Sudden Infant Death Syndrome

Sudden Infant Death Syndrome

Sudden Infant Death Syndrome (SIDS), also called crib or cot death, the unexplained sudden death, usually during sleep, of an apparently healthy infant.

In the United States, SIDS is the third leading cause of death in infants between 1 month and 12 months of age. It primarily strikes children one to six months old—57 percent of SIDS victims are two to four months old and 95 percent are less than six months old. Since 1989, when more than 5,600 infants died of SIDS, the number of cases has decreased steadily in the United States. In 1998 about 2,800 infants died of SIDS . About 60 percent of infants who die of SIDS are males. Native American and African American infants are at highest risk.

Studies show an association between SIDS and one or more risk factors. SIDS is more common in infants with low birth weights—those weighing 2.5 kg (5.5 lb) or less at birth. SIDS is more common in infants whose mothers are under 20 years old, unmarried, have had inadequate prenatal care, did not breast-feed the infant, or have more than one infant. There is a higher incidence of SIDS among infants whose mothers smoked during pregnancy or after birth. Risk also increases in households where the father or another family member smoked—research indicates that infants exposed to cigarette smoke only after birth are twice as likely to die of SIDS. Use of illegal drugs during pregnancy is another major risk factor.

Despite the various risk factors, the cause of SIDS remains unknown. Many researchers suggest that infants who die of SIDS are born with undetected conditions that make them more vulnerable to physical and environmental stresses. Most theories about the actual cause of death focus on difficulties with breathing. Insufficient exchange of oxygen and carbon dioxide in the lungs may be caused by blockage of the air passages, faulty breathing reflexes, or problems with the brain's regulation of breathing. Abnormal heart rates or rhythms may also be involved in these deaths. A 1998 study by researchers in Italy showed that babies who have a heartbeat abnormality known as long Q-T syndrome are 41 times as likely to die of SIDS as babies with normal heartbeats. Other possible contributing factors include poor muscle tone and unstable body temperature.

In cases of sudden, unexpected infant deaths, SIDS is listed as the cause of death only after all other possible causes are eliminated including brain defects, heart disease, acute (sudden) illness like meningitis, or child abuse. A thorough examination of the infant, including a complete autopsy, examination of the infant's sleeping environment, and review of the medical history of both the victim and parents, is conducted in all suspected SIDS cases.

While the cause of SIDS remains unknown, recent advances in prevention have targeted significant risk factors. In 1992 the American Academy of Pediatrics (AAP) recommended that infants be placed on their backs to sleep. One study found that since this recommendation was made public, the rate of SIDS decreased by 38 percent in the United States between 1992 and 1996. This AAP recommendation is for healthy infants only. A physician may suggest another sleeping position if an infant has a condition that affects breathing or swallowing.

An infant's crib should be furnished with a firm mattress that fits snugly against the crib's sides. Infants sleeping facedown on soft surfaces such as water beds, beanbags, or pillows, may form a hollow pocket near the face on the sleeping surface. This pocket may cause infants to inhale their own carbon-dioxide-rich exhalations and suffocate from oxygen deprivation. Heavy bedding and soft stuffed animals that can trap air in the bed should also be avoided.

Research indicates that overheating from too much clothing, exceptionally warm bedding, or a hot room may significantly increase the risk of SIDS for an infant with a common cold or other infection. A constant indoor temperature of 20° to 21° C (68° to 70° F) will minimize overheating.

Breast-feeding appears to decrease the risk of SIDS, apparently because it helps prevent respiratory, gastric, and intestinal illnesses, infections, and certain immune disorders that may make infants more susceptible to SIDS. Eliminating smoking around the baby also decreases risk. A doctor may recommend the use of a heart and respiratory monitor for babies at high risk for SIDS. This machine sounds an alarm when the baby stops breathing or when the heart rate is too high or low. Infant caretakers are encouraged to learn cardiopulmonary resuscitation (CPR) in case an infant stops breathing (see Artificial Respiration).

SIDS is a devastating event for parents, who need support and reassurance for many months afterwards. SIDS support groups, comprised of other parents who have had similar experiences, can be particularly valuable.

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