SIDS

My husband and I are expecting our first child in two months. It seems that in every prenatal class we attend, someone’s talking about SIDS. Is this something we should be worried about?

Worried? No. But you need to be aware of it. The Sudden Infant Death Syndrome (SIDS), sometimes referred to as “sudden unexpected infant death,” is one of the most traumatic and catastrophic things that can happen to young parents and their entire family. The sudden loss of a previously healthy infant is devastating, and the more we know about what causes it and how to keep it from happening, the better off we’ll be. We’ve learned a lot about SIDS over the past two or three decades, and with this knowledge there’s been a significant reduction in its incidence. Yet even one child dying is too many. The American Academy of Pediatrics (AAP) has been in the forefront in addressing this issue, and we will draw largely upon their recommendations.

First, we need to define the term SIDS. This is the sudden death of an infant younger than one year of age, which remains unexplained after a thorough investigation of the case, and including a complete autopsy and examination of the death scene. This is important, because there are other things—cardiac issues, infections, undiagnosed congenital problems—that won’t be uncovered without this complete investigation and shouldn’t be mislabeled a SIDS death. We know of several families whose incapacitating sense of guilt was relieved when they learned the death of their child was not caused by anything they did or didn’t do. Rather, the cause was a subtle congenital finding that would have been very difficult to find and impossible to treat. So there’s the need for a complete review and as painful and difficult as it might be, a complete autopsy.

But how common is this? SIDS is the leading cause of infant mortality between one month and one year of age in the United States. The risk in the U.S. is a little less than 1 per 1000 live births, but is two to three times more common than that among black and American Indian children. And while we used to think it was much more common in boys, we now know that the risk in males is only slightly increased over that in females.

We mentioned that the upper age limit seems to be one year. Current evidence indicates that the median age for SIDS deaths is about 11 weeks (median means that there are as many deaths younger than 11 weeks as there are older) and the peak incidence is between two and four months. 90 percent occur before six months of age, and only 2 percent after nine months. That’s good information, and lets us know when we really need to be vigilant.

Now let’s consider the risk factors, since these are the things we want to eliminate or at least try to manage. We’ll start with those of the mother.

• Young maternal age. This would be less than twenty years old, and while we can’t change it, it’s a risk factor and we need to be aware of it.
• Maternal smoking. This is especially true during pregnancy, but also during the newborn period and beyond. We also know that second-hand smoke confers significant risk as well.
• Late or no prenatal care. There are a lot of factors that come into play here, and every expectant young woman should be actively and repeatedly encouraged to have regular prenatal visits. This is the best opportunity for education, and for modifying dangerous behavior.
• Alcohol and substance abuse. These are some of those dangerous behaviors just mentioned, and we know them to be risk factors for SIDS.

Next, we want to consider the infant and environmental factors we know to be risks.

• Pre-term birth and/or low birth weight. This would be defined as less than 37 weeks gestation and less than 5 ½ pounds. The increased risk is somewhere between 3 and 5 times. Optimal prenatal care can help reduce the incidence of prematurity.
• Prone sleeping position. (Sleeping on your tummy.) This is the big one! It is the strongest modifiable risk factor of SIDS, since the odds ratio can approach a multiplier of 13. That means that if you put your infant to sleep on their tummy, you’ve multiplied their chances of dying from SIDS by 13 times. We’ve known this for a while, and yet some of us apparently are not aware of its importance. Avoidance of side positioning is also important, since the possibility of rolling from the side to the prone position is greater than that of rolling from the supine to the prone position.
• Sleeping on a soft surface with bedding accessories such as pillows and loose blankets. How important is this? When the prone position is combined with use of soft bedding, the risk of SIDS rises by a factor of 21! So what is considered soft bedding? Examples include sheepskin bedding, a sofa or recliner, air mattresses, polystyrene beads, and natural fiber mattresses. A firm sleeping surface is best. And loose blankets, pillows, quilts, stuffed toys, and sheepskins should be avoided. This is especially true as the infant becomes older and can roll onto the soft objects, creating a risk of suffocation.
• Bed-sharing. Infants sleeping in the same bed with their parents are at an increased risk of SIDS. This is greatest for those younger than three months of age or for infants of mothers who smoke. This is different from “room-sharing,” which the AAP encourages, especially if the mother is breast-feeding.
• This risk increases with the amount of clothing or blankets placed on an infant, along with the room temperature. The mechanism is not well-understood, but the risk has been established, and overheating—from whatever cause—should be monitored and avoided.
• This will come as a surprise to many, but swaddling appears to increase the risk of SIDS, especially for older infants and those not placed on their back to sleep. While swaddling might be safe in very young infants, as a child gets older and attempts to roll over, they can move into an unsafe sleeping position. If you’re determined to swaddle your child, talk to your pediatrician and get their guidance.
• Having a sibling who died with SIDS. Siblings of SIDS victims have an increased risk, but in most families, that risk remains less than 1 percent.

An important point to keep in mind is that 95 percent of the victims of SIDS have at least one of these risk factors. That’s why we need to be familiar with all of this, and put our knowledge to use.

What about protective measures? What are some of the things we can do to help reduce the risk of SIDS in our young child? First of course, we need to avoid all of the risk factors noted above. The most important is to put your child on their back to sleep! That can’t be stressed enough. And there are some other things we can do to help lower the risk.

• Room-sharing. We mentioned this earlier, and it’s something to consider, especially if the infant is breastfeeding.
• Several studies have shown that breastfeeding for at least two months cut the risk of SIDS in half.
• Pacifier use. The AAP suggests offering a pacifier during sleep, as long as it doesn’t interfere with establishing successful breastfeeding.
• Using a fan in the room. We’re not sure how this works, but the use of a fan, with increased air movement around the infant, reduces the risk of SIDS.

And a couple of other important points:

• Immunizations – diphtheria-tetanus-pertussis (DTP) or any other vaccines – are not associated with an increase in the risk of SIDS. In fact, up-to-date immunizations may lower the risk.
• There is no proven benefit for the use of home monitors. Save your money. These things don’t work.

So, back to that original question. Should you worry about SIDS? No. But you need to keep this information in mind, eliminate the risk factors that you can, and enjoy your new baby.

…

This is an excerpt from the new book I’m writing with pediatrician Dr. Robert Alexander. The book will address 100 questions from parents regarding their children’s health. Feel free to email us with questions:askthedox@yahoo.com