Background In infancy, fatal events associated to sleep and bedding may occur. While in industrial countries accidents and suffocation have become rare due to manufacturing regulations for infant beds and bedding materials, the Sudden Infant Death Syndrome (SIDS) is still a relevant ‘cause’ of death in infancy. Although the final pathway of SIDS has not been clarified thus far, soft mattresses and cushions may represent a risk factor. Furthermore, materials compromising thermoregulation may play a major role. The same holds true for environmental conditions like excessive temperature and nicotine exposure. Recently, also bedsharing and sleeping on sofas have been identified as factors potentially contributing to SIDS risk.

Recommendations for safe infant sleep

Worldwide, paediatric societies and other health professionals have launched campaigns for a ‘safe infant sleep’ by promoting recommendations how to bed babies. These recommendations include (slogans of individual campaigns in brackets):

- Same room, but individual beds for baby and parents (avoidance of bedsharing)

- Infant beds according to safety regulations

- Avoidance of soft underbedding and (soft) cushions

- Bedding in supine position for every sleep (‘Back to sleep’)

- Avoidance of overheating (‘Keep cool, baby’)

- Preferably sleeping bags instead of blankets (‘Bag to sleep’)

- Neutral thermal environment (16°C–20°C)

- Consideration of pacifier use for every sleep

- Avoidance of nicotine exposure

- Only small toys if any

Consequences of campaigns Recent recommendations have led to a significant reduction of SIDS incidence in many countries. While between 1970 and 1990 SIDS rates were in some countries as high as 2 per 1000 liveborn infants, the introduction of preventive measures have significantly reduced the incidence of this fatal event. In some countries and regions (eg. Netherlands, Styria/Austria) SIDS incidence is now as low as 0,1 per 1000 liveborn infants. Today, SIDS occurs almost exclusively in families not adequately following the recommendations mentioned above.

Conclusion Altogether, it remains unsolved in which way the different preventive measures are able to modify the fatal cascade leading to SIDS. Nevertheless, due to the proven effects, as many of these preventive measures as possible should be applied. By doing so, the risk to experience SIDS in an individual infant can be reduced to almost zero and thousands of lives can be saved worldwide in this way every year.