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Health Tips
SIDS
What is SIDS?
American SIDS Institute
SIDS is the sudden and unexpected death of an apparently healthy infant, whose death remains unexplained after the performance of an adequate postmortem investigation including (1) an autopsy, (2) investigation of the scene and circumstances of the death and (3) exploration of the medical history of the infant and family.
In a typical situation parents check on their supposedly sleeping infant to find him or her dead. This is the worse tragedy parents can face, a tragedy which leaves them with a sadness and a feeling of vulnerability that lasts throughout their lives. Since medicine can not tell them why their baby died, they blame themselves and often other innocent people. Their lives and those around them are changed forever.
What Are the Most Common Characteristics of SIDS?
National Sudden Infant Death Syndrome Resource Center
Most researchers now believe that babies who die of SIDS are born with one or more conditions that make them especially vulnerable to stresses that occur in the normal life of an infant, including both internal and external influences. SIDS occurs in all types of families and is largely indifferent to race or socioeconomic level. SIDS is unexpected, usually occurring in otherwise apparently healthy infants from 1 month to 1 year of age. Most deaths from SIDS occur by the end of the sixth month, with the greatest number taking place between 2 and 4 months of age. A SIDS death occurs quickly and is often associated with sleep, with no signs of suffering. More deaths are reported in the fall and winter (in both the Northern and Southern Hemispheres) and there is a 60- to 40-percent male-to-female ratio. A death is diagnosed as SIDS only after all other alternatives have been eliminated: SIDS is a diagnosis of exclusion.
What SIDS Is and What SIDS Is Not
National Sudden Infant Death Syndrome Resource Center
SIDS Is:
The major cause of death in infants from 1 month to 1 year of age, with most deaths occurring between 2 and 4 months
- sudden and silent--the infant was seemingly healthy
- currently, unpredictable and unpreventable
- a death that occurs quickly, often associated with sleep and with no signs of suffering
- determined only after an autopsy, an examination of the death scene, and a review of the clinical history
- designated as a diagnosis of exclusion
- a recognized medical disorder listed in the International Classification of Diseases, 9th Revision (ICD-9)
- an infant death that leaves unanswered questions, causing intense grief for parents and families
SIDS Is Not:
- caused by vomiting and choking, or minor illnesses such as colds or infections
- caused by the diphtheria, pertussis, tetanus (DPT) vaccines, or other immunizations
- contagious
- child abuse
- the cause of every unexpected infant death
How Do Professionals Diagnose SIDS?
National Sudden Infant Death Syndrome Resource Center
Often the cause of an infant death can be determined only through a process of collecting information, conducting sometimes complex forensic tests and procedures, and talking with parents and physicians. When a death is sudden and unexplained, investigators, including medical examiners and coroners, use the special expertise of forensic medicine (application of medical knowledge to legal issues). SIDS is no exception.
Health professionals make use of three avenues of investigation in determining a SIDS death:
- The autopsy,
- Death scene investigation, and,
- Review of victim and family case history.
- The Autopsy
The autopsy provides anatomical evidence through microscopic examination of tissue samples and vital organs. An autopsy is important because SIDS is a diagnosis of exclusion. A definitive diagnosis cannot be made without a thorough postmortem examination that fails to point to any other possible cause of death. Also, if a cause of SIDS is ever to be uncovered, scientists will most likely detect that cause through evidence gathered from a thorough pathological examination.
- A Thorough Death Scene Investigation
A thorough death scene investigation involves interviewing the parents, other caregivers, and family members; collecting items from the death scene; and evaluating that information. Although painful for the family, a detailed scene investigation may shed light on the cause, sometimes revealing a recognizable and possibly preventable cause of death.
- Review of the Victim and Family Case History
A comprehensive history of the infant and family is especially critical to determine a SIDS death. Often, a careful review of documented and anecdotal information about the victim's or family's history of previous illnesses, accidents, or behaviors may further corroborate what is detected in the autopsy or death scene investigation.
Investigators should be sensitive and understand that the family may view this process as an intrusion, even a violation of their grief. It should be noted that, although stressful, a careful investigation that reveals no preventable cause of death may actually be a means of giving solace to a grieving family.
Who is at risk for SIDS?
CDC - National Vaccine Program Office
- Babies who sleep on their stomachs
- Babies born to mothers who smoke during pregnancy and babies that are exposed to passive smoke after birth
- Babies born to mothers who are less than 20 years old at the time of their first pregnancy
- Babies born to mothers who had no or late prenatal care
- Babies who are premature or low birth weight
- Babies who are placed to sleep on soft surfaces such as soft mattresses, sofas, sofa cushions, waterbeds, sheep skins, or other soft surfaces
- Babies who are placed to sleep in an environment containing fluffy and loose bedding, such as pillows, quilts or other coverings, stuffed toys, and other soft items
It is also important to note that...
- Boys are at greater risk for SIDS than girls.
- African American infants are twice as likely to die of SIDS as white infants.
- American Indian infants are nearly three times more likely to die of SIDS as white infants.
- More SIDS deaths occur in colder months.
- Several studies have demonstrated no association between receiving infant immunizations and SIDS.
- SIDS is not contagious.
- SIDS is not caused by child abuse or neglect.
What causes SIDS?
CDC - National Vaccine Program Office
Although researchers are still trying to understand what causes SIDS, the following are some important clues:
- Evidence suggests that some SIDS babies are born with brain abnormalities that make them vulnerable to sudden death during infancy. In many SIDS babies, abnormalities are found in parts of the brainstem that use serotonin as a neurotransmitter, and are thought to be involved in the control of breathing during sleep, sensing carbon dioxide and oxygen, and the ability to wake up. A baby with this abnormality may lack a protective brain mechanism that senses abnormal respiration or cardiovascular function and normally leads babies to wake up and take a breath.
- Babies who sleep on their stomachs may get their faces caught in bedding, which causes them to breathe too much carbon dioxide and too little oxygen. Researchers are studying whether this is why sleeping on the stomach is hazardous and why babies with brainstem abnormality die when sleeping in this position.
- A larger number of babies who died from SIDS apparently had respiratory or gastrointestinal infections prior to their deaths. This fact may explain why more SIDS cases occur during the colder months of the year.
- Researchers indicate that some SIDS babies had higher-than-normal numbers of cells and proteins generated by the immune system. Some of these proteins interact with the brain to alter heart rate, slow breathing during sleep, or put the baby into a deep sleep, which may be strong enough to cause death, particularly if the baby has an underlying brain abnormality.
What Can Be Done?
American SIDS Institute
Unfortunately, we cannot expect to prevent all SIDS deaths now. To do so requires a much greater understanding of SIDS, which will be achieved only with a commitment from those who value babies and with a considerably expanded research effort. However, there are things that can be done to reduce the risk of SIDS. There are things that parents-to-be can do and there are things that parents can do.
- Parents-To-Be
- Get medical care early in pregnancy, preferably within the first three months, followed by regular checkups at the doctor's office or health clinic. Make every effort to assure good nutrition. These measures can reduce the risk of premature birth, a major risk factor for SIDS.
- Do not smoke, use cocaine, or use heroin. Tobacco, cocaine, or heroin use during pregnancy increases the infant's risk for SIDS.
- Take care to prevent becoming pregnant during the teenage years. If you are a teen and already have one infant, take extreme caution not to become pregnant again. The SIDS rate decreases for babies born to older mothers. It is highest for babies born to teenage mothers. The more babies a teen mother has, the greater at risk they are.
- Wait at least one year between the birth of a child and the next pregnancy. The shorter the interval between pregnancies, the higher the SIDS rate.
- Parents
- Avoid exposing the infant to tobacco smoke. Don't have your infant in the same house or car with someone who is smoking. The greater the exposure to tobacco smoke, the greater the risk of SIDS
- Breast-feed babies whenever possible. Breast milk decreases the occurrence of respiratory and gastrointestinal infections. Studies show that breast-fed babies have a lower SIDS rate than formula-fed babies do.
- Avoid exposing the infant to people with respiratory infections. Avoid crowds. Carefully clean anything that comes in contact with the baby. Have people wash their hands before holding or playing with your baby. SIDS often occurs in association with relatively minor respiratory (mild cold) and gastrointestinal infections (vomiting and diarrhea).
- Place infants to sleep on their backs, even though infants may sleep more soundly on their stomachs. Infants who sleep on their stomachs have a higher rate of SIDS than infants who sleep on their backs.
- Place infants to sleep on a firm mattress with no covering or only a sheet or light blanket used for covering. No stuffed animals or other items should be placed in the crib. Soft mattresses and heavy covering are associated with the risk for SIDS.
- Do not over-clothe the infant while he/she sleeps. Keep the room at a temperature that is confortable for you. Overheating an infant may increase the risk for SIDS.
- Consider using home monitoring systems (apnea/bradycardia monitors) in an attempt to prevent sudden death in high-risk infants.
The risk of SIDS in the following groups exceeds that of the general population by as much and 5 to 10 times.
- Infants born weighing less than 3.5 pounds.
- Infants whose sibling died of SIDS.
- Infants exposed to cocaine, heroin, or methadone during the pregnancy.
- The second or succeeding child born to a teenage mother.
- Infants who have had an apparent life threatening event.
Discuss the advantages and disadvantages of home monitoring with the baby's doctor before making your choice. Many communities have specialized programs for the clinical management of babies at high risk for SIDS. For information about the availability of such programs in your area, ask your baby's doctor or contact the American SIDS Institute.
Protecting America's Infants, Safe Sleep Practices and the Hazards of the Adult Bed
SIDS Alliance
In addition to the more obvious hazards of adult beds for infants (entrapment, overlaying, suffocation or a fall from the bed,) the soft and fluffy bedding materials found in the adult bed can cause a dangerous buildup of carbon dioxide around a sleeping baby.
Rebreathing exhaled carbon dioxide has been identified as a leading cause of Sudden Infant Death Syndrome. As a result of the national "Back To Sleep Campaign", which recommends placing babies to sleep on their back and removing all soft bedding items from the sleep area, SIDS rates have dropped by more than 50%.
"The safest place for your baby to sleep is in a safety approved crib, on a firm mattress, with no loose or soft bedding around them," according to Debra Boyd, spokesperson for the SIDS Alliance out of Baltimore, Maryland. If a crib is not available, or if you choose to bed share with your baby, the SIDS Alliance offers the following recommendations on ensuring a safe sleep environment:
- Always place your baby to sleep on his or her back, on a firm mattress covered with only a tight fitting bottom sheet (no padded mattress tops or covers);
- Remove all loose and fluffy bedding from your baby's sleep area. This includes pillows, blankets, quilts, comforters, bumper pads, sheepskins, stuffed toys and other soft products;
- Never place your baby to sleep on a sofa, waterbed, pillow, soft mattress, or any other soft surface;
- Do not bed share with brothers, sisters or relatives other than the baby's mother;
- When using a crib, make sure it meets current safety standards, and that the mattress fits snuggly in the crib;
- When using a portable crib or playpen, be sure to use only the mattress or pad provided by the manufacturer;
- Be aware of all of the hidden hazards of adult beds for infants. These include the potential for entrapment between the bed, wall, headboard, bed frame or other object; accidental suffocation in soft bedding; overlaying and falls from the bed.
It is important to note that bed sharing has not been found to be protective against SIDS, but studies do suggest that room sharing (having the crib or other separate sleep surface along side the adult bed or sofa) may be beneficial. Given all we know, it would seem that this continues to be the best way to maximize all the benefits and minimize all the dangers associated with bed sharing.
Positional Plagiocephaly, or "Flat Heads"
SIDS Alliance
As a result of the 1992 recommendation by the American Academy of Pediatrics (AAP) that babies sleep on their back, we have seen an increase in the incidence of "flat heads" in infants. Dr. Maurice Edward Keenan of the AAP Task Force on Infant Positioning and Sudden Infant Death Syndrome (SIDS) says that assymetrical heads are a minor problem compared to the success of lowering the risk for SIDS.
Also known as "positional plagiocephaly", experts agree that it is rarely a serious condition and can be avoided if parents make a conscious effort to change the direction the infant's head faces when they are on their backs. Craniofacial specialists and neurosurgeons say that the problem is no reason to go back to putting babies on their stomachs for sleep. In the vast majority of the cases when a baby develops a flattened head, the problem usually resolves with time (by 6 months to one year of age) as the baby spends more time awake and begins to roll to different positions by themselves. The use of helmets (usually costing in the range of $2,000) or surgery to correct this is rarely needed.
The SIDS Alliance reiterates the importance of placing infants on their backs for sleep to reduce the risk of SIDS. However, in an effort to allow parents and caregivers to be more proactive in regard to flattening of the head, the SIDS Alliance offers the following simple recommendations:
- Alternate the direction you place the baby to sleep in the crib;
- Move the mobile, mirror or other object of interest to the opposite side of the sleep and/or play area;
- Switch the arm with which you hold the baby, especially during feeding times;
- Place the car seat on opposite sides of the car;
- Provide the baby with lots of supervised "tummy time" during the day when they're awake. This will not only enhance the shape of the head, but will strengthen the upper body muscles that are not used as much when babies sleep on their backs. It also allows for quality "exercise" or "play" time between you and your baby!
The SIDS Alliance recommends that parents consult with their physician if they are concerned about a more abnormal flattening of the head to eliminate the possibility of a more serious condition such as torticollis (a tightening of the muscles of one side of the neck) or craniosynostosis (a very rare premature closing of the sutures of the skull).
How Does a SIDS Baby Affect the Family?
NICHD
A SIDS death is a tragedy that can prompt intense emotional reactions among surviving family members. After the initial disbelief, denial, or numbness begins to wear off, parents often fall into a prolonged depression. This depression can affect their sleeping, eating, ability to concentrate, and general energy level. Crying, weeping, incessant talking, and strong feelings of guilt or anger are all normal reactions. Many parents experience unreasonable fears that they, or someone in their family, may be in danger. Over-protection of surviving children and fears for future children is a common reaction.
As the finality of the child's acute death becomes a reality for the parents, recovery occurs. Parents begin to take a more active part in their own lives, which begin to have meaning once again. The pain of their child's death becomes less intense but not forgotten. Birthdays, holidays, and the anniversary of the child's death can trigger periods of intense pain and suffering.
Children will also be affected by the baby's death. They may fear that other members of the family, including themselves, will also suddenly die. Children often also feel guilty about the death of a sibling and may feel that they had something to do with the death. Children may not show their feelings in obvious ways. Although they may deny being upset and seem unconcerned, signs that they are disturbed include intensified clinging to parents, misbehaving, bed wetting, difficulties in school, and nightmares. It is important to talk to children about the death and explain to them that the baby died because of a medical problem that occurs only in infants in rare instances and cannot occur in them. The National Institute of Child Health and Human Development (NICHD) continues to support research aimed at uncovering what causes SIDS, who is at risk for the disorder, and ways to lower the risk of sudden infant death. Inquiries regarding research programs should be directed to Dr. Marian Willinger, 301-496-5575.
Families with a baby who has died from SIDS may be aided by counseling and support groups. Examples of these groups include the following:
- Association of SIDS and Infant Mortality Programs
c/o Minnesota SIDS Center
2525 Chicago Ave. South
Minneapolis, MN 55404
1-612-813-6285
- National SIDS Resource Center
2070 Chain Bridge Road
Suite 450
Vienna, VA 22181
1-703-821-8955
- SIDS Alliance (a national network of SIDS support groups)
1314 Bedford Avenue
Suite 210
Baltimore, MD 21208
1-800-221-7437 or
1-410-653-8226
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