SIDS (Sudden Infant Death Syndrome) and Twins

Is the Risk of SIDS Increased in Twins and Multiples?

Newborn twins sleeping.
Jessica Holden

Such a simple-sounding acronym, yet four little letters represent a parent's most terrifying nightmare, the unexplained death of an infant. Sudden infant death syndrome (SIDS) is defined as the sudden and unexplained death of a healthy baby under one year of age. It is also called "crib death", although cribs do not cause SIDS. Rather, the term refers to the circumstances of the death, which generally takes place while a baby is sleeping.

SIDS is the leading cause of death in babies between the ages of 1 month and 1 year but occurs most often in infants aged 2-4 months. Although alarming, the incidence of SIDS is really rather rare, claiming the lives of about 1500 babies every year in the United States. The exact causes of SIDS are unknown, making it a terribly frightening prospect to parents who will do anything to protect their babies.

SIDS and Twins

While not preventable, risk factors for SIDS have been identified. Unfortunately, many of the identified risks can be applied to twins and multiples, making them particularly vulnerable.

A major risk factor is premature birth and low birth weight, conditions which impact more than half of multiples on some level. Therefore, it is vital that parents of twins be aware of the risks and take precautions to protect their babies.

Back to Sleep

Perhaps the most critical component in SIDS prevention is infant sleep positioning. As trends in baby care have transitioned from putting babies to sleep on their backs rather than on their stomachs, the incidence of SIDS has significantly decreased.

From 1992 to 1998, the percentage of infants sleeping on their stomachs decreased from more than 70 percent to about 20 percent. During the same period, the number of SIDS deaths declined by almost half.

The American Academy of Pediatrics states that back sleeping is the preferred sleep position for babies.

"Always place your babies on their backs to sleep, for naps and at night. The back sleep position is the safest, and every sleep time counts." - National Institute of Child Health & Human Development

Many parents are frustrated or concerned with the recommendation to put babies to sleep on their backs. What if they choke? Won't it create flat spots on the back of their heads? What if they roll over? Rest assured. Healthy babies will automatically swallow or cough up fluids; there's no connection between back sleeping and choking.

To compensate for back sleeping and to enhance your babies' physical and cognitive development, allow them plenty of tummy time throughout the day when they're wide awake and supervised. Also, change the babies' orientation within the crib from time to time, or switch them between cribs.

Finally, expect that your babies will begin to roll over and find their own preferred sleep positions as they get older and their physical capabilities expand. There's not much you can do to prevent it, and fortunately, the risk of SIDS drops as they reach that stage in their development.

To minimize the development of flat spots on the back of baby's head, reduce the amount of time that your babies spend lying in car seats, carriers and bouncers while they're awake.

Ways to Reduce Risk

In addition, create a safe sleeping environment for your babies, like a firm crib mattress covered with a fitted sheet. Avoid nesting babies with loose bedding like pillows, quilts, blankets or sheepskins and don't clutter the sleeping area with soft toys. Keep babies from overheating by dressing them in light sleep clothing, and keep the room at a comfortable temperature.

Control your babies' exposure to harmful tobacco smoke. Don't smoke while you're pregnant and don't smoke around them once they're born.

Finally, optimal nutrition always contributes positively to your babies' health. Breastfeed if possible, or follow your doctor's advice for alternative feeding products.


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Article Sources
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Additional Reading
  • Mallow, M.H., Freeman, D.H. Jr. “Sudden infant death syndrome among twins.” Archives of Pediatrics and Adolescent Medicine Journal, July 1999, pg. 736.