SUDDEN INFANT DEATH SYNDROME

Sometimes, also called (cot death). It is a sudden, unexpected and unexplained death of
an apparently healthy baby. Diagnosis requires that the death remains unexplained even after,
1. Anautopsy (by an experienced pediatric pathologist, if possible).
2. Investigation of the death scene and circumstances of the death.
3. Exploration of the medical history of the infant and family.

 SIDS usually occurs when a baby is asleep, although it can occasionally happen while they're
awake.
 There is usually no evidence of struggle and no noise produced.

Incidence:
 In the UK, just under 300 babies die suddenly and unexpectedly every year. This statistic
may sound alarming, but SIDS is rare and the risk of your baby dying from it is low.
 Rates of SIDS vary nearly tenfold in developed countries from one in a thousand to one in
ten thousand.
 Globally it resulted in about 15,000 deaths in 2013 from 22,000 deaths in 1990.
 At present, it is 0.7 per 1000 live births globally.
 SIDS was the third leading cause of death in children less than one year old in the United
States in 2011.
 It is the most common cause of death between one month and one year of age (especially
during the first six months of a baby’s life- 90% cases).
 It occurs more often in males than females.
 Regional comparisons of SIDS incidence rates have limitations, because autopsies by expert
pathologists are seldom available, particularly in Third World countries. Some insist that a
death scene examination or review must be included to exclude accidents, infant neglect or
abuse before a death can be certified as SIDS. Thus, in developing countries generally, the
incidence of SIDS is difficult to establish.
 Also as infant mortality is still quite high in developing and underdeveloped countries and is
generally associated with infectious diseases, diarrhoea, malnutrition, etc so the incidence
of SIDS have not been researched.

Causes:
 The exact cause of SIDS is unknown, but it's thought to be due to a combination of factors.

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 Physical factors:
i. Brain abnormalities. Some infants are born with problems that make them more likely to
die of SIDS. In many of these babies, the portion of the brain that controls breathing and
arousal from sleep doesn't work properly.

ii. Low birth weight. Low birth weight, premature birth or multiple pregnancy increases
the risk of SIDS as there is a likelihood that a baby's brain hasn't matured completely, so
he or she has less control over such automatic processes as breathing and heart rate.

iii. Respiratory infection. Many infants who died of SIDS had recently had a cold, which may
contribute to breathing problems.

iv. Critical development period. SIDS death occur under the age of one year, with the peak
incidence at 2 to 4 months of age because the infant’s ability to arouse from sleep is not
yet mature.

 Sleep environment factors:

i. Sleeping on the stomach or side. Babies who are placed on their stomach or sides to
sleep may have more difficulty breathing than those placed on their backs.

ii. Sleeping on a soft surface. Lying face down on a fluffy mattress can block an infant's
airway. Also draping a blanket over a baby's head also is risky as it may cover the infant’s
face and create difficulty in breathing.

iii. Sleeping with parents(Accidental suffocation) -There's also an association between co-
sleeping (sleeping with your baby on a bed, sofa or chair) and SIDS.A baby can become
trapped and suffocate between the headboard slats, the space between the mattress
and the bed frame, or the space between the mattress and the wall.A baby can also
suffocate if a sleeping parent accidentally rolls over and covers the baby's nose and

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 mouth.While the risk of SIDS is lowered if an infant sleeps in the same room as his or her
parents, the risk increases if the baby sleeps in the same bed — partly because there are
more soft surfaces to impair breathing

 Environmental stresses could include:

i. Tobacco smoke- Nicotine and derivatives cause significant alterations in fetal
neurodevelopment, and is considered to cause SIDS. The infants being second hand
smokers has greater risk of SIDS; and even the smoke can cause suffocation in infants.

ii. excessive bedding or/and clothing- getting tangled by excessive bedding or clothing

iii. breathing obstruction- choking of animal furs, or any objects like polythene bag

iv. room temperature- Elevated or reduced room temperature also increases the risk

v. stuffed animals

vi. Family history- Babies who've had siblings or cousins die of SIDS are at higher risk of
SIDS.

 Maternal risk factors:

i. Is younger than 20
ii. Smokes cigarettes
iii. Uses drugs or alcohol
iv. Has inadequate prenatal care

 Babies who die of SIDS are thought to have problems in the way they respond to these
stresses and how they regulate their heart rate, breathing and temperature.
 Child abuse- infanticide is most often misdiagnosed with SIDS. SIDS deaths that are actually
infanticide vary from less than 1% to up to 5% of cases.
 Although the cause of SIDS isn't fully understood, there are a number of things you can do
to reduce the risk.

Prevention:
1. Always place the baby on their back to sleep.
2. Place the baby in the "feet to foot" position (with their feet touching the end of the cot).
3. Keep the baby’s head uncovered. Their blanket should be tucked in no higher than their
shoulders.
4. Keep the crib as bare as possible- Don't leave pillows, fluffy toys or stuffed animals in the
crib. These may interfere with breathing if your baby's face presses against them.

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5. Use a mattress that's firm, flat, waterproof and in good condition.
6. "room-sharing without bed-sharing"- Let the baby sleep in a cot or Moses basket in the
same room as the parents for the first six months, such an arrangement can decrease the
risk of SIDS by up to 50%. The parents should not sleep on a bed, sofa or armchair with their
baby.
7. The mother should not smoke during pregnancy or let anyone smoke in the same room as
the baby (both before and after birth).
8. Maintain room temperature- A room temperature of 16-20C should be maintained. Don’t
let the baby get too hot or too cold.
9. Immunize the baby as per the national immunization protocol.
10. Offer a pacifier - Sucking on a pacifier at naptime and bedtime may reduce the risk of SIDS.

If the parents cannot manage a separate place for baby to sleep or afford a crib, then they are
going to practice co-sleeping, for this here are some tips to do so safely:
1) Bed surface should be firm. Babies should not be put down on pillows, fluffy mattress, etc
2) No cracks or crevices between the headboard, footboard or sides of the bed where the
baby could get wedged in.
3) No smoking near the baby. Second-hand smoke increases the risk of SIDS. The mother
should never smoke and co-sleep, even away from the baby.
4) No extra bodies in the bed—including other children or pets.
5) Babies should not be placed on couches, or anywhere they can roll and get trapped in a
crevice.
6) Bedding should be tight-fitted to the mattress.
7) If either parent is overly tired, or has consumed alcohol, or taken drugs of any kind
(including sedatives), they should not bed-share with the baby.
8) Babies should always be placed on their back to sleep.
9) Both parents have to be in agreement that the bed is the best place for the baby.
10) Even on bed a separate area must be located for the baby. It is even better if the area is at
the wall’s side with no gap between the bed and wall.

Management:
Coping and support:
Families who are impacted by SIDS should be offered emotional support and grief
counseling.The experience and manifestation of grief at the loss of an infant are impacted by
cultural and individual differences.

 Grief support for families impacted by SIDS is important as the death of the infant is sudden,
without witnesses, and often associated with an investigation.

 Mothers vary in the extent of their reaction to such a tragedy. Some seem to be well
adjusted initially and may suffer much longer with the internal suppression of their grief.

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 There may be psychosomatic symptoms such as aching in the arms or hallucinations of
hearing the baby crying. Such manifestations often decrease with time, but there may be
occurrences of feelings of isolation and remorse for months and years afterwards,
engendered by anniversaries or recollections of the dead child, often long after sympathetic
support has been withdrawn by those about her.

 Psychological reactions are not confined to the mother. The father may also suffer severe
disturbance and be badly affected by the loss. There have been many instances of serious
family disruption and divorce as a result of cot deaths.

 Siblings too may show behavioral expressions of loss and insecurity, such as reversion to
infantile behaviour, bed wetting at night and nightmares.

Intervention:

1) Allow time for grieving

2) Encourage them to ventilate their feelings
3) Encourage the family members to provide support
4) Couple counselling- because losing a child can put a terrible strain on marriage
5) Counseling or psychotherapy — Counseling or psychotherapy can be helpful in coping
with the loss of a child.

a. One-on-one counseling usually includes a discussion of emotional responses to the

loss, coping methods, and ways to maintain personal relationships.

b. Group psychotherapy allows people to compare their experiences, overcome their

tendency to withdraw or become isolated, and support one another's attempts at
coping and recovering.

c. Relaxation techniques can help to relieve feelings of anxiety, and may include
meditation, progressive muscle relaxation, yoga, self-hypnosis, or biofeedback.

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 References
Potts,N.L., and Mandleco,B.L.(2008)Pediatric Nursing,(2nded.).india edition
https://en.wikipedia.org/wiki/Sudden_infant_death_syndrome
retrieved on- 2/1/2016
https://www.nlm.nih.gov/medlineplus/suddeninfantdeathsyndrome.html
retrieved on- 2/1/2016
http://www.mayoclinic.org/diseases-conditions/sudden-infant-death-
syndrome/basics/causes/con-20020269
retrieved on- 2/1/2016
http://www.health24.com/Medical/Diseases/Sudden-Infant-Death-Syndrome-SIDS-20120721
retrieved on- 2/1/2016
http://nursing.unboundmedicine.com/nursingcentral/view/Diseases-and-
Disorders/73721/all/Sudden_Infant_Death_Syndrome
retrieved on- 2/1/2016
http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Safe_Sleeping/
retrieved on- 2/1/2016
http://www.uptodate.com/contents/sudden-infant-death-syndrome-sids-beyond-the-basics
retrieved on- 2/1/2016