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SIDS - Sudden Infant Death Syndrome

SIDS - Sudden Infant Death Syndrome. American Academy of Pediatrics – Policy Statement

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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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