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Sudden infant death syndrome (SIDS) is any sudden and unexplained death of an apparently healthy infant aged one month to one year. The term cot death is sometimes used in the United Kingdom, and crib death in the United States.

Diagnosis

SIDS is a definition of exclusion and only applies to an infant whose death remains unexplained after the performance of an adequate postmortem investigation including (1) an autopsy, (2) investigation of the scene and circumstances of the death and (3) exploration of the medical history of the infant and family. Generally, but not always, the infant is found dead after having been put to sleep and exhibits no signs of having suffered. The inexplicable nature of the syndrome often leaves parents with a deep sense of guilt in addition to their grief.

Statistics

SIDS is responsible for roughly 50 deaths per 100,000 births in the US. It is responsible for far fewer deaths than congenital disorders and disorders related to short gestation; though it becomes the leading cause of death in otherwise healthy babies after one month of age.

The frequency of SIDS appears to be a strong function of the age, race, education, and socio-economic status of the parents.

Risk factors

Very little is known about the possible causes of SIDS. It is important to note that ruling a child's death to be a case of SIDS is not describing the cause of death, but in fact a statement that the cause of death remains unknown. Although there is no known way to prevent it, research has provided several risk factors which are related to an increased incidence of the syndrome.

Prenatal risks

• inadequate prenatal care
• inadequate prenatal nutrition
• tobacco smoking
• use of cocaine or heroin
• teenage pregnancy
• less than a one year interval between subsequent births

Post-natal risks

• low birth weight (especially less than 1.5 kg)
• exposure to tobacco smoke
• laying an infant to sleep on his or her stomach (see positional plagiocephaly)
• failure to breastfeed
• excess clothing and overheating
• excess bedding, soft sleep surface and stuffed animals
• sex (60% of deaths occur in males)
• age (incidence is higher between 2-4 months)

In addition, research indicates a reduced risk of SIDS in conjunction with a safe co-sleeping arrangement. Though findings are still preliminary, the proximity of a parent's respiration is thought to stimulate proper respiratory development in the infant.

(The use of baby monitors, particularly those with motion sensors, can allow the parents to remotely keep track of their child.)

SIDS and child abuse

Controversial British pediatrician Roy Meadow believes that many cases diagnosed as SIDS are really the result of child abuse on the part of a parent suffering from Munchausen Syndrome by Proxy (a condition which he himself identified). During the 1990's and early 2000's, a great many mothers of multiple apparent SIDS victims were convicted of murder on the basis of Meadow's opinion. However, in 2003 a number of high-profile acquittals brought Sir Roy's theories into disrepute, and many now doubt their credibility. Several hundred murder convictions are now under review.

On the other hand, in a 6 March 2004 incident, a father is being accused of the murders of four of his children, one of which had been ruled a case of SIDS, and the National Clearinghouse on Child Abuse and Neglect Information indicates more than half of child abuse cases may be unreported or described as SIDS.

Possible nitrogen dioxide link

A recent study by researchers at the University of California, San Diego suggests a link between nitrogen dioxide (NO₂) levels and SIDS .

Conditions that may mimic SIDS

Medium Chain Acyl Dehydrogenase (MCAD) deficiency.

Prevention

It is important to recognize that there is no such thing as "SIDS Prevention", rather there are commonly understood "risk-reduction" measures; parents of infants are encouraged by pediatricians and popular parenting books to do many things thought to reduce the likelihood of SIDS.

Place the infant on its back to sleep. Among the theories supporting this habit is the idea that the small infants with little or no control of their heads may smother themselves on their bedding. Another theory states that babies sleep more soundly when placed on their stomachs, and are unable to rouse themselves when have an incidence of sleep apnea (which is thought to be common in infants).

Only use a firm mattress with well fitted (tight) sheets in a crib or bassinet. No pillows, stuffed animals, or fluffy bedding should be used or placed in a crib. In cold weather dress the infant warmly in well fitted clothing. Wearable blankets are prefferable over loose blankets. These directions also stem from the belief that small babies with little or no control of their bodies may inadvertently smother themselves in their sleep.

Parents are also encouraged to sleep near their babies. Near is generally understood to mean in the same room, but not in the same bed. Adult bedding often does not follow the 'no pillows, no fluffy blankets and firm mattresses only' instuctions mentioned before. Keeping the baby in the same room as the parent is thought to allow the parent to be wakened by a baby in distress even if the child is unable to cry.

External links

• US Center for Disease Control SIDS page, with links to a variety of information and statistics
• SIDS Families

• Pediatrics
• Infancy