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Sudden Infant Death Syndrome

By Michele Savin, MSN, NNP-BC

Sudden Infant Death Syndrome

Sudden Infant Death Syndrome—SIDS. Can any words strike more fear in a parent’s heart? The name says it all; sudden, irrevocable, and unexplainable.

As a new parent you may wonder how you could ever protect your children enough. But there are things you can do to reduce the chances of your child becoming a victim of this horrible syndrome.

Understanding SIDS

First some history: SIDS was first described thousands of years ago, and was thought to be a social problem not a medical one. In the late 18th century, medical theories began to emerge but still none seemed to get it quite right. Families continued to suffer the stigma of somehow being responsible for their infant’s death, and in some cases this sadly proved true.

It’s important to understand exactly what SIDS is: It’s the sudden death of an infant between 1 month and 1 year of age where the cause of death cannot be explained after a thorough review of the situation.

SIDS is the leading cause of infant death between 1 month and 1 year of age in the US. Every year, approximately 2,500 children die of SIDS in the US. African American children are 2 times as likely as Caucasian children to die of SIDS, and Native American children are 3 times as likely. Approximately 15–20% of SIDS cases happen in childcare settings.

SIDS most commonly occurs between ages 2 and 4 months; 90% of all cases are in babies younger than 6 months. The risk of SIDS is slightly higher for boys.

What causes SIDS?

As research has uncovered more clues to this syndrome, it turns out that the time between the second and fourth months of life is a period of large changes in heart activity, breathing, and sleeping and waking patterns. This leads experts to think that this critical period of development and change may also bring with it a vulnerability for sudden death.

New evidence suggests that abnormalities in a brain chemical called serotonin may play a role in SIDS. Interestingly, in one study researchers observed that boys had a lower binding of this chemical, which may help explain why boys are at increased risk. Since we still don’t know what causes SIDS, our best efforts are aimed at reducing as many as many risks as possible.

Other factors that put your baby at risk for SIDS include:

  • Your age, especially if you were younger than 20 when you birthed your baby
  • Smoking during pregnancy
  • Late or no prenatal care
  • Your baby being born preterm or with a low birth weight
  • Your baby sleeping on her stomach (face down) or on a soft surface
  • Your baby overheating


Preventing SIDS

In 1992, the American Academy of Pediatrics (AAP) recommended all infants be placed on their back to sleep. The “Back to Sleep” campaign reduced SIDS deaths around the world by almost 50% in all ethnic groups.

You may be tempted to place your baby on her stomach, especially if you feel she likes it better and sleeps longer. But this is dangerous! Babies are flexible and your infant will be able to sleep on her back. Don’t worry; back sleeping doesn’t increase her risk of spitting up or choking. Once your infant can roll from her back and side easily, she can choose her own sleep position and you don’t need to reposition her.

While experts would advise having your baby near your bed, in a bassinet or crib, experts at the AAP say you shouldn’t share your bed with your infant. Rather, your baby should always have her own firm sleep surface, free from soft bedding, pillows, stuffed animals or anything else that could affect her breathing. Studies have shown that putting your baby to bed with a pacifier can help prevent SIDS, and as such, the AAP suggest offering one to your baby for sleep time as long as breastfeeding is going well for you and your baby.

Lastly, immunizations may actually lower the risk of SIDS, so make sure you keep all of the scheduled well-child visits with your pediatrician and keep your baby up to date on her shots.
It now appears that SIDS is more likely caused by an underlying problem combined with other risk factors rather than one single catastrophic incident. Research continues into the causes of this devastating condition.

By always remembering “Back to Sleep” you will be doing the best you can to keep your baby safe, and that will make sleep easier for you too.

Reduce Your Baby’s Risk of SIDS

  • Always put your baby to sleep on her back—every time.
  • Always put your baby in her crib to sleep—on a firm surface with no other items in the crib.
  • Never sleep with your baby—even recliners and couches increase suffocation risks.
  • Keep your baby’s sleep area cool—approximately 65ºF to avoid overheating.
  • Don’t smoke during pregnancy—and don’t allow smoking around your infant.
  • Offer your baby a pacifier for sleeping—once breastfeeding is established.
  • If you must use a blanket—your baby’s feet should be placed at the bottom of the crib and the blanket should be tucked around the mattress to prevent it from ever covering your baby’s head. Better yet—don’t use blankets or bedding of any type other than a tightly fitting crib sheet.

Michele Savin MSN, NNP-BC, is a neonatal nurse practitioner at Christiana Care Health Services in Wilmington, Delaware. She is also an expert advisor to Healthy Mom&Baby and Health4Mom.org.

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