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Sudden Infant Death Syndrome (SIDS)

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Margo Kerrigan, M.P.H., Area Director
Indian Health Service California Area Office

Sudden Infant Death Syndrome or SIDS is the sudden and unexplained death of an infant under age 1. Most infants who die of SIDS do so during sleep, and do not appear to suffer or struggle. Most are apparently healthy. A diagnosis of SIDS is made only after all other possible causes of death have been ruled out through a review of the infant's medical history and an autopsy. About 2300 babies die of SIDS in the United States each year.

Most deaths due to SIDS occur between 2 and 4 months of age. 90% of SIDS cases occur by 6 months of age. SIDS cases seem to increase during cold weather, peaking in January. Boys are more likely to die of SIDS than girls.

Unfortunately, American Indian and Alaska Native infants are about three times more likely to die of SIDS than white infants.

Causes and Risk Factors

The cause of SIDS is unknown, although there are theories that it is caused by problems with sleep arousal or an inability to sense a build-up of carbon dioxide in the blood. Many researchers believe that SIDS is not a single condition caused by one medical problem, but rather a syndrome with multiple causes.

There is no one risk factor for SIDS. Known risk factors include:

  • Smoking, drinking, or drug use during pregnancy
  • Poor prenatal care
  • Prematurity or low birth weight
  • Being a twin, triplet, or other multiple
  • Being the sibling of a brother or sister who died of SIDS
  • Having a mother younger than age 20
  • Tobacco smoke exposure before or following birth
  • Overheating from excessive sleepwear and bedding
  • Soft bedding in cribs
  • Stomach sleeping

    The most significant risk factor for SIDS appears to be stomach sleeping. Numerous studies have found a higher incidence of SIDS among babies placed on their stomachs to sleep than among those sleeping on their backs or sides. In 1992, the American Academy of Pediatrics recommended that all healthy infants younger than 1 year of age be put to sleep on their backs. Since the AAP's recommendation, the rate of SIDS has dropped by over 50%.


    The American Academy of Pediatrics and other advisory groups recommend the following steps to prevent SIDS:

  1. Always put a baby to sleep on its back, not on its stomach or side. This includes during naps. Allowing the baby to roll around on his or her tummy while awake can prevent a flat spot from forming on the back of the head. Once babies can roll over consistently, usually around 4 to 7 months, they may not to stay on their backs all night long. At this point, parents can let babies pick a sleep position on their own.
  2. Put babies to sleep in a crib. The AAP advises against allowing an infant to sleep in a bed with other children or adults, or on other surfaces, like a sofa. While infants can be brought into a parent's bed for nursing or comforting, parents should return them to their cribs or bassinets when they're ready to sleep.
  3. Let young babies sleep in cribs in the same room as parents. This has been linked with a lower risk of SIDS. Studies show that infants are safest when their beds are close to their mothers.
  4. Avoid soft bedding materials. Babies should be placed on a firm, tight-fitting crib mattress with no comforter. Use a light sheet to cover the baby. Do not use pillows, comforters, or quilts, and do not place stuffed toys in the crib.
  5. Make sure the room temperature is not too hot; it should be comfortable for a lightly-clothed adult. Some research suggests that a baby who gets too warm could go into a deeper sleep, making it more difficult to awaken.
  6. Offer the baby a pacifier when going to sleep. Pacifier use is associated with a lower risk of SIDS. The pacifier might allow the airway to open more, or prevent the baby from falling into a deep sleep. If the baby is breastfeeding, it is best to wait until 1 month before offering a pacifier, so that it doesnt interfere with breastfeeding. Do not force a baby to use a pacifier.
  7. Do not use breathing monitors or products marketed as ways to reduce SIDS. In the past, home breathing monitors were recommended for families with a history of SIDS, but they have been shown not to have an effect.

Other recommendations from SIDS experts include:

  1. Do not smoke, drink, or use drugs while pregnant and do not expose your baby to secondhand smoke. Infants of mothers who smoked during pregnancy are three times more likely to die of SIDS than those whose mothers were smoke-free. Exposure to secondhand smoke after birth doubles a baby's risk of SIDS. The greater the exposure to tobacco smoke, the greater the risk of SIDS.
  2. Breastfeed your baby, if possible. There is evidence that breastfeeding may help decrease the incidence of SIDS. Researchers think that breast milk may help protect babies from infections that increase the risk of SIDS. Studies show that breastfed babies have a lower SIDS rate than formula-fed babies do.
  3. Never give honey to a child less than 1 year old. Honey may cause infant botulism, which may be associated with SIDS.
  4. Avoid exposing the infant to people with respiratory infections. SIDS often occurs in association with relatively minor respiratory (mild cold) and gastrointestinal infections (vomiting and diarrhea).
  5. Make sure all caregivers understand the importance of taking steps to prevent SIDS and what to do in an emergency. If a baby is not moving or breathing, begin CPR and call 911. Parents and caregivers of all infants and children should be trained in CPR.

Parents who have lost a baby to SIDS need emotional support and counseling. Family counseling may help siblings and all family members cope with the loss.

American Sudden Death Syndrome Institute
www.sids.org Exit Disclaimer – You Are Leaving www.ihs.gov

National SUID/SIDS Resource Center
www.sidscenter.org Exit Disclaimer – You Are Leaving www.ihs.gov

SIDS Families
www.sidsfamilies.com Exit Disclaimer – You Are Leaving www.ihs.gov

CJ Foundation for SIDS
www.cjsids.org Exit Disclaimer – You Are Leaving www.ihs.gov

American Association of Pediatrics- Children's Health Topics- Sleep Issues
http://www.aap.org/healthtopics/sleep.cfm Exit Disclaimer – You Are Leaving www.ihs.gov

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