Quick Answer: Crib death -- medically known as Sudden Infant Death Syndrome (SIDS) -- is the sudden, unexplained death of an apparently healthy infant under 12 months of age. The single most important prevention step is placing infants on their back to sleep on a firm, flat surface. Back sleeping reduces SIDS risk by approximately 50%.
In This Guide
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What Is Crib Death?
Crib death is the common term for Sudden Infant Death Syndrome, or SIDS -- the sudden, unexpected death of an apparently healthy infant, usually during sleep, that cannot be explained even after a thorough investigation including an autopsy, a death scene examination, and a review of the clinical history.
SIDS is the leading cause of death for infants between 1 month and 12 months of age in Canada. According to the Public Health Agency of Canada, approximately 100-150 infants die from SIDS each year in Canada. SIDS occurs most commonly between 2 and 4 months of age, when the infant's arousal responses and breathing control mechanisms are still maturing.
The Triple Risk Model
Current research supports a "triple risk" model of SIDS (Filiano & Kinney, 1994). The theory holds that SIDS occurs when three factors converge simultaneously: (1) an underlying vulnerability in the infant, such as a defect in the brainstem region that controls breathing and arousal; (2) a critical developmental period (0-6 months, when these systems are maturing); and (3) an external stressor, such as prone sleeping, soft bedding, overheating, or secondhand smoke exposure. Removing external stressors is the primary prevention strategy because vulnerability and developmental stage cannot be controlled.
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Known Risk Factors for SIDS
While no parent can eliminate all risk, understanding the contributing factors helps families make protective choices. Risk factors fall into two categories: those that cannot be changed and those that can be addressed.
Risk Factors That Cannot Be Changed
- Age: Peak risk is between 2 and 4 months. Risk decreases significantly after 6 months and is very rare after 12 months.
- Sex: Male infants have approximately a 60% higher rate of SIDS than female infants.
- Premature birth or low birth weight: Preterm infants have higher SIDS rates, likely related to brainstem immaturity.
- Previous SIDS in the family: Subsequent siblings have a slightly higher risk, though the absolute risk remains low.
- Race and ethnicity: Indigenous and First Nations infants in Canada have higher SIDS rates, a disparity linked to socioeconomic factors and sleep environment conditions rather than inherent biological differences.
Modifiable Risk Factors
| Risk Factor | Risk Contribution | Protective Action |
|---|---|---|
| Prone (stomach) or side sleeping | Very high -- multiplies risk | Always place infant on their back |
| Soft sleep surface | High -- 5x increased risk | Use firm, flat crib mattress |
| Loose bedding, bumper pads, pillows | High -- suffocation risk | Remove all soft objects from crib |
| Bed sharing | Moderate to high, especially with risk factors | Room share; use separate sleep surface |
| Maternal smoking during pregnancy | High -- triples risk | Smoking cessation before and after birth |
| Secondhand smoke exposure | Moderate | Smoke-free home environment |
| Overheating | Moderate | Maintain 18-20°C bedroom temperature |
| No breastfeeding | Moderate -- breastfeeding is protective | Breastfeed if possible; every amount helps |
| No pacifier use | Moderate -- pacifier use is protective | Offer pacifier at sleep time once breastfeeding is established |
How to Reduce the Risk of Crib Death
The "Safe Sleep" campaign -- known as "Back to Sleep" when first launched in the 1990s -- has reduced SIDS deaths dramatically in Canada and internationally. Canadian SIDS rates fell by more than 70% between 1990 and 2010, largely attributed to the adoption of back sleeping as the default infant sleep position.
Health Canada and the Canadian Paediatric Society recommend the following practices for every sleep:
Health Canada Safe Sleep Recommendations
- Back is best: Always place your infant on their back to sleep -- for naps and at night. Side sleeping is not safe. Once an infant can roll both ways independently, they can be allowed to find their own position.
- Firm, flat surface: Use a crib, bassinet, or play yard that meets the Canada Consumer Product Safety Act (CCPSA) standards. The sleep surface must be firm and flat -- not inclined, not padded.
- Clear the crib: No pillows, blankets, comforters, bumper pads, stuffed animals, or positioners. A fitted crib sheet on a firm mattress is all that is needed.
- Room share, do not bed share: The Canadian Paediatric Society recommends room sharing (infant in their own sleep space in the parents' room) for at least 6 months, ideally 12 months. Bed sharing, particularly with a smoker, after alcohol, or on a soft surface, significantly increases risk.
- Smoke-free environment: Maternal smoking during pregnancy and secondhand smoke exposure after birth both independently increase SIDS risk.
- Comfortable temperature: Dress your infant in one more layer than an adult would wear at that temperature. Avoid swaddling if the infant can roll. Room temperature 18-20 degrees Celsius.
- Offer a pacifier: Research consistently shows pacifier use at sleep time is associated with reduced SIDS risk. The mechanism is not fully understood but may be related to reduced deep sleep.
- Avoid overheating: No hats indoors, no heavy swaddling blankets. Check that the back of the neck is not sweaty.
The Sleep Environment: Why the Crib and Mattress Matter
Safe sleep begins with a properly constructed crib and a firm mattress. In Canada, cribs and bassinets must comply with Health Canada's regulations under the Canada Consumer Product Safety Act. Cribs manufactured before 2009 may not meet current standards and should not be used.
Crib Safety Checklist
- Crib was purchased new or verified to meet current CCPSA standards
- Slat spacing is no more than 6 cm (2⅜ inches) -- a soft drink can should not fit through
- No missing, loose, or broken hardware
- No drop-side rails (these were banned in Canada in 2011)
- Mattress fits snugly -- no more than two finger-widths of gap between mattress and crib frame on any side
- Mattress is firm -- pressing the centre with both hands should not leave a lasting indentation
- Fitted sheet fits properly without loose corners
A standard Canadian crib mattress measures 27¼ inches by 51⅝ inches (approximately 69 x 131 cm). Mattresses that are too small create dangerous gaps between the mattress edge and the crib frame, which is a risk for head entrapment. At Mattress Miracle, we can help families in Brantford and surrounding areas select properly sized, firm crib mattresses that meet Canadian standards.
When Does the Risk of Crib Death Decrease?
SIDS risk peaks between 2 and 4 months and declines significantly after 6 months. After 12 months, SIDS is very rare. This is because the brainstem arousal mechanisms that are thought to be implicated in SIDS mature considerably by 6 months, and infants develop the motor ability to reposition themselves if they encounter a breathing obstruction.
That said, safe sleep practices -- back sleeping, firm surface, clear crib -- are recommended throughout the first 12 months. Continuing these practices even as the risk naturally declines ensures the protection remains in place during the entire vulnerable period.
If You Are Grieving a Loss
If you have lost a child to SIDS or sudden unexplained infant death, you are not alone. SIDS Canada provides support and resources for bereaved families. You can reach SIDS Canada at 1-800-END-SIDS. Healthcare providers and grief counsellors in Brantford are also available through Brantford General Hospital and Six Nations community services. Grief after the loss of an infant is profound, and support is available.
Brantford Safe Sleep Resources
The Brant Community Healthcare System and the Brant County Health Unit offer infant safe sleep education for new parents. The Brant County Health Unit's Healthy Babies Healthy Children program connects families with public health nurses who can provide personalised safe sleep guidance and home visits for high-needs families. These programs are free for Brantford and Brant County residents.
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Call 519-770-0001Frequently Asked Questions
What is the difference between SIDS and crib death?
They are the same thing. "Crib death" is the informal term commonly used in Canada and the United States, while "Sudden Infant Death Syndrome" (SIDS) is the medical diagnosis applied when an infant under 12 months dies unexpectedly and no cause can be determined after thorough investigation. The terms are used interchangeably.
What is the peak age for SIDS?
SIDS risk peaks between 2 and 4 months of age. It is rare before 1 month and after 6 months, and very rare after 12 months. The 2-to-4-month window coincides with a period of rapid developmental change in the brainstem systems that regulate breathing and arousal from sleep.
Does a firm crib mattress reduce SIDS risk?
Yes. Soft sleep surfaces significantly increase SIDS risk because they can conform around an infant's face, impeding breathing and reducing the ability to reposition. Research has found soft sleep surfaces increase SIDS risk by approximately five times. Health Canada requires infants to sleep on a firm, flat surface. At Mattress Miracle in Brantford, we can help you select a crib mattress that meets Health Canada's firmness requirements.
Is it safe to use a second-hand crib?
It depends on the age and condition of the crib. Cribs manufactured before 2009 may not meet current Canadian safety standards, and drop-side cribs (banned in Canada in 2011) should never be used. If using a second-hand crib, verify that it complies with CCPSA standards, that all hardware is intact, and that the mattress is new. Never use a second-hand mattress -- pathogens and material degradation create risk.
Does breastfeeding reduce SIDS risk?
Yes. Research consistently shows that breastfeeding is associated with a reduced risk of SIDS. A meta-analysis published in Pediatrics found that any breastfeeding reduces SIDS risk by approximately 60%, with exclusive breastfeeding offering even greater protection. The mechanism is not fully established but may involve improved immune function and more frequent arousal during lighter sleep stages.
Sources
- Filiano, J.J., & Kinney, H.C. (1994). A perspective on neuropathologic findings in victims of the sudden infant death syndrome: The triple-risk model. Biology of the Neonate, 65(3-4), 194-197. doi.org/10.1159/000244052
- Moon, R.Y., & Task Force on Sudden Infant Death Syndrome. (2016). SIDS and other sleep-related infant deaths: Evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics, 138(5), e20162940. doi.org/10.1542/peds.2016-2940
- Vennemann, M.M., et al. (2009). Breastfeeding and the risk of sudden infant death syndrome. Epidemiology, 20(4), 484-487. doi.org/10.1097/EDE.0b013e318197e1f0
- Health Canada. (2021). Safe sleep for your baby. Public Health Agency of Canada. canada.ca/en/public-health/services/infant-care/safe-sleep.html
- Canadian Paediatric Society. (2019). Safe sleep environments for infants. Paediatrics & Child Health, 24(1), 66. doi.org/10.1093/pch/pxy166
- Hauck, F.R., Thompson, J.M., Tanabe, K.O., Moon, R.Y., & Vennemann, M.M. (2011). Breastfeeding and reduced risk of sudden infant death syndrome: A meta-analysis. Pediatrics, 128(1), 103-110. doi.org/10.1542/peds.2010-3000
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