May 25, 2025, 6:41 am | Read time: 7 minutes

SIDS is not a disease in the traditional sense: The baby dies unexpectedly, and no clear medical reason can be found. According to current knowledge, sudden infant death results from a combination of several factors. For example, a baby with a physical sensitivity (such as in breathing regulation), a particularly sensitive developmental phase (usually in the first six months of life), and an external trigger like sleeping on the stomach or tobacco smoke in the environment.¹ “Sudden infant death is, of course, an absolutely tragic event for those affected,” says Dr. Rodeck. The good news: Many of these triggers can be avoided, significantly reducing the risk.

Numbers: a decline through prevention

“Sudden infant death has become much rarer than it was 30 years ago,” explains Dr. Rodeck: In 1991, 1,285 children in Germany died from SIDS according to the Federal Statistical Office–about 1.5 deaths per 1,000 live births. In 2023, this number was only 83 cases, or about 0.1 per 1,000.² “This means that the measures taken have led to a massive reduction in risk,” says Rodeck. Above all, better parental education has achieved a lot in recent years.

Sleeping position: back sleeping as the most important rule

Dr. Rodeck names the most important factor: “Babies should always sleep on their backs when unsupervised. That is the first and most important rule.” For a long time, sleeping on the stomach was considered helpful, especially for restless children or those with reflux (when the baby frequently spits up). Today we know: Sleeping on the stomach significantly increases the risk of SIDS. At the same time, Dr. Rodeck advises placing infants on their stomachs during the day–under supervision–to prevent flattening of the back of the head.

No “nesting”: air must circulate

Some parents worry that their child might catch a cold draft while sleeping. As a result, babies are sometimes wrapped up extra warmly with pillows, blankets, and stuffed animals. Rodeck recalls a cartoon he saw in a magazine: “Mom and Dad are standing in front of the bed, and somewhere in the bed lies the child–buried under a pile of stuffed animals. And he asks, ‘Are you sure we put our child in there yesterday?'” But that’s exactly how it shouldn’t be: The child’s head should always be free, and air should circulate unhindered. Thick featherbeds are also taboo. According to Rodeck, “swaddling,” where babies are tightly wrapped to sleep, is not recommended: “It exists in certain cultures, but it should be avoided. It restricts freedom of movement and can be problematic for breathing.” Instead, the DGKJ recommends a suitable sleeping bag–without a blanket, on a firm mattress, in the baby’s own crib in the parents’ bedroom.³ “Co-sleeping,” or sharing the parents’ bed, is not recommended.

Smoking (even passive) is high risk

Cigarette smoke is pure poison–especially for an infant’s sensitive respiratory center. And not just after birth. “Smoking during pregnancy is a massive risk factor for sudden infant death,” warns Rodeck. Numerous studies also confirm this.⁴ “It’s best not to smoke at all–neither before nor after birth.” Drug and alcohol use during pregnancy are also clearly established risk factors for SIDS.

How useful are pacifiers?

Pacifiers are considered a protective factor against sudden infant death. The reason: “The child’s airways should be as open as possible, and this is promoted by the placement of a pacifier,” explains Dr. Rodeck. The pacifier could also help keep babies in a lighter sleep phase and keep the airways open.⁵ But here, there’s no need to force it. And if the child loses the pacifier at night, there’s no need to put it back in their mouth. Important: The pacifier should not be attached to the body with a string–choking hazard! The Clinic for Gynecology and Obstetrics at the University Hospital Ulm also advises: The pacifier should be used from the 6th to 8th week of life at the earliest and up to a maximum of the 12th month.⁶

Avoid overheating

Babies get cold quickly–but they also overheat quickly. Therefore, the right balance is crucial. Thick blankets, hot water bottles, or electric blankets are taboo. “If I wrap the children up to the max, they get too warm–that’s also a risk factor,” warns Rodeck. The optimal room temperature is between 16 and 18 degrees Celsius. An ideal choice is a breathable cotton sleeping bag. A useful tip: The baby’s neck should be warm but not sweaty.

Vaccination can protect

Vaccinations also contribute to prevention. Not because they directly protect against SIDS, but because they strengthen the child’s immune system and prevent infections that could impair the respiratory center. “The protective effect is explained by this mechanism–the child is made ‘life-proof,'” says Rodeck. Therefore, vaccinations should be carried out consistently according to STIKO recommendations–also to protect against sudden infant death.

Breastfeeding significantly reduces the risk

Breastfeeding offers multiple protections. It boosts the immune system, soothes, and improves breathing regulation. “Breastfeeding–four to six months–is better than formula feeding,” says Rodeck. He adds, “That doesn’t mean mothers should be judged if they can’t or don’t want to breastfeed.” But if breastfeeding is possible, it is also a protective factor against SIDS. According to a study, even two months of breastfeeding reduces the risk by half.⁷

Monitors, apps, and gadgets–really necessary?

Many parents rely on breathing monitors or baby mats with sensors. But Dr. Rodeck advises caution. The data is weak, false alarms are frequent–and the safety is often deceptive. “It’s a good sales idea,” says Dr. Rodeck openly. “Parents have a supposed security, but it’s only supposed.”

More on the topic

Experts Explain What to Do When the Baby Cries

Plagiocephaly When a Baby’s Head Deformation Needs Treatment After Birth

Where can I find reliable help?

“Not Dr. Google,” warns Dr. Rodeck. “And no forums either. You’ll find more opinions than scientifically sound information. The risk of encountering unreliable content is high.” Instead:

• Pediatricians (especially during U-examinations)
• DGKJ information sheets (dgkj.de)
• Early Help: free support services from the Federal Center for Health Education for (expectant) parents with children up to three years old, especially in challenging life situations. You can find local contacts directly through the search function. There are also various explanatory videos.

Checklist: Safe baby sleep

These points help minimize the risk of sudden infant death:

• Always sleep on the back
• Sleeping bag instead of a blanket
• No pillows, bumpers, or stuffed animals in the bed
• Room temperature: 16 to 18°C
• Baby sleeps in the parents’ room–but in their own bed
• Smoke-free environment (don’t allow guests to smoke either)
• Breastfeed if possible
• Pacifier if needed–don’t force it
• Avoid overheating
• Vaccinations according to STIKO
• No sleep apps or mats as a substitute for prevention
• Seek information from professional portals or consult pediatricians if unsure