Running head: EVIDENCE BASED PRACTICE PAPER: SIDS 1

Evidence Based Practice Paper: SIDS in Relation to Sleeping Position, Parental Smoking, and
Co-sleeping

Jessica Erin Crumpler

Bon Secours Memorial College of Nursing

September 20, 2016

I have neither given nor received aid, other than acknowledged, on this assignment or

test, nor have I seen anyone else do so.- I pledge. JEC

EVIDENCE BASED PRACTICE PAPER: SIDS 2

Bringing home, a newborn baby is a very exciting experience. Mom and Dad have spent

nine long months preparing for their little miracle to arrive, so that they can bring baby home to

start a new chapter in their lives. The last thing on their minds is that their precious bundle of joy,

so healthy and perfect could suddenly die.

Sudden Infant Death Syndrome (SIDS) is a very scary, yet very real threat to the lives of

infants. It is when an infant dies for reasons that are explainable or not. There is no one way for

SIDS to occur. However, SIDS is the third leading cause of infant deaths (Moon, 2011). There

are many different issues that can cause SIDS, but a few of the main risk factors researchers

believe to cause SIDS are sleep position, second hand smoke, and co-sleeping.

Sleep position is probably the most important because it is the easiest fix to a seemingly

avoidable problem. Not to say that all reasons for SIDS are avoidable, but this is the one mom

and dad have the most control over. SIDS was first defined in the 1980s, but in 1992 was the

first surfacing in the decline of these occurrences when studies conducted in Europe and

Australia proved that babies who slept supine, or on their backs, were less likely to pass away in

the first year of life. This spurred on the Back to Sleep initiative in 1994; which dropped the

incidence of SIDS 56% over ten years time (Moon, 2011). This is because when babies sleep on

their backs it allows them to breathe in fresh air instead of rebreathing the CO2 that they breathed

out; which causes hypoxia. The baby also isnt at risk for becoming trapped face down in the

mattress leading to suffocation. Once a baby is able to turn itself over, SIDS (due to sleeping

position) is no longer a risk factor because the baby can readjust itself from supine to prone and

back again. Evidence based practice shows that the more babies that sleep on their backs, the

less infant deaths occur over time.

EVIDENCE BASED PRACTICE PAPER: SIDS 3

Second hand smoke is another significant reason for the occurrence of SIDS. A study

conducted in the Netherlands concluded that when one or both parents smoke postnatally the

infant is at a significant risk for SIDS. It does not matter whether the smoker is maternal or

paternal, both have significant effects (Liebrechts-Akkerman et.al., 2011). Babies have less

alveoli in their lungs than adults do. If these alveoli are compromised in any way, this could

cause less oxygen to go to the babys brain. This could in turn compromise the brain in its control

centers for breathing or other functions that sustain the life of the baby. Smoking has a sticky tar

that builds up on the cilia of the airway and in the lungs. If the cilia cannot move freely to sweep

out bacteria and dust from the lungs, then it will accumulate and cause infection. Infection will

cause a buildup of mucus; which will occlude the airway. This could cause the baby to suddenly

die due to inadequate gas exchange. As adults, it is important to remember that babies do not

have fully developed organ systems, and what they do have is not very strong yet. To

compromise these little beings organ function is very irresponsible, especially with something

like smoking, of which is totally avoidable on the parents part (Sears, 2016). Evidence based

practice shows that babies that live in homes where parents smoke, have a greater risk of SIDS

than infants that do not live in homes where the parents smoke.

Co-sleeping is another avoidable risk that can lead to SIDS. Researchers conducted a

study to see how prevalent co-sleeping was in the involvement of infant deaths. The results

showed that co-sleeping played a significant role; however, it wasnt so much due to the sharing

of a bed between an infant and a parent, but more to do with the surfaces that were being slept

on. Sofas were a prime example as an inappropriate sleep surface, along with sleeping with an

infant as an intoxicated adult, that could roll on to the infant without realizing due to inhibited

intuition (Carpenter, 2013). The proper way to sleep with an infant is to have them room-in,
EVIDENCE BASED PRACTICE PAPER: SIDS 4

where they are in the room with you sleeping, but not in the same bed. It is also important to

make sure that their bed is clear of bedding, pillows, stuffed animals, or anything else that the

baby could press its face into and cause suffocation. Evidence based practice shows that infants

with proper sleep surfaces, coherent parents, and less items in their beds are at a lower risk of

SIDS.

SIDS is almost totally avoidable if the complications that lead to it are discovered and

eradicated. The three causes that have been touched on here are by no means the only ones that

lead to SIDS. There are countless, even some that are not so avoidable perhaps relating to

genetics. Many studies have been done, and will continue to be done in order to help decrease

the occurrence of SIDS even more. Research only goes so far though. After discoveries have

been made and breakthroughs have been announced, the findings then need to be utilized in the

form of education in order to prevent further happenings. The only levels of prevention for SIDS

are primary or secondary. Using evidence based practice methods to set up the safest and most

correct sleeping environment for an infant is the best way to implement primary prevention for

the avoidable reasons that cause SIDS. Having screenings done for genetics, or medical

anomalies that could lead to SIDS in a particular infant is a great secondary prevention

technique. There is no way to treat SIDS so tertiary prevention is not possible. This is why

prevention through teaching is so vital.

Teaching should start on the front lines with the nurses to the new parents in the hospital

or birthing center. Nurses should be educated on what SIDS is, how it happens, and how it can be

prevented. This way the nurse can then educate the parents on how to avoid SIDS. A common

consensus throughout the articles used to build this paper, was undereducated parents, and how

the deaths of infants could have been avoided had the parents known better. Since one knows not
EVIDENCE BASED PRACTICE PAPER: SIDS 5

what one does not know, it is important for those that do know, to ask and educate. If nurses are

not already educating each and every patient on SIDS, then they certainly should be.

The interventions for SIDS are simple and can be taught to the new parents at any time

before discharge. Make sure the parent is awake and alert enough to comprehend. Explain that

back sleeping, not smoking, proper bedding, etc. are all ways to prevent SIDS. Provide a

pamphlet with a similar break down and a number to call for questions. SIDS is irreversible, the

best way to beat SIDS is to prevent it, mainly by going Back to sleep.
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References:

Carpenter, R., Mcgarvey, C., Mitchell, E. A., Tappin, D. M., Vennemann, M. M., Smuk, M., &

Carpenter, J. R. (2013). Bed sharing when parents do not smoke: Is there a risk of SIDS?

An individual level analysis of five major casecontrol studies. BMJ Open, 3(5).

doi:10.1136/bmjopen-2012-002299

Liebrechts-Akkerman, G., Lao, O., Liu, F., Sleuwen, B. E., Engelberts, A. C., LHoir, M. P., . . .

Kayser, M. (2011). Postnatal parental smoking: An important risk factor for SIDS.

European Journal of Pediatrics Eur J Pediatr, 170(10), 1281-1291. doi:10.1007/s00431-

011-1433-6

Moon, R. Y. (2011, November 17). SIDS and Other Sleep-Related Infant Deaths: Expansion of

Recommendations for a Safe Infant Sleeping Environment. Pediatrics, 128(5), 1030-

1039. doi:10.1542/peds.2011-2284

Sears, W. (2013). 4 Ways Smoking Increases the Risk of SIDS | Ask Dr Sears | The Trusted

Resource for Parents. Retrieved September 20, 2016, from

http://www.askdrsears.com/topics/parenting/child-rearing-and-development/bringing-

baby-home/how-smoking-harms-babies/4-ways#