Reducing the risk of Sudden Infant Death Syndrome

Dear Dr. Crutchfield, my sister is expecting a baby soon. I have heard about something called “SIDS.” What is SIDS, and what advice can I give her to prevent SIDS in her new baby?

SIDS stands for Sudden Infant Death Syndrome (SIDS), also known as crib death. This is the sudden death of a child less than one year of age that occurs without explanation. In the United States, 2,500 babies die of SIDS every year. This is a stunning number of deaths.

Autopsy and complete death scene investigations demonstrate no definitive cause of death. Most deaths occur between midnight and 8 am. The majority of cases occur in babies between ages two and six months when the infant’s ability to wake up from certain stimuli is not fully developed.

SIDS is more common in boys than girls but occurs among all children. Some experts are now calling this Sudden and Unexplained Death in Infancy (SUDI). Additionally, the U.S. Centers for Disease Control and Prevention (CDC) has recently proposed that such infant deaths be called “sudden unexpected infant deaths” (SUID) and that SIDS is a subset of SUID.

As you can imagine, no matter what the syndrome is called, the condition is devastating to families.

Diagnosis

The diagnosis is one of exclusion. If an autopsy and complete death scene investigation demonstrate no definitive cause of death, the diagnosis of SIDS is made.

The cause of SIDS remains unknown. Eighty percent of sudden and unexpected infant deaths result from SIDS. The other 20 percent of sudden and unexpected infant deaths are a result of heart problems, genetic disorders or infections.

Risk factors

The following are known risk factors for the development of SIDS:

• Sleeping on the stomach
• Exposure to tobacco smoke
• Sleeping  on a soft mattress
• Sleeping with cushions or bumpers in the crib
• Prematurity
• Low birthweight
• Young mother’s age
• Children who have not been breastfed
• Children who have anemia

Treatment

There is no treatment of SIDS. The goal is to prevent the occurrence of SIDS. As of October 2016, the American Academy of Pediatrics has come up with a new set of guidelines  to minimize SIDS:

• Have the baby sleep on its back, always, even for quick naps.
• Have the baby sleep in the same room, but not same bed, as parents, until the age of one.
• Have the baby sleep alone, always.
• Make sure the mattress is firm.
• No cushions or soft toys in the bed.
• Breastfeed the baby as long (months) as possible.
• Make sure the room is not too hot; keep the temperature under 76 degrees. Use light clothing and blankets.
• Do not smoke around child.
• Make sure immunizations are up to date.
• Use a pacifier.
• Don’t give honey to a baby under one year of age (has increased risk of botulism).

There are also several special heart and breathing monitors that alert parents to abnormal situations and reduce the risk of SIDS. Surprisingly, in the medical community these are controversial, so discuss their recommended use with your pediatrician.

It appears that one of the major preventive measures is to make sure the baby sleeps alone, on the baby’s back, in the same room (not same bed) as the parents for at least the first six months, and preferably the first year. The evidence is compelling. This simple measure, coupled with the preventive list above, has decreased the incidence of SIDS by 50 percent!

Surprisingly, as simple as this may seem, it goes against the family tradition of preparing a beautiful nursery for the newborn. The advice I give is to create a beautiful nursery but use it at the one-year mark. This is a very small price to pay to decrease the risk of SIDS.

Unfortunately, SIDS is a major cause of infant death. Shockingly, more infants die every year from SIDS than in automobile accidents. There are many things you can do as a parent to minimize the occurrence of this devastating condition. Be sure to discuss SIDS with your pediatrician and develop a plan to keep your baby as safe as possible.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine.  Dr. Crutchfield was recognized by Minnesota Medicine as 1 of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations.