Sudden infant death syndrome (SIDS) is the sudden death of an infant younger than 1 year that remains unexplained by other causes or events after a thorough investigation. The infant's medical history must be reviewed, an examination of the death scene must be conducted, and an autopsy must be performed before the diagnosis of SIDS can be used.1
INCIDENCE
SIDS remains the leading cause of death for infants aged 1 month to 1 year, with a peak incidence between 2 and 4 months of age. The incidence of SIDS in African Americans is 2.1 times that of whites, followed closely by American Indians with an incidence of 1.9 times that of whites.2
MODIFIABLE RISK FACTORS
When talking with parents about SIDS, PAs should discuss both prenatal and postnatal risks.
Prenatal risk factors include maternal cigarette smoking, drug or alcohol use, and inadequate prenatal care. These factors also put infants at risk for health problems other than SIDS.
Postnatal risk factors are often ignored when talking with parents. The most well known way to reduce the risk of SIDS is use of a supine sleeping position. The supine position is thought to reduce the risk of pharyngeal collapse during sleep as well as to increase the number of spontaneous arousals an infant experiences during sleep. Both effects improve respiratory stability during sleep. Many parents already know about the recommendation to place a healthy infant on its back to sleep. However, a recent survey revealed that many still do not follow the guideline.3 Unless an existing medical condition prohibits use of a supine sleeping position, the importance of using it every time must be stressed to new parents. PAs should not assume that parents of second and later babies already know about this risk reduction practice and should discuss its importance with all expectant parents.
Co-sleeping is a controversial risk factor for SIDS. The American Academy of Pediatrics (AAP) recommends against this practice because the risk of SIDS has been shown to increase when cosleeping is practiced, presumably for reasons such as accidental asphyxiation of the infant. Providers should explain the reasoning behind the AAP recommendation, as many parents find co-sleeping to be an important bonding ritual with their child. Safer alternatives, such as placing the crib next to the parents' bed, should be recommended.
Parents should be encouraged to use firm bedding in the baby's crib. Soft objects, stuffed animals, and loose bedding should be avoided. These objects may obstruct the airflow around an infant's face, possibly causing the infant to rebreathe expired CO2.
Parents should be advised to avoid overheating of their infant during sleep. The air temperature in the infant's room should be regulated, and the infant should not be dressed in excessively warm clothing. Leaving the head uncovered during sleep can reduce the risk of SIDS by up to 25%.4
The risk of SIDS has been shown to be reduced by using a fan in the room during sleeping. First, a fan helps prevent overheating of the infant during sleep; and second, the fan may help to circulate air past the infant's face, decreasing the incidence of CO2 rebreathing.
Another important way to reduce the risk of SIDS is to limit the infant's exposure to secondhand tobacco smoke. The SIDS risk has been shown to rise exponentially with increasing numbers of smokers in the infant's household as well as with increasing numbers of hours of smoke exposure per day.5 Parents should be advised to avoid smoking in the house and to limit their child's exposure to secondhand smoke as much as possible.
Finally, parents should understand the importance of educating all care providers about the strategies used to reduce the risk of SIDS. PAs should instruct parents to discuss the SIDS risk prevention strategies they utilize at home with anyone who will be providing care to their child.
BOTTOM LINE
The uncertainty surrounding SIDS makes it a difficult topic to discuss, but by staying abreast of the most current research, providers can help parents to reduce their child's risk as much as possible. Risk reduction strategies should be discussed with expectant parents and at all visits through the first year of life. With strong communication and continued research, PAs can play an important role in reducing the incidence of SIDS. JAPPA
Shannon Corcoran works in family practice at Flaming Medical Center in Dallas, Oregon. She has indicated no relationships to disclose relating to the content of this article.
Mary Hewett, MS, PA-C, department editor
REFERENCES
1. Kraus HF, Beckwith JB, Byard RW, et al. Sudden infant death syndrome and unclassified sudden infant deaths: a definitional and diagnostic approach. Pediatrics. 2004;114(1):234-238.
2. Mathews TJ, MacDorman MF. Infant mortality statistics from the 2004 period linked birth/infant death data set. Natl Vital Stat Rep. 2007;55(14):1-32.
3. Patrick P, Lincoln A, Lorenz D, et al. Infant sleep position in Oklahoma: evidence from PRAMS. J Okla State Med Assoc. 2008;101(8):182-187.
4. Blair PS, Mitchell EA, Heckstall-Smith EM, Fleming PJ. Head covering – a major modifiable risk factor for sudden infant death syndrome: a systematic review. Arch Dis Child. 2008;93(9):778-783.
5. Fleming P, Blair PS. Sudden infant death syndrome and parental smoking. Early Hum Dev. 2007;83(11):721-725.
Click NEXT for Patient Information.