Sudden infant death syndrome

Sudden infant death syndrome (SIDS) is any sudden and unexplained death of an apparently healthy infantaged 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 historyof 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 inexplicability of the death often leaves parents with a deep sense of guiltin 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; there is no method for absolute prevention. However, several risk factors are associated with increased probability of the syndrome.

Prenatal risks

• inadequate prenatal care
• inadequate prenatal nutrition
• tobacco smoking
• use of cocaineor 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 tobaccosmoke
• 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-sleepingarrangement. Though findings are still preliminary, the proximity of a parent's respirationis 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 BritishpediatricianRoy Meadowbelieves that many cases diagnosed as SIDS are really the result of child abuseon the part of a parentsuffering from Munchausen Syndrome by Proxy(a condition which he himself identified). During the 1990sand early 2000s, a great many mothersof multiple apparent SIDS victims were convicted of murderon the basis of Meadow's opinion. However, in 2003a number of high-profile acquittalsbrought Sir Roy's theories into disrepute, and many now doubt their credibility. Several hundred murder convictionsare now under review. BBC TV presenter Anne Diamondhas been responsible for raising awareness of causing cot death in the UK.

On the other hand, in a 6 March2004incident, a fatheris being accused of the murders of four of his children, one of which had been ruled a case of SIDS[1], and the National Clearinghouse on Child Abuse and Neglect Informationindicates 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 Diegosuggests a link between nitrogen dioxide(NO₂) levels and SIDS [2].

Conditions that may mimic SIDS

Medium Chain Acyl Dehydrogenase (MCAD) deficiency.

Prevention

Though SIDS cannot be prevented absolutely, parents of infants are encouraged by pediatricians and popular parenting books to take several precautions in order to reduce the likelihood of SIDS.

Sleep position

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 preferable 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.

Breastfeeding

A study published in the May 2003 issue of Pediatrics [3]revealed that breastfeeding infants have 1/5 the rate of SIDS as formula-fed infants. Two other studies supported breastfeeding for reducing SIDS rates:

• Hoffman, H.J., "Risk Factors for SIDS: Results of the National Institute of Child Health and Human Development SIDS Cooperative Epidemiologic Study". Ann NY ACAD Sci, 1988.
• Mitchell, A. "Results from the First Year of The New Zealand Count Death Study". N.Z. Med A, 1991; 104:71-76

Co-sleeping

A controversial approach to lowering SIDS rates is co-sleeping. Although a 2005 policy statement by the American Academy of Pediatricson sleep environment and the risk of SIDS condemned all co-sharing and bedsharing as unsafe, empirical data[4]has suggested that almost all SIDS deaths in adult beds occur when other prevention methods, such as placing the infant on his back, are not used. Infant deaths in adult beds are also reduced when parents are non-smoking, not impaired by drugs or alcohol, not obese, and are not using fluffy comforters and pillows. A firm sleeping surface is also required, which rules out waterbeds or soft mattresses. With these factors accounted for, SIDS rates for co-sleeping infants are actually lower than for crib-sleeping infants. A 2005 study states that "sleeping with an attentive, unimpaired mother is not only safe but biologically sound" (McKenna JJ, McDade T. Why babies should never sleep alone: a review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Paediatr Respir Rev 2005;6:134-52. PMID 15911459).

Sleep near baby

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.

Pacifiers

A 2005 study indicated that use of a pacifieris associated with a 90% reduction in the risk of SIDS (Li et al). PMID 16339767

Vitamin C

Australian medical doctor Archie Kalokerinoshas done scientific and clinical research to show that if vitamin C levels are adequate it will prevent cot-death. This has not been accepted by mainstream medicine[5].

Reference

• Li DK, Willinger M, Petitti DB, Odouli R, Liu L, Hoffman HJ. Use of a dummy (pacifier) during sleep and risk of sudden infant death syndrome (SIDS): population based case-control study. BMJ 2005. PMID 16339767.

External links

• US Center for Disease Control SIDS page, with links to a variety of information and statistics
• SIDS Families
• BBC Article - Large rise in infant sofa deaths in UKde:Plötzlicher Säuglingstod

id:Sindrom kematian bayi mendadak it:Sindrome di morte infantile improvvisa nl:wiegendood sv:Plötslig spädbarnsdöd ja:乳幼児突然死症候群 fi:Kätkytkuolema

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It uses material from the http://en.wikipedia.org/wiki/Sudden+infant+death+syndrome Wikipedia article Sudden infant death syndrome.