Dead babies aren’t something anybody likes to talk about. But while it may be a difficult topic, it’s also an important one–because there are things we can do to make it happen less frequently. The loss of an infant is something parents never really get over, and something that no parent should have to experience. Here’s a look at the most common causes of infant mortality and some things you can do to reduce your baby’s risk. [Warning: This is about to get real, and maybe a bit uncomfortable. But stick with me; it’s important.]

Babies die—a lot of them. And no matter how hard we try, babies are still going to die. The only way to have a society with no infant mortality is to stop having babies. If you think that’s a sustainable plan, talk to a Shaker (if you can find one).

The infant mortality rate (IMR) in the United States in 2014 was 6.17 per 1,000 live births—this number does not include miscarriages or stillbirths. More simply stated, just over 6 out of every 1,000 babies in the US die before their first birthday (which comes out to about 25,000 babies per year). That sounds horrible, and it is, compared to many other developed nations. But it’s a heck of a lot better than Afghanistan, which has the world’s highest IMR at 117 out of every 1,000 children (yes, almost 12%).

My first experience with a dead baby was during the first month I worked in the NICU. I was paged about a 24-week infant who was being delivered by emergent C-section because of “non-reassuring fetal status” (which is OB/GYN code for “somethin’ ain’t right”). The baby came out limp and gray, and things didn’t improve much from there. We spent the next hour placing tubes and lines into every hole that baby had–and making a few of our own as well. And then we had the dreaded conversation with his mother about withdrawing care. Despite delivering in a well-equipped facility with a well-trained neonatal intensive care team, this baby was not destined to survive. Something had gone wrong with his development long before he made it to us, and nothing we did was going to change it.

I tell this story because it’s important to recognize that some babies are born with problems we just can’t fix. It may be poorly developed lungs, kidneys that never formed, a brain that doesn’t function appropriately, or a host of other congenital problems that–despite all of our advances in medical knowledge and technology–simply can’t be overcome. Another important point is that we are delivering infants at earlier gestational ages than ever before—sometimes successfully. The “age of viability” is generally considered to be around 24 weeks (out of a 40-week full-term pregnancy). At 24 weeks, an infant has roughly a 50% chance of survival. I often argue that defined cutoff values are artificial and arbitrarily selected, but in this case, every day matters. Around 24 weeks of gestation, an infant’s chance of survival increases by about 2-3% per day.

Before I’m accused of being fatalistic, here’s where I’m going with this: we can’t drive the infant mortality rate down to zero, but we certainly can do better. Our goal isn’t to be better than Afghanistan; it’s to do everything we can to reduce preventable infant deaths. And while many deaths in the first month of life are difficult or impossible to prevent, the number one cause of death between 1 and 12 months of age is SIDS.

SIDS stands for Sudden Infant Death Syndrome, and the name is wonderfully descriptive (far better than the hundreds of diseases that are named after the physicians that discovered them). Let’s break down the name:

1. Sudden: SIDS is unexpected and happens to seemingly healthy babies.

2. Infant: SIDS occurs only in the first year of life, but is most common in infants under 4-6 months.

3. Death: There’s no “near-SIDS” or “partial-SIDS.” There’s no warning, and once it happens, it’s too late to do anything about it.

4. Missing from the name is another important part of the diagnosis; the death must be unexplained. It can’t be from suffocation, another medical problem, or abuse. A diagnosis of SIDS requires an autopsy, an investigation of the death scene, and a review of the infant’s medical history. Only if all those things fail to reveal another cause of death can we label the death as being due to SIDS.

SIDS deaths happen in about 2,300 infants per year in the US. That’s about 70 per 100,000 live births, or 0.07% of infants. It’s the leading cause of death between 1 month and 1 year of life. The SIDS rate has decreased since the mid-1990’s, but it’s likely that a large part of this was due to a stricter interpretation of which deaths qualify as SIDS; they may have simply been redefined as suffocation or other types of deaths. Unlike many other causes of infant deaths, there are a number of things that we know can reduce the risk of SIDS and allow us to save some babies’ lives. Are you in?

1. Put your baby down to sleep on his back. Infants that sleep in the prone (face-down) position are several times more likely to die from SIDS. One theory is that it has something to do with re-breathing exhaled air, which makes carbon dioxide levels go up and oxygen levels drop fatally low. Side-sleeping isn’t much better. The safest way for a baby to sleep is on his back, and there has been an ongoing campaign since 1994 (“Back to Sleep”) to educate parents about proper sleep positioning. You don’t need any special equipment–wedges or other devices to help with positioning haven’t been shown to be effective, and some of them have contributed to infant deaths by suffocation.

2. Don’t smoke (during pregnancy or after). Both of these have been shown to dramatically increase the risk of SIDS, and tobacco exposure carries numerous other risks for you and your baby.

3. Have girls. I know, this one is beyond your control. But boys are 50% more likely than girls to die from SIDS. I have no idea why, but it’s consistently true.

4. Choose your race wisely. Again, this is what we call a “non-modifiable risk factor.” There’s not much you can do about it. But the rate of SIDS varies wildly with race. In general, white babies are twice as likely as Asian or Hispanic babies to die from SIDS, and the risk doubles again in black or Native American babies. There’s probably more than one factor involved here—likely a combination of genetic predisposition and socioeconomic/cultural factors.

5. Give your baby a pacifier. Babies who sleep with pacifiers are at least 50% less likely to die from SIDS, even if it falls out overnight. The best theory I’ve heard is that it provides some stimulation to keep the baby in a somewhat alert state even during sleep, minimizing the chances that she’ll sleep through whatever warning signs may precede SIDS. If you’re breastfeeding, it’s fine to wait 2-4 weeks before starting this to minimize nipple confusion, but it’s a good idea even for breastfed babies. Which leads me to…

6. Breastfeed your baby. Infants who are exclusively breastfed are about half as likely to die from SIDS as their formula-chugging counterparts. There are numerous other health benefits to breastfeeding, which I’ll cover in a later post. But if you can breastfeed, do it. If you can’t, but you can pump and give breastmilk in a bottle, that’s a close second. If formula’s your only option, it’s a lot better than nothing.

7. Sleep in the same room, but not in the same bed. This has been shown to reduce SIDS deaths by about 50%. I’ll probably take some heat from the attachment parenting crowd (like that hasn’t happened before), but the data is there. I’ll admit that there are some co-sleeping arrangements that are safer than others, but one of the biggest risk factors is exhaustion, which I hear is pretty common in new moms. Two of the least safe places to co-sleep are on the couch or in a recliner. Ideally, a crib or bassinet in your bedroom allows you to be aware of what’s going on with your baby and provides easy access while eliminating the risks of co-sleeping. The various co-sleeping devices available probably have varying degrees of safety/risk, but there’s not enough data yet to say for sure. (As a side note, the boxes that Finnish babies sleep in seem pretty safe; their IMR is about half of ours.)

8. Don’t put anything in the crib. Except a firm mattress with a fitted sheet. And your baby. Not pillows. Not stuffed animals. Not blankets or quilts. Not matching crib bumpers. I’m sorry–I don’t know why these things still come packaged with infant bedding sets. But you should put them in the closet or throw them out. They pose a risk for SIDS as well as death by suffocation. As cute as they may be, it’s just not worth it.

9. Immunize your baby. There has been some concern about an increased risk of SIDS after infants are immunized. Some past studies showed a temporal association between immunizations and deaths from SIDS. But the fact that two things happen around the same time doesn’t mean that one caused the other. SIDS is most common around 2-4 months of age–also a time when many infants receive immunizations. It’s easy to see why this would be concerning. But the best evidence we have shows not only that immunizations don’t increase the risk for SIDS, but that they actually cut that risk in half. And while we’re on the topic, they might just keep your baby from dying because of a few other things as well.

OK, I’m done. Sorry if that was depressing. Like I said, it’s never a fun topic, but it’s one that’s important to talk about–and one about which some parents are afraid to ask. Try to remember that SIDS happens in a very small percentage of infants (0.07%); assuming you have a pretty normal baby that made it through the first month, the odds are good that she’ll be fine. But I’d hate for you to be one of the few parents that has to live with the preventable death of a child just because we didn’t talk about it.

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