Understanding Sudden Infant Death Syndrome

Sudden infant death syndrome, or SIDS, is one of the most tragic and puzzling causes of infant death. SIDS has occurred for thousands of years. In the past, it was called "overlaying" because it was believed that the mother had rolled onto the baby during sleep. Now it is known that this is not the case, but the true cause of SIDS is still unknown. In fact, SIDS is only diagnosed when no other cause of death can be identified.

With SIDS, death occurs quickly and usually without being noticed immediately. The baby apparently dies during sleep and without suffering. In the few reported instances in which a SIDS death was observed, the baby simply stopped breathing. In the most common situation, an apparently healthy baby is put to bed and is later found dead.

Typically, younger infants are at higher risk of death from identifiable causes, and the risk declines as the baby becomes older. However, in contrast, few SIDS deaths occur in infants younger than one month old; most deaths occur when the baby is two to four months old, and the incidence of SIDS decreases dramatically after the age of six months. SIDS rarely occurs in babies one to two years old.

SIDS deaths occur in families from all socioeconomic backgrounds, from all races, from all ethnic backgrounds, and from urban and rural areas. Autopsies have shown no consistent findings to indicate a cause of death. Although parents cannot anticipate or prevent SIDS, they need to be informed about it in case their child or the child of someone they know becomes a victim of a SIDS death.

While some factors seem to be associated with a higher incidence of SIDS, none has been established as a cause. These factors include soft bedding or stuffed toys in the crib, which can cause suffocation; cigarette smoke (more babies who die of SIDS come from environments in which they were exposed to smoke); overheating; lying on the tummy in the prone position; and premature birth.

Research into the cause of SIDS is difficult because of all the events occurring when a baby is two to four months old-for example, the baby may switch from breast to bottle or begin receiving immunizations. This has raised many false alarms, but to date, research has not proved that the method of feeding, vaccination, or any specific event is linked to SIDS.

The "Back to Sleep" campaign, sponsored by the National Institute of Child Health and Human Development (NICHD), is credited with reducing the number of deaths from SIDS by more than 50 percent since 1992, when it was launched. The campaign has raised awareness that parents should put their babies to sleep on their backs on firm surfaces that do not have soft bedding, loose blankets, or stuffed toys.

All of the baby's caregivers, including grandparents and babysitters, should also know this information. Swaddling, or carefully wrapping a baby in a blanket, may comfort your baby and help her feel more snug and secure while sleeping on her back. Using a pacifier may also help prevent SIDS (and has not been shown to cause any damage to developing teeth in this age group). Avoid putting your baby to sleep in your bed with you; the blankets and pillows put her at risk for suffocation.

Despite all these precautions, some babies may still experience an "apparent life-threatening event," or ALTE. Babies who experience ALTE may stop breathing, turn pale or blue, or become limp. If this happens, gently rock or otherwise stimulate your baby to promote breathing. Never shake your baby under any circumstances. Shaking a baby can cause irreversible brain damage. When your baby begins breathing again, immediately take her to the nearest emergency department.

Your doctor will want to examine the baby and perform certain tests. After these tests are concluded, your doctor may elect to send your baby home for a short time and, while there, have her connected to an infant cardiopulmonary monitor. Such monitors are designed only to warn parents of breathing difficulties or low heart rate in their infants, not to prevent SIDS from occurring.

Many episodes of choking or cessation of breathing are not caused by ALTE events; they should be studied to determine the actual cause and then treated accordingly. Many parents have read or heard a lot about SIDS, and they have become very concerned when their babies have problems with pauses in respiration and other respiratory events. The majority of these events are not related to SIDS. However, if you are concerned about your baby, consult your doctor.

As one could imagine, Sudden Infant Death Syndrome claims more victims than just the baby itself. Parents, siblings, and even babysitters often feel responsible for the untimely death. The unfortunate resulting trauma sometimes leads to family disintegration: divorce, substance abuse, blame and severe psychological problems. Read how to overcome guilt about SIDS next.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

The parents of a SIDS baby also become victims of the disease. Their grief and guilt may be overwhelming. Unlike parents whose baby was ill before dying, the parents of a SIDS baby have no warning or time to prepare emotionally for the loss of their child. Feelings of guilt and self-recrimination are normal first reactions. The parents immediately begin to wonder what they did or did not do to cause the death. But there has never been evidence that any special care, or lack of it, can prevent or contribute to a SIDS death.

The emotional trauma experienced by the family frequently results in the family's disintegration. Rates of divorce, substance abuse, and serious psychological problems are high in SIDS families. Fathers of SIDS babies may seek excuses not to be home, such as working longer hours. They tend to internalize their grief and may have difficulty talking about the baby and his or her death.

Mothers frequently wish to talk about their loss but have difficulty finding someone to talk to. They may undergo physical changes that are difficult to handle, especially if they were nursing the baby. While fathers may have a strong desire to "replace" the lost child, mothers may be less inclined to have another baby as soon as possible. In reaction to the SIDS death, both parents may become overly protective of their other or subsequent children.

The trauma suffered by other children in a family that has experienced a SIDS death -- or other caregivers, such as babysitters -- may go unrecognized as everyone concentrates on the parents' loss. Yet siblings may suffer from the loss and from guilt feelings, sometimes to the extent that psychological counseling is necessary.

Siblings old enough to have helped care for the baby would have established a special bond to the baby that makes their loss very real and very big. Also, they are apt to develop guilt feelings about what they might have done to cause the death, especially if they tended to the baby shortly before the death. Younger siblings, who probably experienced brief periods of jealousy when they wished the baby would go away, may have difficulty coping with a feeling that they somehow caused the baby's death.

In many areas of the United States, efforts have been expanded to help SIDS families. Some states now have SIDS projects, and all SIDS activities and counseling are available through these projects. In other states, SIDS activities and counseling are offered through state public health departments. Also, many parents of SIDS babies are active in self-help groups. Parents and others who have difficulty obtaining information about SIDS can contact the First Candle/SIDS Alliance, 1314 Bedford Avenue, Suite 210, Baltimore, MD 21208 (800-221-7437 or www.sidsalliance.org) for more information.

Remember that Sudden Infant Death Syndrome is not the fault of parents, and you should not take it out on yourself or anyone else. SIDS is a tragedy that even doctors cannot fully explain, and parents should not shoulder the weight of this unfortunate event themselves.

ABOUT THE CONSULTANTS

Alvin Eden, M.D. serves as a Clinical Professor of Pediatrics at the Weil Medical College of Cornell University in New York, New York. He is Chairman of the Department of Pediatrics at the Wyckoff Heights Medical Center in Brooklyn. Dr. Eden is also the author of a number of child care book, including Positive Parenting and Growing Up Thin.

Dr. Elizabeth Eden, M.D.

is a practicing obstetrician with her own private practice in New York City. She serves as an attending physician at the Tisch Hospital of the New York University Medical Center, as well as a Clinical Assistant Professor at the New York University School of Medicine.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.