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Sudden Infant Death Syndrome (SIDS)

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By PaulinoMilla, M.D. FAAP

Sudden Unexpected Infant Death (SUID) is a term used to describe the sudden and unexpected death of a baby less than one year old in which the cause was not obvious before investigation. These deaths often happen during sleep or in the baby’s sleep area.

Sudden Infant Death Syndrome (SIDS) is a subcategory of SUID and is a cause assigned to infant deaths that cannot be explained after a thorough case investigation, including a scene investigation, autopsy, and review of the clinical history.

About 3,500 babies in the United States die suddenly and unexpectedly each year. A thorough investigation is necessary to learn what caused these deaths.

What Causes SIDS?

There’s no established cause of SIDS. It’s called a “diagnosis of exclusion,” meaning that it’s the diagnosis given after everything else has been ruled out.

Although medical experts haven’t found a cause, they have identified many risk factors that contribute to SIDS. Those include:

  • Physical Factors — Factors like brain abnormalities, low birth weight, and respiratory issues can increase the risk of SIDS.
  • Sleeping Environment Factors — Babies who sleep on their tummies or sides, babies who sleep on overly soft bedding or with loose blankets and babies who sleep with their parents are more likely to die of SIDS.
  • Other Factors — Boys are more likely to die of SIDS than girls, and babies are most vulnerable in their second and third month of life. Babies who are exposed to cigarette smoke (both before and after birth) have a higher risk of SIDS. Babies who have a family history of SIDS are also at greater risk.

Can SIDS Be Prevented?

Unfortunately, there’s no way to prevent SIDS entirely. Sometimes, parents do everything right, and they still lose a little one to SIDS.

However, there are preventative steps parents can take, and research has shown again and again that when these steps are taken, SIDS rates are drastically reduced.

After case investigation, SUID can be attributed to suffocation, asphyxia, entrapment, infection, ingestions, metabolic diseases, arrhythmia-associated cardiac channelopathies, and trauma (unintentional or nonaccidental).

The distinction between SIDS and other SUIDs, particularly those that occur during an unobserved sleep period (sleep-related infant deaths), such as unintentional suffocation, is challenging, cannot be determined by autopsy alone, and may remain unresolved after a full case investigation. Many of the modifiable and nonmodifiable risk factors for SIDS and suffocation are strikingly similar.

The recommendations outlined herein were developed to reduce the risk of SIDS and sleep-related suffocation, asphyxia, and entrapment among infants in the general population.

Summary of Recommendations with Strength of Recommendation:

  • A-level recommendations
    • Back to sleep for every sleep.
    • Use a firm sleep surface.
    • Breastfeeding is recommended.
    • Room-sharing with the infant on a separate sleep surface is recommended.
    • Keep soft objects and loose bedding away from the infant’s sleep area.
    • Consider offering a pacifier at naptime and bedtime.
    • Avoid smoke exposure during pregnancy and after birth.
    • Avoid alcohol and illicit drug use during pregnancy and after birth.
    • Avoid overheating.
    • Pregnant women should seek and obtain regular prenatal care.
    • Infants should be immunized in accordance with AAP and CDC recommendations.
    • Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS.
    • Health care providers, staff in newborn nurseries and NICUs, and child care providers should endorse and model the SIDS risk-reduction recommendations from birth.
    • Media and manufacturers should follow safe sleep guidelines in their messaging and advertising.
    • Continue the “Safe to Sleep” campaign, focusing on ways to reduce the risk of all sleep-related infant deaths, including SIDS, suffocation, and other unintentional deaths. Pediatricians and other primary care providers should actively participate in this campaign.
  • B-level recommendations
    • Avoid the use of commercial devices that are inconsistent with safe sleep recommendations.
    • Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly.
  • C-level recommendations
    • Continue research and surveillance on the risk factors, causes, and pathophysiologic mechanisms of SIDS and other sleep-related infant deaths, with the ultimate goal of eliminating these deaths entirely.
    • There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS

An electronic copy of a safe sleeping brochure can be accessed at: https://www.ounce.org/PDFs/safe_sleep.pdf

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