Health Evidence Bulletins - Wales

Date of Completion: 23.6.97

The contents of this bulletin are likely to be valid for approximately one year, by which time significantly new research evidence may be available

23. Sudden Infant Death Syndrome

(Users are advised to consult the supporting evidence for a consideration of all the implications of a recommendation)

The Statements The Evidence
23a. The risk of SIDS is increased by a prone or side sleeping position and loose bedding which can slip over the baby’s head. A sleeping position on the back is recommended(i, ii, iii).

(Health gain notation - 1 "beneficial")

i. Fleming PJ et al. Environment of infant during sleep and risk of the sudden infant death syndrome; results of 1993-5 case-control study for confidential enquiry into stillbirths and deaths in infancy. British Medical Journal 1996;313:191-5
(Type IV evidence - case control study);
ii. Guntheroth MD, Spiers PS. Sleeping prone and the risk of sudden infant death syndrome. Journal of the American Medical Association 1992; 267: 2359-62
(Type IV evidence - review of observational studies);
iii. Confidential Enquiry into Stillbirths and Deaths in Infancy 1 Jan-31 December 1994. London: Department of Health, 1996. Chapters 4-9.
(Type IV evidence - statistical information)
23b. Exposure of babies to tobacco smoke from other members of the household before or after birth increases the risk of death: the greater the exposure the higher the risk(i, ii). 62.6% of mothers with babies who died from sudden infant death smoked as compared to 25.1% of mothers in the case-matched control group (i).

(Health gain notation - 6 "likely to be harmful")

i. Blair PS, Fleming PJ, Bensley D et al. Smoking and the sudden infant death syndrome. British Medical Journal 1996;313:195-8
(Type IV evidence - case matched control of 195 babies who died and 780 case-matched controls);
ii. Poets CF, Schlaud M, Kleemann QJ et al. Sudden infant death and maternal cigarette smoking: results from the Lower Saxony Perinatal Working Group. European Journal of Paediatrics 1995;154:326-9
(Type IV evidence - statistical information)
23c. Health promotion campaigns directed towards the reduction of sudden infant death syndrome should be aimed specifically at more socially deprived families who do not share in the general fall in the incidence of this condition(i).
(Health gain notation - 2 "likely to be beneficial")
i. Confidential Enquiry into Stillbirths and Deaths in Infancy. 1 January - 31 December 1994. London: Department of Health, 1996. p. 119
(Type IV evidence - statistical information)

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Health Evidence Bulletins: Wales, Duthie Library, UWCM, Cardiff CF14 4XN. e-mail: