Sudden Infant Death Syndrome

Sudden Infant Death Syndrome (SIDS) is defined as "the sudden death of an infant under one year of age that remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination ofthe death scene, and review of the clinical history." SIDS kills approximately 5,000-7,000 babies in the United States each year between the age of one week and one year, with the highest incidence from one to four months. SIDS strikes even healthy babies; more males than females; is more frequent in fall,winter, and early spring; and, while the rate is higher among African-American babies, it is no respecter of race, education, or socioeconomic factors. No one can predict which baby will die from SIDS and, while it is neither contagious nor hereditary, a baby whose sibling died from SIDS is at increased risk. Death is sudden and painless and occurs within seconds, usually during sleep.

SIDS, commonly called "crib death" or "cot death," can be traced through history to at least Old Testament times yet today its cause remains a mystery. For decades, researchers looked for biological or physiological causes. Centralsleep apnea (cessation of breathing during sleep), the focus of intense investigations over many years, has now been ruled out, as have suffocation, aspiration, and immunization. A turn-around developed in the late 1980s when studies determined that a baby placed on its stomach or side to sleep wasat increased risk, probably because of rebreathing its own carbon dioxide resulting in asphyxiation. The U.S. Consumer Products Safety Commission estimates 30% of SIDS-related deaths may be due to unsafe sleeping environments or bedding, such as placing the baby on a soft mattress, waterbed, comforter, pillow, or in a crib with soft toys or bumpers. Babies of pregnant women who smoke, and young babies exposed to passive cigarette smoke, are at higher risk ofSIDS. Babies kept too warm are also more susceptible.

Massive public health awareness campaigns in New Zealand, Australia, and Norway addressing the above risk factors, reduced the number of SIDS deaths by as much as 50%. Similar campaigns in the United States--particularly the"Back to Sleep" campaign which followed recommendations by the American Academy of Pediatrics that healthy babies be placed on their backs to sleep--sawa 20-30% decline from 1992 to 1994, and by 35% in 1996. In countries where the prone sleeping position has been reduced by as little as five to 10%, the SIDS death rate has declined by 70-80%. The higher incidence of SIDS among theAfrican-American population may be because public awareness campaigns are not effectively reaching that population.

Several other theories encompass SIDS: In 1989, a British scientist implicated mould, flame retardants, and other fumes in cot mattresses--this controversial finding was ruled out in a British Medical Journal news release in May, 1998. Some experts believe infant-parent "co-sleeping" is beneficial in helping prevent SIDS--others say the opposite. While breast feeding increases a baby's natural immunity and provides psychological and physiological benefits to mother and baby, it has not been found to protect against SIDS. A paper published in the British Medical Journal in March, 1998 reportedthat two babies died of what was attributed to SIDS following a transcontinental flight--no scientific studies have been done to determine the safety of air travel for young infants. A case-control study reported that babies of pregnant women who drank more than four cups of coffee daily were more prone toSIDS--these results need to be confirmed by other studies.

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