Sudden infant death syndrome (SIDS)

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Sudden infant death syndrome (SIDS) is very rare. It affects about 1 in every 1300 infants, and the incidence has dropped significantly in the past few years all over the world. It is generally more common in winter, in colder climates, in families from lower socioeconomic groups, and in babies who have been born very prematurely.

Sudden infant death syndrome is the term used for when a baby dies unexpectedly with no explanation. SIDS usually afflicts babies between the ages of 1-6 months, and is rare beyond one year of age. There is usually no indication that anything was wrong with the baby, and no sign during the night that the baby was distressed, or that anything was amiss. Sometimes the baby will have had a very mild cold in the days before the death.

What causes it?

The exact cause of SIDS is unknown, despite an enormous amount of research. The most common theories suggest it has something to do with viral infections, or with the part of the brain that controls a baby’s breathing or sleep patterns. It is likely that SIDS is due to a number of different causes, one or more of which may be responsible for a particular baby’s death.

What are the symptoms?

There are no specific symptoms, before the death or afterwards, that predict the event or explain why it happened. In about half the cases parents report a mild cold – perhaps a snuffly or runny nose or mild fever – in the days before death, but in most instances this has been so mild that parents have not gone to the doctor. Some have been to the doctor and have been told their baby is well.

What is the impact?

Parents and other family members are understandably devastated by SIDS. They feel anger, guilt, frustration and above all, grief. Family members might be angry at health professionals, for somehow not preventing this from happening, or family or friends. Parents will re-examine every moment over the last few hours or days of their child’s life, searching for some clue as to what may have contributed to the death. They will also feel guilty, wondering whether, if they had done things a little differently, the baby might still be alive. They may feel guilty that they did not check on the baby before going to sleep themselves, or that the cot was not in their room, or that they did not wake the baby for a midnight feed. These thoughts are all a normal part of the grieving process, and will come up irrespective of any reassurances.

Unfortunately, there is absolutely nothing that parents can do to predict the death of the baby as a result of SIDS, and apart from following the SIDS guidelines for preventing SIDS, nothing that they could have done to prevent it.

The SIDS Foundation counsels bereaved families around Australia, as well as funding SIDS research and conducting community education about SIDS. Talking with trained counsellors from this organisation can really help. The tragedy will also have a devastating effect on siblings, as well as on members of the extended family such as grandparents, and counselling can really help these family members too. At times like this, it’s very important to look after yourself.

How can I prevent it?

Although the cause of SIDS is not known, research over recent years has shown some links between SIDS and a number of factors. Paying attention to these factors may reduce the chance of SIDS. In fact, it has been suggested that the reduction in the incidence of SIDS worldwide is due to the publicity that has been given to these risk factors.

Sleeping position

There is now very strong evidence that babies put to sleep on their stomach are at increased risk for SIDS. Put your baby to sleep on their back or side, with the lower arm well forward so that they do not roll over onto their tummy.

Keep the baby cool

Babies get too hot if they are covered with too many blankets. If the baby has a cold or a fever, then even fewer blankets are needed. Wrap the baby so his head and arms move freely. Bonnets for the baby will increase body temperature and are not recommended for sleeping. Bumpers in the cot restrict the flow of fresh air around the baby’s head, and may increase the temperature; the same applies to soft pillows and cushions. Make sure the room is not overheated.

Smoke-free environment

Smoking is associated with an increased risk of SIDS. The best thing to do is to not smoke during pregnancy (it causes other problems for the unborn baby as well) or in the same room as the baby. Ask others not to smoke near the baby. Keep the baby in a smoke-free environment. If you smoke, sharing a bed with your baby can increase the risk of SIDS.

Avoid stuffed toys in the cot

Comforters, fluffy blankets and pillows and stuffed toys can all increase the baby’s temperature or suffocate the baby.

Apparent life-threatening episodes (ALTE)

A number of babies have these episodes, which in the past have sometimes been called ‘near miss SIDS’. The baby is found limp, sometimes blue, sometimes unconscious or unresponsive and not breathing. Varying degrees of stimulation seem necessary to revive them, ranging from noise or gentle movement of a limb to full-blown resuscitation, including mouth to mouth. This is terrifying for parents, and these babies are usually admitted to hospital for close monitoring and investigation.

The causes of these episodes are varied and include:

• convulsions (fits)
  
• choking, sometimes due to food coming up from the stomach and going down the wrong way (gastro-oesophageal reflux)
  
• where the heart loses its rhythm (cardiac arrhythmias)
  
• where the baby ‘forgets’ to breathe (apnoeic episodes), which is usually due to an immature central nervous system.

Most often, no cause at all is found.

The relationship between ALTEs and later SIDS is uncertain, although less than 7% of infants who die from SIDS have had an ALTE. If a cause is found for the episode, this is treated. If no cause is found, parents are assured that it is unlikely to happen again. Sometimes an apnoea alarm is used for a time in case the baby stops breathing again. This is a mat containing wires that sense the movement the baby makes when they breathe. If the movement stops for a predetermined length of time, then an alarm is triggered. The use of apnoea alarms does have problems, however, as they are not 100% reliable and can contribute to great anxiety in parents, who often say they lie awake at night listening for the alarm to go off.

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