SIDS
Sudden Infant Death Syndrome (SIDS) is the "sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history" (Willinger, et al., 1991).
Common Characteristics Of SIDS
Most researchers now believe babies who die of SIDS are born with one or more conditions that make them especially vulnerable to stresses that occur in the normal life of an infant, including both internal and external influences. SIDS occurs in all types of families and is largely indifferent to race or socioeconomic level. SIDS is unexpected, usually occurring in otherwise apparently healthy infants from 1 month to 1 year of age. Most deaths from SIDS occur by the end of the sixth month, with the greatest number taking place between 2 and 4 months of age. A SIDS death occurs quickly and is often associated with sleep, with no signs of suffering. More deaths are reported in the fall and winter (in both the Northern and Southern Hemispheres) and there is a 60 to 40-percent male-to-female ratio. A death is diagnosed as SIDS only after all other alternatives have been eliminated: SIDS is a diagnosis of exclusion.
Diagnoses Of SIDS
Often the cause of an infant death can be determined only through a process of collecting information, conducting sometimes complex forensic tests and procedures, and talking with parents and physicians. When a death is sudden and unexplained, investigators, including medical examiners and coroners, use the special expertise of forensic medicine (application of medical knowledge to legal issues). SIDS is no exception. Health professionals make use of three avenues of investigation in determining a SIDS death: (1) The autopsy, (2) Death scene investigation, and, (3) Review of victim and family case history.
The Autopsy
The autopsy provides anatomical evidence through microscopic examination of tissue samples and vital organs. An autopsy is important because SIDS is a diagnosis of exclusion. A definitive diagnosis cannot be made without a thorough postmortem examination that fails to point to any other possible cause of death. Also, if a cause of SIDS is ever to be uncovered, scientists will most likely detect that cause through evidence gathered from a thorough pathological examination.
Scene Investigation
A thorough death scene investigation involves interviewing the parents, other caregivers, and family members; collecting items from the death scene; and evaluating that information. Although painful for the family, a detailed scene investigation may shed light on the cause, sometimes revealing a recognizable and possibly preventable cause of death.
Review & Case History
A comprehensive history of the infant and family is especially critical to determine a SIDS death. Often, a careful review of documented and anecdotal information about the victim's or family's history of previous illnesses, accidents, or behaviors may further corroborate what is detected in the autopsy or death scene investigation. Investigators should be sensitive and understand the family may view this process as an intrusion, even a violation of their grief. It should be noted, although stressful, a careful investigation that reveals no preventable cause of death may actually be a means of giving solace to a grieving family.
SIDS Myths
Any sudden, unexpected death threatens one's sense of safety and security. We are forced to confront our own mortality (Corr, 1991). This is particularly true in a sudden infant death. Quite simply, babies are not supposed to die. Because the death of an infant is a disruption of the natural order, it is traumatic for parents, family, and friends.
The lack of a discernible cause, the suddenness of the tragedy, and the involvement of the legal system make a SIDS death especially difficult, leaving a great sense of loss and a need for understanding.
What SIDS Is
The major cause of death in infants from 1 month to 1 year of age, with most deaths occurring between 2 and 4 months
Sudden and silent--the infant was seemingly healthy
Currently, unpredictable and unpreventable
A death that occurs quickly, often associated with sleep and with no signs of suffering
Determined only after an autopsy, an examination of the death scene, and a review of the clinical history
Designated as a diagnosis of exclusion
A recognized medical disorder listed in the International Classification of Diseases, 9th Revision (ICD-9)
An infant death that leaves unanswered questions, causing intense grief for parents and families
What SIDS Is Not
Caused by vomiting and choking, or minor illnesses such as colds or infections
Caused by the diphtheria, pertussis, tetanus (DPT) vaccines, or other immunizations
Contagious
Child abuse
The cause of every unexpected infant death
SIDS Stats & Research
SIDS Statistics
For about 10 years, from 1983-1992, the average number of SIDS deaths reported annually ranged from 5,000 to 6,000. Beginning in 1992, this number began to change. In the past few years, especially in the mid 1990's, the number of SIDS deaths has declined significantly resulting form the message of the Back To Sleep campaign. The National Center for Health Statistics (NCHS) reported, in 1997, in the United States, 2,991 infants under 1 year of age died from SIDS; down from 3,050 in 1996. Preliminary figures show that, in 1998, 2,529 infants died from SIDS. (NCHS, Telephone interview, July 2000.) The rate for Sudden Infant Death Syndrome dropped by an estimated 20.9 percent from 1999. Four hundred and ninety-seven fewer infant death occurred in 2000 due to SIDS. Based upon the preliminary 2000 data, 2,151 babies died of SIDS, at a rate of .529 per 1,000 live births.
Significant Decline In SIDS Deaths?
According to most professionals, the significant decline in SIDS deaths starting in the mid-1990's can be attributed to results achieved from health messages promoted in the public health campaign known as the "BACK TO SLEEP CAMPAIGN" (BTS). In April 1992, the American Academy of Pediatrics, Task Force on Infant Sleep Position (AAP), issued a statement recommending infants be placed on their backs to sleep to reduce the risk of SIDS. In 1994, in response to the 1992 AAP announcement, a national campaign was initiated.
This campaign was a joint effort of the U.S. Public Health Service (National Institute of Child Health and Human Development and the Maternal and Child Health Bureau), the AAP, the SIDS Alliance, and the Association of SIDS and Infant Mortality Programs. Public service announcements from both government and private sectors were circulated. Largely as a result of public awareness raised by BTS Campaign messages, the number of SIDS deaths declined by more than 40% between 1992 and 1997. (Pediatrics, March, 2000, p.650)
The BTS Campaign expanded to become a nationwide public health effort. Major responsibility for disseminating information and educational materials on this crucial health topic was assigned to the National Institute of Child Health and Human Development (NICHD).
NICHD adopted the following recommendations to implement this nationwide effort to increase awareness of the critical importance of infant sleep position as a risk factor for SIDS:
Preparation and dissemination of several publications on infant care practices targeted at both consumer and health professional audiences
Establishment of a toll-free hotline as a contact point for obtaining these publications
Design of a web page with current information about activities of and resources available from the BTS Program
The Safe to Sleep® campaign, formerly known as the Back to Sleep campaign, has helped educate millions of caregivers—parents, grandparents, aunts, uncles, babysitters, child care providers, health care providers, and others—about ways to reduce the risk of Sudden Infant Death Syndrome (SIDS) and other sleep-related causes of infant death.