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SIDS - Sudden Infant Death Syndrome

This article discusses Sudden Infant Death Syndrome (SIDS), including its definition, epidemiology, risk factors, and recommendations from the American Academy of Pediatrics to reduce SIDS risk. Topics covered include sleep position, sleep environment, pacifier use, overheating prevention, and more. The document aims to educate caregivers and provide guidelines for a safe infant sleep environment.

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SIDS - Sudden Infant Death Syndrome

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  1. SIDS - Sudden Infant Death Syndrome American Academy of Pediatrics – Policy Statement The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk. Pediatrics, 2005. 116(5): 1245-55.

  2. SIDS Defined • The sudden death of an infant under 1 year of age, which remains unexplained after thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history.

  3. Epidemiology • Unknown cause • Responsible for more infant deaths than any other cause (USA) • despite >50% reduction since 1992 • Rare during the 1st month • Peaks between 2-3 months

  4. SIDS – USA • 2001 0.56 deaths per 1000 live births • 2002 0.57 deaths per 1000 live births • Consistently higher rates are found in black and American Indian/Alaska Native children* • 2-3x national average *less likely to position baby supine

  5. Risk Factors • Prone sleep position • Sleeping on a soft surface • Maternal smoking during pregnancy • Overheating • Late or no prenatal care • Young maternal age • Preterm birth and/or low birth weight • Male gender

  6. AAP - Recommendations • Back to sleep • Infants should be placed for sleep in a supine position for every sleep • Side sleeping is not as safe as supine sleeping • Not advised

  7. AAP - Recommendations • Use a firm sleep surface • Firm crib mattress, covered by a sheet • Soft materials (pillows, quilts, comforters, etc.) should not be placed under a sleeping infant

  8. AAP - Recommendations • Keep soft objects and loose bedding out of the crib • If bumper pads are used, should be thin, firm and well-secured • Use sleep clothing with no other coverage or infant sleep sacks

  9. AAP - Recommendations • If blankets are used, they should be tucked so that the infant’s face is less likely to be covered • With infant’s feet to the foot of the bed, tuck blankets in so that they only reach the infant’s chest

  10. AAP - Recommendations • Do not smoke during pregnancy • Major risk factor • Also avoid infant exposure to second hand smoke

  11. AAP - Recommendations • Separate but proximate sleeping environment • Risk is reduced when infant sleeps in the same room as the mother • Bed sharing is not recommended • Breastfeeding/comforting - return to crib/basinet when parent is ready to return to sleep

  12. AAP - Recommendations • Offer a pacifier at nap and bedtime • Pacifier use during sleep reduces risk of SIDS • Mechanism unknown? NOTE: Evidence that pacifier use inhibits breastfeeding or causes later dental complications is not strong enough at this time to outweigh this benefit…

  13. First Year – Pacifier Use • Pacifier should be used when placing the infant down for sleep and not be reinserted once the infant falls asleep • If the infant refuses, s/he should not be forced • Pacifiers should not be coated in any sweet solution • Pacifiers should be cleaned often and replaced regularly • For breastfed infants, delay pacifier introduction until 1 month of age • Ensure breastfeeding is firmly established

  14. AAP - Recommendations • Avoid overheating • Should be lightly clothed for sleep • Bedroom temperature should be kept comfortable for a lightly clothed adult • Overbundling should be avoided • Infant should not feel hot to touch

  15. AAP - Recommendations • Avoid commercial devices marketed to reduce the risk of SIDS • None have been tested sufficiently to show efficacy or safety

  16. AAP - Recommendations • Do not use home monitors as a strategy to reduce SIDS • No evidence that they decrease the incidence of SIDS

  17. AAP - Recommendations • Avoid development of positional plagiocephaly • Encourage “tummy time”* • infant is awake and observed • Encourage upright “cuddle time” • Avoid excess time in car-seat carriers and “bouncers” • Alter supine head position during sleep *also enhances motor development

  18. What’s wrong with this picture?

  19. AAP - Recommendations • Continue the Back to Sleep campaign • Public education should be intensified • Secondary care-givers • Child care providers • Grandparents • Foster parents • Babysitters • Black and American Indian/Alaska Native populations

  20. Other theories related to SIDS?

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