Multiples SIDS (Sudden Infant Death Syndrome) and Twins Is the Risk of SIDS Increased in Twins and Multiples? By Pamela Prindle Fierro Pamela Prindle Fierro is the author of several parenting books and the mother of twin girls. Learn about our editorial process Pamela Prindle Fierro Medically reviewed by Medically reviewed by Joel Forman, MD on October 16, 2016 Joel Forman, MD, is a board-certified pediatrician and associate professor of pediatrics, environmental medicine, and public health at Mount Sinai School of Medicine. Learn about our Review Board Joel Forman, MD Updated on October 19, 2019 Print 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. How to Follow Safe Sleep Guidelines for Babies Resources American SIDS InstituteTwins and Sudden Infant Death Syndrome Was this page helpful? Thanks for your feedback! Get diet and wellness tips to help your kids stay healthy and happy. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Duncan J, Byard R. Sudden Infant Death Syndrome: An Overview. SIDS Sudden Infant and Early Childhood Death: The Past, the Present and the Future. Published 2018. Ahrens KA, Thoma ME, Rossen LM, Warner M, Simon AE. Plurality of Birth and Infant Mortality Due to External Causes in the United States, 2000-2010. Am J Epidemiol. 2017;185(5):335–344. doi:10.1093/aje/kww119 de Luca F, Hinde A. Effectiveness of the 'Back-to-Sleep' campaigns among healthcare professionals in the past 20 years: a systematic review. BMJ Open. 2016;6(9):e011435. 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PMID: 1437432 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.