Sudden infant death syndrome (SIDS) also known as crib or cot death is when a seemingly healthy baby (less than one year old) suddenly dies. The death is unexpected and cannot be explained. Autopsies done in most cases are inconclusive.
It accounts for up to 35-55% of all deaths in infants less than 12 months and it is the commonest cause of death in this age group. A classic presentation is an infant who was put to bed, usually after bottle feeding or breastfeeding. Parent or carer may report multiple checks on baby was done while sleeping and child appeared to be fine but baby was suddenly found dead, usually in the same position they’d been placed to take a nap.
The exact cause is unknown, however, it is believed to be due to a combination of factors, physical and environmental.
A poorly developed brain increases vulnerability of an infant to SIDS. Premature babies and those part of a multiple birth are at an increased risk as there is a likelihood that the brain center responsible for regulation of respiration, heart rate and temperature isn’t well formed. These are automatic processes and they have less control over it.
A history of an infection like common cold may precede event. A flu increases the risk of SIDS as respiration is compromised. In the second case above, on probing, mother reported a history of mild flu in infant prior to incident. This is not to say that every infant that suffers from a flu is at risk of having SIDS. An interplay of certain factors increases vulnerability, like history of prematurity, low birth weight, etc.
Tobacco smoking increases the risk of sudden infant death and parents are advised to cease smoking during pregnancy and avoid exposing infant to smoke.
Ensure babies are placed on their backs while sleeping, not on their stomachs or sides as studies have showed that babies not placed on their backs have increased difficulty in breathing.
Breastfeed babies before placing them down for a nap. This has been shown to decrease incidence of SIDS. Parents instinctively want to get a soft, comfortable mattress for their new born but this is not advisable as a soft mattress, fluffy comforters, pillows can get in the way and obstruct breathing. It is important not to share a bed with your infant. Increased incidence of SIDS has been linked to infants who share beds with parents, siblings or pets. Where possible, ensure they have their own beds. Overdressing a sleeping infant increases the risk of SIDS. Infant must be dressed in adequate clothes, one that is neither too warm or too bare to avoid temperature extremes. The American Academy of Paediatrics recommends the following ‘Back to sleep’ guidelines to reduce risk of SIDS
- Always place infants on their backs to sleep.
- Use a firm, safety approved crib mattress with a tight fitting sheet. Pillows, quilts, comforters, sheepskins should not be placed under the infant.
- Keep soft objects and loose bedding out of the crib. If blankets are used, they should be tucked in under the mattress so the infant head is less likely to become covered by bedding.
- Do not smoke during pregnancy and avoid second hand smoke exposure for the infant.
- A room -sharing sleep arrangement is recommended. Bed sharing is associated with higher risk of SIDS.
- Avoid overheating and overbundling
- Offer pacifier when placing infant down for sleep. Delay use of pacifier until after one month of age in breastfed infants
- Avoid commercial devices marketed to reduce risk of SIDS
- Don’t use home monitors as strategy to reduce risk of SIDS.
- Positional flattening of the head can be reduced by alternating head position during placement for sleep and use of ‘tummy time’ when awake.
While a lot remains unknown about sudden infant death syndrome, measures can be taken to prevent its occurrence. If your baby has an illness or you are worried about your baby at any time, do not hesitate to seek medical help and advice.