Sudden infant death syndrome (SIDS) remains one of the most anxiety-provoking topics for new parents, and with good reason. Despite decades of research and public health campaigns, about 10 babies still die each day in the United States from SIDS, many from accidental suffocation. If you’re expecting or a parent with a child under 1, this episode is a must listen–we’re talking with Dr. Russell Ray and Dr. Savannah Lusk, Directors of the Isabel Davis Center for Safe Children and longtime SIDS researchers. Today they’re walking us through everything a parent should know about SIDS, what the ABCs of safe sleep really mean, which products to avoid, and how parents can manage the overwhelming anxiety that comes with protecting their children.
Note: Information in this episode is provided for educational and entertainment purposes only. Information in the podcast does not constitute personal professional advice. We encourage you to independently evaluate any content and consult with appropriate professionals as needed for your specific circumstances.
Getting Started with Baby Podcast
A Few Key Quotes
On SIDS risks:
In the US, the focus is risk elimination. But there's common sense. If you're sleeping in a bed with an infant, the fewer pillows and blankets you have, the better. Bedsharing increases the risk of SIDS four-fold. Sleeping on a couch with an infant increases the risk more than 20-fold. These are risky behaviors, but speaking as a parent, you do your absolute best. — Dr. Ray
On sleep product essentials:
"Less is more. As long as you buy a pack-and-play, bassinet or crib in the United States that has been produced within the last ten years, you can buy the cheapest thing available to you and your child will be just as safe as if you spend $5,000 on some fancy crib." — Dr. Lusk
On product safety and marketing:
"If it's a product that says it reduces the rate of SUID or SIDS, you likely don't need it because there is no product that can do that." — Dr. Lusk
On calming SIDS anxiety:
"The fact is that it's less than 1% of these cases where the baby is in a safe environment, everything has been followed, and they just suddenly pass away. If you're [following safe sleep guidelines], what I would say is relax and go to sleep. Comfort yourself with the thought that you have done everything that you possibly can for your child. You are the absolute best parent that you can be to that child at that point in time." — Dr. Lusk
The Takeaways
- The ABCs of safe sleep are your most powerful tool: Alone, on their Back, in a Crib, in a Smoke-free environment. Following these guidelines reduces your risk significantly. Less than 1% of SIDS cases occur when all safe sleep guidelines are followed.
- Smoking and alcohol are major modifiable risk factors: Maternal smoking doubles SIDS risk, and prenatal alcohol exposure increases risk four-fold. When combined, smoking and alcohol use can increase risk up to 12 times. Even a father smoking outside the home increases risk due to third-hand smoke.
- Most unsafe sleep deaths aren't just about the environment: Hundreds of thousands of babies sleep in unsafe conditions every night and survive. Some babies may have underlying genetic vulnerabilities that make them more susceptible under stressed conditions. Because we don’t know how to identify those vulnerabilities yet, we need to be careful of the risk with all babies.
- Less is more when it comes to sleep products: Any crib, bassinet, or pack-and-play made in the US within the last ten years meets safety standards regardless of price. Avoid products claiming to reduce SIDS risk—no product can make this claim scientifically or legally.
- Baby monitors that track breathing aren't recommended: These products often create false alarms that increase parental anxiety and sleep deprivation. They can also give parents a false sense of security that leads to riskier sleep practices. If you’re baby truly needs medical intervention, the hospital will give you the devices you may need.
- Bouncers can be particularly dangerous: These products make it harder for babies to get back into safe positions with the incline making it easier for them to roll to their stomachs but harder to roll back, creating a suffocation risk. The incline can also lead to airway obstruction even when babies remain on their backs and awake due to chin-to-chest positioning.
- Build your village before you need it: Sleep deprivation can lead to compromised safety decisions. Identify your support network while pregnant and create a plan for getting help with safe sleep practices when exhaustion hits.
- If emergency strikes, call 911 immediately: Specify that it's an infant who isn't breathing. Don't attempt to drive to the hospital yourself—EMS teams are equipped to provide life saving interventions.
Safe Sleep Essentials
What You Need:
- Any CPSC-approved crib, bassinet, or pack-and-play made in the US within the last ten years
- Tight-fitting sheet over a firm mattress
- Sleep sacks are recommended over swaddles
What to Avoid:
- Bumper pads, even those marketed for playtime and to protect from bumps
- Bouncers as the level of incline can increase risk whether baby is sleeping or awake
- Products claiming to reduce SIDS risk as no product has been proven to reduce this risk
- Baby breathing monitors and oxygen saturation devices as they can increase false alarms
- Bed rails and bedside sleepers with walls as they can increase suffocation risks
Where to Check Product Safety:
- Consumer Product Safety Commission (CPSC) website for safe sleep (including recalls)
- Safe sleep Facebook groups where experts review sleep environments
Resources for Support:
- Safe to Sleep from the National Institute of Health (NICHD) for general information (https://safetosleep.nichd.nih.gov/)
- Northwest Infant Survival and SIDS Alliance (NISSA) helps support parents who have experienced loss including with a 24/7 hotline (https://nwsids.org/)
- First Candle for bereaved parent support (https://firstcandle.org/)
- Cribs for Kids for free safe sleep equipment for those who need it (https://cribsforkids.org/)
The Full Conversation
[edited from audio transcript forclarity]
Jane Dashevsky: Today's topic is so important. We're discussing sudden infant death syndrome and safe sleep with the directors of the Isabel Davis Center for Safe Children, Dr. Russell Ray and Dr. Savannah Lusk. They've spent years researching sudden unexplained infant death, reviewing cases and talking to parents who've lost children. As a mom of two, I thought I knew safe sleep, but this conversation opened my eyes.
Jane: You're the directors of the Isabel Davis Center for Safe Children. What is the mission of that organization?
Dr. Russell Ray: This started as a joint program between Texas Children's Hospital and Baylor College of Medicine. The overarching goal is really to end sudden, unexpected death across pediatrics. We've developed a strong research program to understand the causes of SIDS and clear a path towards developing diagnostics that identify at-risk infants. Another major part is supporting bereaved parents in different ways.
Jane: Could you tell us about your background and research interests?
Dr. Ray: My professional background has always been focused on understanding how the complexity of the brain is organized. Through serendipitous experience, my research track took me into sudden infant death syndrome. Once I was there and really saw how important this subject is and how much it matters to parents who have lost children, it became all the more important. I have two children, one going on 11 and one 13, and watching the whole process of pregnancy and birth really hit home because I was already about 3 or 4 years into SIDS research at that point.
Dr. Savannah Lusk: I was always interested in science. I was originally exposed to SIDS research in graduate school at Dartmouth. I'll be completely honest—at first, I thought it was a bit of a hoax. I didn't think SIDS was a thing. I thought it was shaken baby syndrome. Now, knowing what I know having done this research a decade later, it's not at all the same thing. Then I had my son Henry, who is now two. About 7 or 8 months after I had Henry, we got pregnant again with a daughter, Aria, but she passed away. We lost her. I think that made it even more real in terms of what parents are going through, but also what parents can offer in terms of understanding why these deaths are happening.
Jane: How did having kids change how you thought about this research?
Dr. Lusk: For me, it changed what I realized parents might know. A lot of my research now is focused on learning from parents and really listening to their detailed stories. As a crazy as it might sound, it even extends as far as premonitions. Over half of parents that have lost a child to SIDS report having premonitions of the death prior to it happening. When you listen to their stories from a scientific perspective, you actually learn more about the physiology of that child and what might have been underlying the death.
Jane: It feels so murky as a parent—like it could happen at any moment. What do we know now about sudden infant death syndrome?
Dr. Ray: The most difficult thing about SIDS is we don't know why the child passed. From a purely academic perspective, that's one of the most difficult ways to approach a disease. Despite those challenges, there has been a lot that we've learned that brings us closer every day to finding ways to identify vulnerable infants and intervene to prevent those outcomes.
Dr. Lusk: SIDS is part of a larger umbrella category called sudden unexpected infant death (SUID). SUID includes three things: SIDS, accidental suffocation and strangulation in bed, and undetermined. SIDS deaths are those cases where there is nothing that indicates why that child passed away. In the most pristine case, you would imagine a child alone in the bed, in a crib with nothing in the crib with them, in the parents' room, and they just pass. From experience, that situation is less than 1% of the cases that I deal with. Most end up either undetermined or accidental suffocation and strangulation in bed.
What parents should understand is that hundreds of thousands of babies sleep in unsafe situations every night and don't die, but some do. That suggests it's not just the unsafe sleep environment. There's some underlying genetic vulnerability or intrinsic vulnerability that makes them predisposed to passing away under those stressed conditions. We don't know what those are yet, which is what makes every baby have equal risk in the mind of the United States and the American Academy of Pediatrics. It's not the fault of the parent.
In Harris County, which includes Houston, the number one cause of death in the first year is sleep-related deaths. We saw a reduction in rates back in the 90s during the Back to Sleep campaign, but since then, the rates have not changed. We have had the same number of babies dying every year for 30 years. In the United States, it's about ten babies every day that die from SUID.
Dr. Ray: It's one that outpaces every other cause of death across all ages of pediatrics. We're just looking at the first 12 months, and sleep-related death in infants still outpaces that, in some cases 4 to 1.
Jane: What should parents be looking for or vigilant about?
Dr. Lusk: By and large, following the ABCs of safe sleep is the best thing you can do for your child. That's Alone in their crib, on their Back, and in their Crib. Many organizations have expanded that to include S for smoke-free environment because that has turned out to be a huge modifiable factor.
There are non-modifiable factors you can't change about yourself, the father of the child, or your situation. But there are modifiable factors, and a lot of them are behavioral changes that are really hard. Prenatal alcohol exposure alone increases the risk of SIDS by four times. Postnatal alcohol consumption by whoever is caring for the infant, especially if combined with sleeping with the infant on the same surface, can lead to really deadly situations. We've seen significant increases in deaths just after New Year's Eve and July 4th because your neurological system is being depressed by alcohol and you're not going to wake up as much.
About 34% of SIDS cases every year can be attributed solely to maternal smoking. A mother who smokes during and after her pregnancy doubles their child's risk of dying of SIDS. Recent studies have shown that a father smoking, even if the mom never smokes and the father only smokes outside of the home, can also increase the risk. Smoking and alcohol are multiplicative—if you do both prenatally, it goes up to 12-fold increased risk.
Jane: If you've had a history of smoking, get pregnant, and drop smoking during the pregnancy, does that reduce your risk?
Dr. Lusk: With the father, it's more about the third-hand smoke aspect. It does matter if he stops once mom knows she's pregnant, but it's better if he stops while they're trying to conceive. For mom, there is a reduction in risk if she quits smoking. Even 24 hours after quitting, there are improvements in your health. However, it's not back to baseline—there are going to be effects of withdrawal from nicotine. If you quit smoking at any point in your pregnancy, that is better for your child.
Jane: That 0 to 1 phase is also the most stressful from a parent perspective. Sleep-deprived people may end up making compromises on sleep practices. What's your advice on thinking about SIDS risk?
Dr. Ray: I can speak as a father—I'm utterly empathetic to those challenges. With my wife, I was the one shuttling the baby because I had the knowledge. We had the crib in the room, and during night feeding, I'd get up, move the child over, let my wife do what she needed to do, even if she was falling asleep, because I was awake and watching. Then I'd move the baby back to the crib where it was going to be safe. Everyone is going to have different perspectives in terms of what's important to them culturally and what they need to do just to get through the situation. No matter what you do, you try to do your best.
Dr. Lusk: Being alone in the first month of life is hard. It's everything you expected and everything you didn't expect all at the same time. No matter what your socioeconomic status, race, or religion, think about who you call when something big happens in your life. Bring them into a circle of safety for your baby and for yourself. At the end of the day, it comes down to parents having the capacity, both in terms of energy and wherewithal, to abide by the best recommendations we have. You can't do it on your own—well, you can, but it's hard. Bring in that friend you call for stuff. Tell them what's going on, what you're trying to prevent, and ask for help so you can sleep and keep yourself healthy. A lot of these cases can happen when moms are exhausted and start compromising safety for sleep.
Dr. Ray: In the US, the focus is risk elimination. But there's common sense. If you're sleeping in a bed with an infant, the fewer pillows and blankets you have, the better. Bedsharing increases the risk of SIDS four-fold. Sleeping on a couch with an infant increases the risk more than 20-fold. These are risky behaviors, but speaking as a parent, you do your absolute best. Sometimes if you just have to put the child down with you on the floor on a blanket where everything's flat, that's your best option. If you can't be perfect and do risk elimination, do your best to do risk reduction.
Dr. Lusk: If you sleep with your child on the same surface, it makes sense to not have any pillows or blankets in that area, accomplishing the "alone" part of the ABCs. But there are additional risks with adult beds. I've reviewed cases where babies get wedged between the mattress and those walls that attach to adult beds to keep babies from rolling off. It is literally better for them to fall off the bed than to have that device there, because they're not going to get wedged between anything. They'll fall off, wake up, and you'll put them back on a safe surface.
Jane: How can parents who are following the ABCS of the safe sleep manage the anxiety around this?
Dr. Lusk: My husband is a police officer and was used to being on high alert. When my son was born, he would stay up with him at night and watch him the whole night, and I would be up during the day. I understand the anxiety. The fact is that it's less than 1% of these cases where the baby is in a safe environment, everything has been followed, and they just suddenly pass away. It is extremely rare. If you're doing that as a parent, relax and go to sleep. Comfort yourself with the thought that you have done everything you possibly can for your child. You are the absolute best parent you can be at that point in time. The only thing we have control over are those modifiable factors. All you can do is change your behavior. Anything else that's going to happen, you have no control over.
Dr. Ray: That was certainly the perspective I arrived at with our first child. My background is in genetics and developmental biology, so my anxiety already started with ultrasounds, where I'm trying to pick things out faster than the ultrasound tech. By the time my daughter was born, it came down to what Savannah said. I knew what I was supposed to be doing—crib in the room, tight-fitting sheet over a well-fitted mattress in a modern crib. At that point, I had to say there's nothing more I can do. That didn't make everything go away, but it became a lot more manageable.
We also talked about leaning on your support network, and I wanted to bring up that when you think about your village it isn't just your personal network, but also your broader community and organizations you can lean on. For example, if you need a safe sleep environment and simply can't afford one, there's Cribs for Kids—they are fantastic. Most hospitals, if they're not already part of Cribs for Kids, will have resources to get you a pack-and-play, crib, or bassinet that is safe for the child.
Jane: If you suspect your child is not breathing, what should you do?
Dr. Lusk: First and foremost, take a deep breath and call 911 immediately. Ensure that you specify it's an infant that is not breathing. That's one of the big common errors—it's not communicated to dispatch that it's an infant. The operator will walk you through infant CPR. Do not convince yourself that you can drive to the hospital in a private vehicle with your child. In almost every case, when that's happened, it doesn't end up better. Wait for the ambulance to arrive. They are equipped to do everything an ER can do except for diagnostic testing like MRIs. They can resuscitate children and bring them back. Let them do their job.
Dr. Ray: Savannah is absolutely right to call 911 right away. This is called sudden infant death syndrome, so it's really rare that you're going to see anything indicative of this. Always, out of abundance of caution, take every measure needed to ensure your baby's safety. If you think there's any respiratory distress, immediately call. Don't wait it out. 911 is the best thing you can do.
Dr. Lusk: Know that you're not alone. There are so many organizations throughout the United States that are here for you. These are moms who have lost children to the same thing and are available to talk 24/7. If you're in that 20-minute period on the way to the hospital and freaking out, call someone. When you're at the hospital, ask for a social worker so they can walk you through what you might qualify for. Make sure you advocate for yourself. You can assume they're going to do everything possible to save your child's life, but what might fall by the wayside is what they can do for you.
Jane: What are some organizations you recommend for parents who want to learn more or are looking for support?
Dr. Lusk: For general information, the Safe to Sleep page by the NICHD is really helpful. If you need help dealing with loss, NISSA is wonderful—they have a 24/7 hotline where you can reach a bereaved parent. First Candle also has a hotline and several different services. Many of these also have Facebook pages. There's a Facebook page where you can post a picture of your baby's sleep environment, and moderators who are well-educated in safe sleep guidelines will point out everything that needs to be addressed. For example, if you have something hanging on a wall, your crib needs to be at least a foot away because if it falls, it's going to end up in that crib.
Jane: In terms of safe sleep, with so much marketing out there, are there any products that you think are good ones for parents to know about?
Dr. Lusk: The answer is less is more. As long as you buy a pack-and-play, bassinet, or crib in the United States that has been produced within the last ten years, you can buy the cheapest thing available and your child will be just as safe as if you spend $5,000 on some fancy crib. If it's a product that says it reduces the rate of SIDS, you likely don't need it because there is no product that can do that.
Dr. Ray: Technically, I think it would be illegal because they're making a medical claim that's not proven.
Dr. Lusk: You don't need bumper pads or anything else like that. Bumper pads have been recalled, but manufacturers have altered their marketing to say they're not for sleep—they're for protecting baby from hitting their head while playing. They're still sold in stores. Be educated about what you're looking for.
Dr. Ray: What's crazy about non-medical devices surrounding infant care is there's no approval process. The only way we know to take those off the market is when enough children are hurt or die. You can't make assumptions like you can at a grocery store that something is safe. Even after something's recalled, there's an entire secondary market for reusing and recycling. You can sometimes find these recalled items in secondhand stores, so it helps to do the research and get educated on these products before you go to the store.
Dr. Lusk: If you need to do research, the best website is the Consumer Product Safety Commission (CPSC).They have a list of banned products for infant sleep with the exact product numbers that have been discontinued.
Jane: Are there other products parents are commonly using that they should eliminate or be cautious about?
Dr. Lusk: The biggest thing I've seen is bumper pads. Another thing would be the "medical devices" you can get for your child—any kind of sock or device that indicates when blood oxygen levels reach a low level and then alarms. The American Academy of Pediatrics has provided some feedback that this can often lead parents to have a false sense of safety for their child in an unsafe sleep environment. These devices can make you take riskier decisions, and often have false alarms. This can be detrimental to an already anxious parent. Every parent with a baby under a year old is already freaking out. If you're getting alarms every night, that's stressful, waking you up, and you have to reset the device. I would not recommend those systems.
Dr. Ray: None of those products surrounding baby monitoring have ever been shown to have any effect on SIDS outcome rates. Either it gives you false security or it exhausts you, and you end up turning it off or ignoring it.
Dr. Lusk: The other thing is bouncers or what used to be called inclined sleepers. They are one of the most unsafe products you can use with your child. You increase the inclination level above a certain degree, which decreases the work for babies to turn onto their stomach and increases the work to get back on their back. They get stuck and suffocate in the material.
Dr. Ray: Even on their back, because of the incline, babies aren’t safe because the chin can go to the chest and that creates a suffocation risk.
Dr. Lusk: When their chin touches their chest, that's a risk for suffocation. This applies to car seats as well. If they fall asleep in the car and you're driving, there's nothing you can do about that—it's safest to have your baby in a car seat while driving. But you should never leave a baby in a car seat after a drive to sleep because there's a safer alternative.
Dr. Ray: Literally putting them on a floor is the safer alternative.
Dr. Lusk: One last thing about products not to recommend: swaddling is not required for your baby. Even though we tell people to stop swaddling as soon as your kid can roll over, babies can learn to roll over so quickly, and it's impossible to know that exact moment. The safe sleep community recommends sleep sacks over swaddles so the baby’s arms are free, but they can still feel held and nurtured. If they rollover, they have their arms available to push back over.
Jane: That's interesting because I remember feeling like I was stopping the swaddle too early.
Dr. Lusk: There's no limit on how early to put your kid in a sleep sack. You can do it on day one if you wanted to.
Jane: If you wanted parents to take one thing away from this, what would you say?
Dr. Ray: In a perfect world, if you're thinking about having a baby, that's actually when the most productive work can be done. Instead of trying to get your safe sleep information as you're being wheeled out of the maternity ward utterly exhausted, do everything you can prenatally if you have that opportunity.
Dr. Lusk: I would say less is more. Don't worry about how much something costs. Just because it's cheaper doesn't mean it's less effective. You don't have to spend thousands of dollars to have a healthy, safe baby.
Jane: Thank you both for being here and sharing this message. I thought I knew a lot about safe sleep, but I've learned so much from this conversation.
To learn more, check out the Isabel Davis Center for Safe Children by visiting: https://idcsc.org/.
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