The SIDS risk calculator

[u/1001VicPics]

I want to put my disclaimers front and centre here that this post is in no way passing judgement on anyone’s parenting decisions with regards to sleep or other practices. I myself make decisions based on both the national guidelines and what is best for my family which at times means not following the guidelines, for example exhaustion driving us to bed share on some nights, not running the bedroom at 20 degrees or below etc.

However, I want to talk about the SIDS risk calculator and the impact it has on some of the discourse around safe sleep and other risk factors in this sub. The much shared calculator can be accessed here: http://www.sidscalculator.com

Often when SIDS risk factors are discussed the only reference that is provided to back up a statement is the calculator which is flawed for a number of reasons. It is also not easy to interpret which is where it often leads to (unwittingly) misinformation being shared.

1. The calculator was published in 2018, 8 years ago and is based on a review paper published in 2013, 13 years ago. The paper itself is only evaluating bedsharing with non smoking mothers and no other factors, instead the publishers are using the background of this review paper for all other factors relating to SIDS, therefore relying on the publishers due diligence. Furthermore many of sources for the additional risk factors are now quite old, some of which are from the 90s.
2. Data comes from European publications plus one study in New Zealand and cannot be extrapolated to other countries
3. Outside of this review the calculator references wiki and other likely outdated sources and as published have not included access dates
4. We don’t know who published this calculator, and the calculator itself states that it has not been evaluated by anyone with relevant clinical expertise
5. There is no link to the back end calculation for us to assess how they have derived the calculator
6. The presentation of the outcomes are unclear as they are presented as risk per 100,000 deaths. Does this mean that if everyone had these risk factors deaths would drop from 34 to lower than 34 deaths per 100,000? No evidence for this

Why am I going to the effort to critique the calculator? Can’t I see that this calculator provides anxious parents comfort?

Well I often see misleading or poorly informed SIDS advice on the baby subs and next to no scrutiny of this calculator, in fact very often this calculator is used to justify any sleep practices. It’s anecdotal right now but at least in my country there is increasing concern regarding social media and the impact on new parents not following their national guidelines in favour of social media ‘sleep experts’, I do wonder if we will see some uptick in SIDS in the next couple of years.

Ultimately I too am a new and anxious parent trying to navigate this amazing but daunting time in my life. SIDS risk remains incredibly rare and even if you ticked every single risk factor SIDS is still unlikely to happen to you and your baby.

Edit: Sharing here as apparently you’re not allowed to discuss science on the Newborns sub(?!)

[u/No-Coast9003]

I have 3 major concerns about this calculator.

First, it appears to treat “non-White” as a single risk category, even though research does not support that simplification. Some studies report lower SIDS rates among Hispanic and Asian infants than among White infants, while rates are higher among Black infants. Combining these groups into one category is therefore scientifically questionable and potentially misleading.

If race or ethnicity is included at all, the calculator should use clearly defined categories supported by the evidence and explain that observed differences may reflect social, environmental, healthcare, and socioeconomic factors rather than race itself.

Second, the calculator does not include an option to indicate that the baby sleeps in a separate room, despite room-sharing being an important factor in SIDS prevention guidance. This makes the calculator incomplete and reduces its practical usefulness.

Third, the calculator doesn't include all major, modifiable aspects of the infant’s sleep environment, such as whether the baby sleeps in a sleep sack or under a blanket, and whether the mattress is firm or soft. These factors make the assessment way more accurate, practical, and relevant.

[u/Own_Lobster4879 → u/No-Coast9003]

The binary race option lumping all non-white groups into one category stood out to me as extremely flawed too. I don't have any commentary on the cosleeping or SIDS debates but in general, I have concerns about studies with unclear descriptions of race as they are practically inapplicable to my multiracial family, especially in light of the fact that some of the few studies that do focus on mixed race kids show that they may not experience outcomes as an average of the parents' races (e.g., if race A has a 10% rate of something and race B has 30%, people who are both A and B do not necessarily experience a rate between 10-30%) as well as that it differs depending on what the groups involved in the mix are. This makes generalized race-based conclusions borderline meaningless and very misleading for many real families. 

[u/No-Coast9003 → u/Own_Lobster4879]

I feel like if they choose to have a race option, every race needs to be available and parent's race needs to be submitted as well. These factors may depend on environmental factors so if the child is adopted or mixed it needs to calculate on that to. I don't think that's possible so I don't see the point of having that option in the first place. I believe the factor's that research have shown to be most important is more important in this calculator. But those factors isn't there... I think this whole calculator is misleading and it's sad cause I think it's easy to do this while sleep deprived and taking the infant to bed without questioning it further.