What is SIDS?  And/or SUID Sudden Unexplained Infant Death?

Sudden Infant Death Syndrome is defined as a sudden, unexplained death of an infant under 1 year of age that remains unexplained after a thorough case investigation that includes a complete autopsy, an examination of the death scene and a review of the clinical history.

What is the prevalence of SIDS?

Nationally about 3500 babies die each year of SIDS or SUID.

20% of SIDS deaths throughout the US occur while the infant is in the care of someone other than their parents.  14% of the deaths occur while the infant is in a child care center or in family day care.

For every homicide of an infant in the US there are almost 4 infant deaths by accident and 12 infant deaths from SIDS.

Challenging the myths about SIDS 

Sometimes called crib death but not caused by cribs

Not hereditary                                    Not neglect

Not contagious                                   Not child abuse

Not predictable-no warning               Not anyone’s fault

Not caused by immunizations

Not the cause of every unexpected infant death

What do we know about SIDS?

SIDS is the number one cause of death in infants from the age of 1 month to 1 year.

There are approximately 3500 deaths per year nationally.

SIDS occurs in families of all economic and social levels

SIDS is a silent death- occurs quickly

SIDS almost always occurs during a sleep period

90% of SIDS deaths occur before the age of 6 months

Peaks between 2-4 months of age 

There is a higher incidence in males

SIDS is nobody’s fault

If a baby is used to sleeping on his/her back and is placed on his/her stomach to sleep the risk of SIDS is 4 times greater.

The baby appears to be healthy.

No other health conditions identified that would result in death.

Co-sleeping (sharing your bed or couch with an infant has been found to increase the risk of SIDS)

What is a risk factor?

There are a number of factors that seem to put a baby at a higher risk for SIDS.  These are not causes.  The factors appear in higher numbers for SIDS babies than for the general population.  A risk factor is an association, not a cause.  Half of all SIDS cases do not have any of the following risk factors.

What causes SIDS?

It is not known what causes SIDS.  We do know that it is a functional birth defect that begins before the baby is born.  Researchers have studied the part of the brain that controls breathing, waking, blood pressure, heart rate and temperature control.  These are functions that the body normally controls automatically.  Researchers believe that this defect occurs as the baby’s brain in maturing and the sensors that are responsible for giving information to the brain do not send the information.  Because of these malfunctions the basic system that maintains that automatic functioning does not work correctly when stressed.  The stressor might be sleep position, a cold, a soft sleep surface.

Identifying risk factors for SIDS

Mothers:         young age-under 20

                        Moms who use drugs during pregnancy

                        Moms who get little, late or no prenatal care

                        Moms who smoke when pregnant 

                        Moms who get pregnant less than 6 months after the last baby was born

Infants:            Low birth weight baby

                        Premature babies

                        Babies who spent time in a Neonatal Intensive Care Unit

                        Babies who are exposed to smoke or second hand smoke

Babies placed on soft sleep surface (waterbed, sheepskin, comforter,    sleeping bag, etc.)

                        Babies placed to sleep on their stomachs

Gas trapping objects (comforters, stuffed animals, etc.) in sleep environment

                        Co-sleeping

Back to Sleep risk reduction practices.

1. Back to Sleep:  Infants should be placed for sleep in a supine position (wholly on the back) for every sleep.  Side sleeping is not as safe as supine sleeping and is not advised.

• Safe sleep environment- firm sleep surface. A firm crib mattress, covered by a sheet, is the recommended sleeping surface.

• Keep soft objects and loose bedding out of the crib, Soft objects such as pillows, quilts, comforters, sheepskins, stuffed toys, and other soft objects should be kept out of an infant’s sleeping environment.  If bumper pads are used in cribs, they should be thin, firm, well secured, and not “pillow-like”.  In addition, loose bedding such as blankets and sheets may be hazardous.  If blankets are used they should be tucked in around the crib mattress so that the infant’s face is less likely to become covered by bedding.  One strategy is to make up the bedding so that the infant’s feet are able to reach the foot of the crib (feet to foot) with the blankets tucked in around the crib mattress and reaching only to the level of the infants chest.

• Temperature in the room- should be comfortable for an adult, no comforters or thick blankets ( consider using a onesie sleeper instead of a blanket). Infant should not feel hot to the touch.

• Consider offering a pacifier at nap time and bed time.  The pacifier should be used when placing the infant down for sleep and not be reinserted once the infant falls asleep.  If the infant refuses the pacifier, he or she should not be forced to take it.  Pacifiers should be cleaned often and replaced regularly.

• Keep babies face uncovered during sleep

• Environment should be smoke free

• No wedges or other positioning devices 

• Avoid using couches, chairs and adult beds for infant sleep. Sitting devices such as swings, infant seats, car seats strollers are not recommended for routine sleep particularly for infants younger than 4 months, because they may assume positions that can create a risk of suffocation or airway obstruction or may not be able to move out of a potentially asphyxiating situation.

Strategies caregivers should implement:

* Learn CPR- remember we don’t know it is SIDS until after the autopsy.

* Discuss with parents what position the baby should be placed in and have a form that you and the parents sign indicating the sleep position you should use.

* Develop a policy on back sleep positions for healthy babies indicating that all healthy babies will be placed to sleep on their backs unless a medical condition requires a different sleep position.

* Take advantage of classes on emergency procedures, first aid and risk reduction.

* Caregivers should follow current recommendations for infant sleep position and bedding- if an infant dies while in your care and you have not followed recommendations you may be sued.

The role of the child care provider in providing a healthy environment for an infant:

* Make sure babies are put to sleep on their backs

* Make sure the babies are in a safe crib, with a mattress that fits the crib and slats that meet safety standards. 

* Assure that babies have time on their stomachs when awake while supervised by an adult so they develop their neck and shoulder muscles.

* Look through your center to make sure it is safe for children

* Make sure everyone washes their hands well.

* Talk to parents about safe sleep and other risk factors related to infant death.

* Make sure no one props a baby for feeding

Emergency Procedures for an Unresponsive Infant

1. Start CPR
2. Dial 911 or your local emergency number.
3. Calm the other children and remove from area.
4. Call the child’s parents first, then the other children’s parents.
5. Call your licensing agency.
6. As much as possible, leave the area where the baby was found undisturbed.  Do not clean or tidy anything in the room until the investigators tell that it is okay to do so.
7. Contact your local SIDS organization for support materials.

After the Emergency:

1. Inform parents of other children in your care that an emergency occurred and offer them information to help them understand and cope.
2. Debrief your staff and offer support and information on bereavement.
3. Be prepared to give information to the investigators such as:

The last time and place that the infant was seen alive and by whom.

The time, position and condition of the infant when found, and by whom.

The infant’s last feeding.

Any observations regarding the infant’s behavior.

            Information sheets from The Infant Death Center and DHFS

            American Academy of Pediatrics Updated 11/05 updates 11/2016