS. These are sold with promise of maintaining sleep position or to reduce the risk of rebreathing. However, there is no evidence of these being effective.

    Home monitors to measure breathing or heart rates should not be used routinely. These are needed for only few selected infants. There is no evidence that use of such home monitors decreases the incidence of SIDS.

  • Other preventive measures include regular health check-ups for young pregnant mothers to ensure normal birth weight mature term births.

    Too frequent pregnancies and early or teenage pregnancies raise risk of SIDS and should be avoided.

    Babies with heart defects or breathing problems need attention and early management. Babies must be given all recommended vaccinations.

    There are studies that show that immunizations can reduce the risk of SIDS by 50%. Pacifiers may help some infants and reduce the risk of SIDS.

Further Reading

Last Updated: Jun 9, 2023

Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.


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