Sudden Infant Death Syndrome: SIDS

Sudden infant death syndrome (SIDS) is the leading cause of death for infants between one month and one year old. SIDS occurs when a baby who seems to be healthy dies in his or her sleep.(1) No one is sure of the cause. However, researchers found that babies who slept on their stomachs had a higher statistical risk for SIDS. For a long time, doctors had advised parents to lay their baby down on his stomach, so that the baby wouldn't choke on his own vomit ("spit-up."), and so the soft spot on the back of the baby's head wouldn't be damaged if bumped on the surface below the baby. Even in 1982, the hospital nursery lay infant Emilie on her stomach, something they would not do today.

The U.S. Government (since 1994) and the American Academy of Pediatrics (since 1992) have strongly advised all doctors to recommend that infants be set to lie down on their backs for sleeping. (2) The reason for this change was a theory to explain the statistical relationship to SIDS. When the infant is lying stomach-side down, a bubble of carbon dioxide can accumulate between the baby's head and the surface below. Because the baby's neck muscles are not yet fully developed, the infant might not be able to raise her head for a breath of fresh air. She risks suffocation when lying on her stomach. Because babies who had been exposed prenatally to alcohol or drugs tend to have weaker bodies, there is a higher incidence of SIDS in these infants (3).

The National Institute of Child Health and Human Development issued a reminder in Jan. 1999, "that traditionally there has been a higher incidence of sudden infant death in cold weather." (4) By 1997, infant sleeping practice had already changed from 70 percent of infants being placed on their stomach (prone) to sleep, to 76 percent being placed on their back or side, NICHD Director Dr. Duane Alexander announced. Also, since the "Back to Sleep" campaign to get parents to place babies on their backs there has been a 43 percent reduction in sudden infant deaths. (5) In France, a similar campaign , brought about a 70% reduction in SIDS cases over 5 years. (6)

Recent studies have shown that SIDS is more likely to occur at daycare than at home (7). For those infants who spend 40% of their time in daycare (under care of someone other than their own parent), it was estimated that 10% of those who died of SIDS, their deaths would occur during that time period away from home. Instead, results indicate the real percentage to be 20.4%. Proper training of how to handle infants and lay them down to sleep is not only important for the baby's parents, but for childcare providers as well.

The U.S. Government maintains an information line: 1-800-505-CRIB which is available to answer questions about infant sleeping position. Are there some parents out there in the U.S. and the rest of the world who have not yet gotten the message on how to have a better chance of protecting their babies from SIDS? (8)

There is a SIDS Network which has much information available and links to further information, including translations about prevention. The SIDS network provides information, links, and support: http://sids-network.org/ ; German link: http://sids-network.org/german.htm , Massnahmen gegen die Gefahr des ploetzlichen Kindstodes; French link: http://sids-network.org/riskfr.htm , la Mort Subite du Nourrisson; Spanish link: http://sids-network.org/smis.htm , S̀ndrome de Muerte Infantil S™bita (SMIS). (9)

(1) "What is SIDS?" [c. Associated Press] Blue Bell, PA, InteliHealth, Johns Hopkins U.,Nov. 20, 1996. As of: April 1, 1999. URL: http://www.intelihealth.com/IH/ihtIH?t=4513&p=~br,IHW|~st,408|~r,WSIHW000|~b,*|

(2) U.S. National Institute of Health's "Back to Sleep" main page. http://www.nih.gov/nichd/docs/news/SIDS_HP_2/home1B.shtml

The NIH "Back to Sleep" page in Spanish. http://www.nih.gov/nichd/docs/news/SIDS_HP_2/Spanish.shtml

(3) This information is based on Emilie Sutterlin's notes taken from a discussion on SIDS in school [TJHSST] health class, Mar. 1999. There are more detailed links on SIDS statistics from the NIH pages.

(4) NIH: Put Babies in Bed on Backs" [c. Associated Press] Blue Bell, PA, IntelHealth, Johns Hopkins U., Jan. 20, 1999. URL as of April 1, 1999:

http://www.intelihealth.com/IH/ihtIH?d=dmtICNNews&c=208174&p=~br,IHW|~st,408|~r,WSIHW000|~b,*|

"Incidence of SIDS Increases during Cold Weather: A Winter Alert to All Caregivers of Infants." Jan. 14, 1998, reported a similar warning the previous year. http://www.nih.gov/nichd/docs/news/wintal2.htm

(5) This study by Rachel Y. Moon, involving 2,315 SIDS cases, was described in: "SIDS Deaths In Daycare Double Expected Rate." [c. Reuters] Blue Bell, PA, InteliHealth, Johns Hopkins U., Health News. Mar. 22, 1999. URL still valid as of Aug 7, 1999:

http://www.intelihealth.com/IH/ihtIH?d=dmtICNNews&c=216299&p=~br,IHW|~st,408|~r,WSIHW000|~b,*|

(6) MORT SUBITE DU NOURRISSON France-Forte baisse des cas de mort subite du nourrisson. http://esculape.com/fmc/nnomortsubite.shtml

(7)"Incidence of SIDS Increases during Cold Weather: A Winter Alert to All Caregivers of Infants." Jan. 14, 1998.

http://www.nih.gov/nichd/docs/news/wintal2.htm

(8) Infant Sleeping Position: Pregnancy Risk Assessment Monitoring System. (Fact sheet) Atlanta, GA., U.S. Centers for Disease Prevention and Health Promotion. Office of Communication. Media Relations. October 23, 1998. (Public domain) http://www.cdc.gov/od/oc/media/fact/infantsp.htm

In 1996, 3,050 infants, <1 year of age, died from SIDS. SIDS rates for black and American Indian infants was two to three times higher than for whites. In 1994, a national "Back to Sleep" educational campaign was launched to encourage the public and healthcare providers to put babies to sleep on their backs or sides, and to avoid putting them on their stomachs.

The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, state-based surveillance system of maternal behaviors that occur before, during, and after pregnancy, including the child's early infancy. Population-based data on the usual infant sleeping position for 1996 births, by race, from 10 states participating in the PRAMS (Alabama, Alaska, Florida, Georgia, Maine, New York, Oklahoma, South Carolina, Washington, and West Virginia) showed that the percentage of respondents who reported usually putting their babies to sleep on their stomach varied by state from 16.0% to 30.8%. In most states, most respondents usually put their babies to sleep on their sides, which is recommended over the stomach sleep position, but is not as effective in reducing the risk of SIDS as the back sleep position. In five southern states, the prevalence of the stomach sleep position was about twofold higher than in the states having the lowest percentages (Maine and Washington). The percentage of respondents who reported putting their babies to sleep on their back was the highest in Washington (42.9%) and Alaska (40.8%), and lowest in Georgia (24.5%), Florida (25.4%), and South Carolina (25.8%). Black mothers were more likely (11% to 54% higher) than white mothers to put their babies to sleep on their stomach. Among black mothers, the percentages ranged from 22.5% in Washington to 42.1% in Florida; white mothers from 16.1% in Maine to 30.5% in Oklahoma. Data for American Indians in two states, Washington and Oklahoma, indicated that 16.0% and 33.9% of respondents reported usually putting their babies down to sleep on their stomachs. The comparable percentage for Alaskan Natives was 23.5%. The national goal of the "Back to Sleep" campaign is to reduce the percentage of infants put to sleep on their stomachs to 10% or less by the year 2000. According to the National Infant Sleep Study, 24% of U.S. infants are put to sleep on their stomachs.

(9) The SIDS network provides information, links, and support: http://sids-network.org/; German link: http://sids-network.org/german.htm, Massnahmen gegen die Gefahr des ploetzlichen Kindstodes; French link: http://sids-network.org/riskfr.htm, la Mort Subite du Nourrisson; Spanish link: http://sids-network.org/smis.htm, S̀ndrome de Muerte Infantil S™bita (SMIS). © <http://sids-network.org> 1995-1996-1997-1998-1999, SIDS Network, Inc. All rights reserved. Permission to use, copy, and distribute this document, in whole or in part, for non-commercial use and without fee, is hereby granted, provided that this copyright, permission notice, and appropriate credit to the SIDS Network, Inc. be included in all copies.

Questions and Answers for Professionals on Infant Sleeping Position and SIDS can be found at:

http://www.nih.gov/nichd/docs/news/SIDS_HP_2/quan.shtml

1-800-505-CRIB is available to answer other questions about Infant sleeping position