Sudden Infant Death Syndrome (SIDS)
Sudden Infant Death Syndrome (SIDS) is the diagnosis given
for the sudden death of an infant, 1 month to 1 year of age, which remains
unexplained after a complete investigation. The investigation includes an
autopsy, examination of the death scene, a review of the child's symptoms or
illness the infant had prior to the death, and any other pertinent medical
history. Because most cases of SIDS occur when the baby is sleeping in a
crib, SIDS may also be know as crib death. The event may occur wherever
the infant is sleeping, not necessarily the crib.
SIDS can occur anytime between 1 month and 1 year of age,
however, 90% of the deaths occur before the age of 6 months, with the
concentration between 2 and 4 months. Approximately 3,000 babies die of
SIDS in the U.S. each year, and 218 babies died in Texas of SIDS during 1999.
There is an increase incidence in the winter months. It is more common
with male children than females, (60% vs. 40%). SIDS happens suddenly and
silently in a seemingly healthy infant. The death leaves many unanswered
questions, causing intense grief for parents and families.
SIDS is not:
SIDS is not hereditary, contagious, caused by
immunizations, choking, suffocation, or apnea. It is not child abuse, and
not the reason for all unexpected infant deaths.
Which babies are at
Infants born weighing less than 5 to 6
lbs., premature babies, twins or triplets, babies born to mothers younger than
20 years old, and babies born to mothers who smoked during pregnancy
increase the risk by three times. Factors after birth that increase the
risk of Sudden Infant Death Syndrome are babies that sleep on their stomachs and
smoking in the infant's environment. Smoke in the environment doubles the
What can be done to
reduce the risk of SIDS?
Even though SIDS cannot be completely
prevented, there are things that can be done to reduce the risk of SIDS.
Place babies on their back for sleep.
Always position the baby on their back for nighttime and naptime. Do
not place the baby on their stomach or side. Starting in 1992, the
American Academy of Pediatrics (AAP) recommended that babies be put down to
sleep on their backs instead of their stomachs and in 1994, began the
nationwide "Back to Sleep" campaign. Since this recommendation, the
incidents of SIDS have reduced 40%, which means saving about 2,00 babies
each year from SIDS. The concern expressed with placing babies on
their backs is that those infants may choke. There is not evidence to
support this as researched by countries where "back to sleep" was the
standard, and these countries also had a much lower incident rate of SIDS.
Place the baby on a tight-fitting
mattress in a crib meeting current safety standards. Don't put babies
to sleep on soft mattresses, sofas, waterbeds, pillows, beanbags or other
Remove all fluffy and loose bedding
from the sleep area. Pillows, quilts, and comforters and stuffed toys
should not be in the sleep area. If using a blanket it should be thin.
Place the baby in the crib with his feet at the foot and tuck the blanket
around the crib mattress, only as far as the baby's chest. Blankets
and coverings can bunch up around the baby's face, which can cause
potentially dangerous re-breathing of stale air. Also, make sure the
baby's head is uncovered during sleep.
Make sure the baby does not
become over heated by wearing too much clothing, heavy bedding or too warm a
room. Babies cannot regulate their own body temperature well, so the
baby should be dressed in whatever clothing is comfortable to you as an
adult. Remover outer wear (jackets, sweaters, hats) once inside so not
to overheat the baby.
Keep the environment smoke free.
Breast-feed the baby, if possible.
Breast-fed baby's are at a lower risk for respiratory illnesses. The
increase of SIDS during the winter months may be due to use of heavier
bedding, over dressing the baby, and increased respiratory infections which
may be triggering events for a SIDS death.
What causes SIDS?
While the causes of SIDS are still
unknown, a triple-risk model is not often used to describe the elements that
occur together that may lead to the sudden death of infants.
During the first 6 months of life, the
rapid growth that occurs with infants may periodically destabilize their
system that controls sleeping and waking, breathing, heart rate, blood
pressure and temperature - this is know as the critical development period.
The vulnerable infant has an
underlying defect in the brain that controls breathing and heart rate during
early life, and
There are outside or environmental
challenges present that a normal baby can overcome, but an already
vulnerable infant might not. Stressors such as second-hand exposure to
tobacco smoke, stomach sleep position or an upper respiratory infection
alone do not cause death in an infant, but may further tip the balance
against an infant's chances for survival. According to this model, all
3 elements must come together for SIDS to result. The babies seem to
not have enough protective responders to handle changes in oxygen and carbon
Child Care Providers
need to consider:
Study results released in September 2000,
evaluating the circumstances of nearly 2000 SIDS deaths, found that 20% of those
SIDS deaths occurred in child-care settings. Thought to be a contributing
factor was a high percentage of the caregivers were not aware of the "back to
sleep" recommendation and other risk reducing techniques - probably because most
of them had children that were older than when the recommendation came out in
Also, it has been found that babies who
routinely are used to sleeping on their backs and are then placed on their
stomachs for sleep have a 20 times greater risk of SIDS. A well
intentioned, yet possibly uninformed caregiver, feels the baby would "sleep more
soundly" on their stomach. It is essential that sleep position be
nighttime, and naptime, and from parent to grandparent to child-care provider.
"Tummy time" while the baby is awake and
being observed, is important to develop shoulder and neck muscles and
coordination, as well as reduce the flattening that can develop on the back of
If you have a child in care with reflux,
respiratory disease or some other breathing dysfunction, be sure and obtain
information from the child's physician on the recommended sleep position.
1. At what age is SIDS most like to occur?
2. Factors that
would place babies at higher risk for SIDS would include
3. It doesn't matter
if babies are placed on the stomach or back as long as they are not too warm.
4. Babies should
not be placed on soft mattresses or surfaces if unattended.
5. What percent of
SIDS deaths occurred in childcare settings?