This document summarizes information about sudden infant death syndrome (SIDS) including risk factors, prevention strategies, and resources for families affected by SIDS. It discusses that placing infants to sleep on their backs has reduced SIDS rates since the 1990s. Risk factors include prone sleeping, soft bedding, and bedsharing. Prevention strategies focus on supine sleeping, room sharing without bedsharing, and avoiding soft bedding/objects in the crib. It provides contacts for support organizations.

1. HOUSE CALL

2.  Defined by the CDC as:
“sudden death of an infant less than 1 year of
age that cannot be explained after a thorough
investigation is conducted, including a
complete autopsy, examination of the death
scene, and review of the clinical history”

3. 120 deaths/100,000 in 1992
56 deaths/100,000 in 2001
No change from 2001-2006

5. “Convergence of these factors ultimately results in a combination of progressive asphyxia, bradycardia, hypotension, metabolic acidosis, and
ineffectual gasping, leading to death”

6.  1992: AAP recommends infants be placed in
non-prone position (side or supine) for
sleep
 1990s: National Institute of Child Health
and Human Development conducts surveys
on SIDS
 1994: NICHHD, AAP, SIDS Alliance, and
US Public Health Service campaign “Back to
Sleep”
 2000: AAP advised sleeping on back confers
the lowest risk of SIDS

8.  Age less than 6 months
 African American and Native American race
 Sleeping prone and side position
 Use of soft bedding (pillows, blankets, bumpers)
 Sleeping in carseat or bouncer
 Maternal smoking during pregnancy
 Exposure to second-hand smoke
 Respiratory infections
 Bed sharing
 worse with multiple bed sharers, use of alcohol or
overtired adult, bed sharing on couch
 Child care
 Higher incidence of prone positioning during sleep

9.  Age less than 6 months
 African American and Native American race
 Sleeping prone and side position
 Use of soft bedding (pillows, blankets, bumpers)
 Sleeping in carseat or bouncer
 Maternal smoking during pregnancy
 Exposure to second-hand smoke
 Respiratory infections
 Bed sharing
 worse with multiple bed sharers, use of alcohol or
overtired adult, bed sharing on couch
 Child care
 Higher incidence of prone positioning during sleep

10.  Room sharing without bed sharing
 Use of pacifier at bedtime and naptime
 Cool sleeping environment
 Tummy time
 Breastfeeding infant
 Immunization (possibly)

11.  Co-sleeping is associated with unexplained SUDI/SIDS
in infants aged < 6 months, suggesting that co-sleeping
is related to the pathogenesis of death in younger
infants.
 The finding that intra-alveolar hemorrhage is more
common in co-sleeping suggests that a minority of co-
sleeping-associated deaths may be related to an
asphyxial process.
 Accounts for 50% of SUIDS/SIDS in U.K.
 Co-sleeping is increasing in U.S.

12.  There is no evidence that bumper pads reduce
the risk for injury to young infants, and these
devices are not recommended because of the
potential for entrapment or strangulation
 Firm mattress
 Avoid excessive blankets
 Avoid overheating

13.  Co-sleeping
 Shown to facilitate breastfeeding, popular in USA
 No evidence for protective benefit against SIDS
 Immunization
 Case reports from 1970s suggested relationship
between vaccination and SIDS
 No relationship exists and suggests vaccination
could be protective against SIDS

15.  “Safe to Sleep” campaign (formerly “Back to
Sleep” campaign)
 SIDS resource kits targeted for specific populations
(African Americans, Native Americans, Hispanics)
 Safe Sleep for your Baby YouTube video

18. Nonprofit organization dedicated to safe pregnancies
and survival of babies through first years of life

19.  Families who have had an infant die from SIDS should be treated with
compassion and empathy.
 They should be supported through the process of the death
investigation and guided through problems:
 Such as ending lactation and funeral planning.
 Grief counseling and referral to a SIDS support group should be offered.
 Parents should be counseled that the risk of future children dying from SIDS
is not increased
 First Candle has bilingual crisis counselors available 24 hours a day, 7
days a week. Call toll free at (800) 221-7437
 American SIDS Institute Phone: 239-431-5425 Fax: 239-431-5536
Autopsy should be done quickly. As soon as the preliminary results are
known
(usually within 12 h), they should be communicated to the parents.

20.  Educate patients in family practice
 Ask about sleeping on back at EVERY pediatric visit
for infants
 Review modifiable risk factors for SIDS and educate
about myths vs facts about SIDS
 CE program for SIDS risk reduction for nurses
 http://www.nichd.nih.gov/SIDS/sidsnursesce.cfm

21. Myth: Babies can catch SIDS Fact: SIDS can not be caught. It is not contagious
and there are not symptoms before death.
Myth: Cribs cause death or SIDS Fact: Cribs do not cause SIDS
Myth: Babies who sleep on their back Fact: Babies cough up or swallow fluid that
choke on spit or vomit enters their airway. Doctors found no increase
risk in choking or other problems in babies
sleeping on their backs.
Myth: Only white babies die of SIDS Fact: African American babies are twice as likely to
die of SIDS as white babies
Myth: SIDS deaths can be prevented Fact: Although there is no way to ensure a baby
will not die of SIDS, the chances can be reduced by
placing babies on their backs.
Myth: Shots/medications cause SIDS Fact: Shots or medications do not cause SIDS. All
babies should be seen for well-baby checkups and
receive shots on-time.
Myth: SIDS can occur at any age Fact: SIDS is the unexplained death of a baby
younger than 1. Most deaths occur between 2 and
4 months of age. The number of deaths drop
significantly after 6 months of age.

22. 3 month old male infant found dead after being placed in prone position.

23.  Centers for Disease Control and Prevention (2012). Sudden infant
death syndrome and vaccines. Retrieved from
http://www.cdc.gov/vaccinesafety/Concerns/sids_faq.html.
 First Candle (2012). First Candle. Retrieved from
http://www.firstcandle.org.
 National Institute of Child Health and Human Development
(2012). Safe to Sleep public education campaign. Retrieved from
http://www.nichd.nih.gov/sids.
 Task Force on Sudden Infant Death Syndrome (2011). SIDS and
other sleep-related infant deaths: Expansion of recommendations
for a safe infant sleeping environment. Pediatrics, 128(5), 1030-
1039.
 Task Force on Sudden Infant Death Syndrome (2005). The
changing concept of sudden infant death syndrome: Diagnostic
coding shifts, controversies regarding the sleeping environment,
and new variables to consider in reducing risk. Pediatrics, 116(5),
1245-1255.