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.

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.

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Patient Information

Q: How can I reduce the risk of SIDS?

WHAT IS SIDS?

SIDS stands for sudden infant death syndrome. SIDS is the leading cause of death for babies 1 month to 1 year old. Most deaths from SIDS occur between 2 and 4 months of age. About 2,500 deaths from SIDS occur per year. SIDS almost always occurs while a baby is sleeping. Although the exact cause of SIDS is not known, we do know many of the risk factors for SIDS. These risk factors are important for you to know. This will help you to do things that will reduce the risk of SIDS for your baby.

WHAT CAN I DO TO REDUCE THE RISK OF SIDS?

• Put your baby on its back to sleep.

This is the best thing you can do to reduce the risk of SIDS. Your doctor or PA may tell you that your baby should sleep in a different position. If not, always put your baby on its back to sleep.

• Do not sleep with the baby. Do not put your baby to sleep in bed with you (or anyone else) while you are sleeping. Put your baby to sleep somewhere safe. The safest place is the baby's crib. If you want to sleep with the baby, move the crib next to your bed. You can also put the baby to sleep in other places that follow the rules in this handout.

• Use a firm sleeping surface for your baby. Never put your baby to sleep on a pillow, comforter, or rug. They may look nice to sleep on, but they can make it hard for your baby to breathe during sleep.

• Keep loose bedding out of the crib. No loose objects should be in the crib while your baby is sleeping. Never put pillows, blankets, or stuffed toys in the crib with your baby. These objects may make it hard for the baby to breathe.

• Don't let your baby get too warm. Don't let the baby's room get too hot. Dress the baby in light clothing for sleep. Don't cover the baby's head while he or she is sleeping. Covering the baby's head may cause the baby to get too hot.

• Use a fan in the baby's room. A fan can keep the air moving around the baby's face. It can also help to keep the baby from getting too warm while sleeping.

• Keep your baby away from smoke. Do not smoke cigarettes (or anything else) in your house or anywhere around your baby. Keep other people who are smoking away from the baby. If you smoke, try to quit. Your hair and clothes can expose your baby to the bad effects of smoke. This is true even if you don't smoke around the baby.

• Talk about SIDS with those who care for your baby. Tell these people how to reduce the risk of SIDS. Don't assume they know what to do. Give them a copy of this handout. Tell them you want them to do these things when they care for your baby.

HOW DO I FIND OUT MORE?

Your doctor or PA can tell you more about how to reduce the risk of SIDS. You can also learn more on the Internet at these Web sites:

American SIDS Institute
www.sids.org

National SIDS Resource Center
www.sidscenter.org

American Academy of Pediatrics
www.aap.org/healthtopics/Sleep.cfm

JAPPA