Imagine the thought of a mother going in to her child’s room and kissing her baby good night. Expecting to hear the gentle breath of her baby all that she hears is silence. 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).
More children die of SIDS in a year that all who die of cancer, heart disease, pneumonia, child abuse, AIDS, cystic fibrosis and muscular dystrophy combined. Many researchers now believe that 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 and there is a 60-to-40-percent male-to-female ratio. A death is diagnoses as SIDS only after all other alternatives have been eliminated: SIDS is a diagnosis of exclusion (Willinger, et al., 1991).
Risk factors are those environmental and behavioral influences that can provoke ill health. Any risk factor may be a clue to finding the cause of a disease, but risk factors in and of themselves are not causes. Researchers now know that the mother’s health and behavior during her pregnancy and the baby’s health before birth seem to influence the occurrence of SIDS, but these variables are not reliable in predicting how, when, why, or if SIDS will occur. Maternal risk factors include :
? Maternal age less than 20 years
? Poor prenatal care
? Low weight gain
? Use of illegal drugs
? History of Sexually transmitted diseases
? Urinary tract infection
These factors, which often may be subtle and undetected, suggest that SIDS may
Somehow associated with a harmful prenatal environment. After birth, there also are numerous risk factors which can significantly influence the chance of SIDS. These include such things as: (Corr, et al., 1991)
? Sleeping position
? Crib and bedding materials
? Breast feeding
By definition, the causes of SIDS are not known. Attempts to explain the sudden and unexpected death of an infant adequately have been difficult since earliest times. Initially, if a baby died suddenly and unexpectedly in a bed shared with adults, it was thought to be due to an adult rolling on to the infant during sleep.
This was called ‘over-laying’ (Goyco, et al., 1990). Later, it was suggested that babies may have choked on something or that death was caused by prenatal neglect. It is clear now that in most cased none of these explanations was correct~that they were, in all probability, the victims of what is now known as SIDS (Goyco, et al., 1990).
No consistent warning signs occur that might alert us to the risk of SIDS. Sometimes the infant was not feeding so well on the day he or she died, or there may have been symptoms of a slight cold or tummy upset (Goyco, et al., 1990).
The National Center for Health Statistics (NCHS) reported that, in 1988 in the United States, 5,476 infants under 1 year of age died from SIDS; in 1989, the number of SIDS deaths was 5,634 (NCHS, 1990, 1992). However, other sources estimate that the number of SIDS in this country each year may actually be closer to 7,000 (Goyco and Beckerman, 1990).
The larger estimate represents additional cases that are unreported. Then considering the overall number of live births each year, SIDS remains the leading cause of death in the United States among infants between 1 month and 1 year of age and second only to congenital anomalies as the leading overall cause of death for all infants less than 1 year of age (CDC, 1996).
Often the cause of an infant death can be determined only through a process of collecting information, conducting sometimes complex 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 medicine (CDC, 1996).
Health professionals make use of three avenues of investigation in determining a SIDS death: (CDC, 1996)
? The autopsy
? Death scene investigation
? Review of victim and family case history
The autopsy provided anatomical evidence through microscopic examination of tissue samples and vital organs. An autopsy in important because SIDS is a diagnosis of exclusion. A definitive diagnosis cannot be made without a thorough potsmortem 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 examination (Hoffman, et al., 1995).
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 (Hoffman, et al., 1995).
Review of the victim and family case history is 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 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 that the family may view this process as an intrusion, even a violation of their grief. It should be noted that, although stressful, a careful investigation that reveals no preventable cause of death may actually be a means of giving solace to a grieving family (Willinger, et al., 1991).
Parents’ immediate reactions to their baby’s death may be shock, denial, disbelief, or a sense of numbness or unreality. These are completely normal, and cushion the impace of the loss o until the parents are ready to face the devastating reality of the baby’s death (National Center for Health Statistics, 1990).
Grief is not simple sadness, nor is it expressed only by crying. Each parent, and other family members, will feel many strong emotions in the following days, weeks, and months. It is not unusual for parents to feel some of these emotions from time to time, for years to come. Grief is not something which can be measured. It is very unlikely that any one person will feel exactly the same range of emotional responses as anybody else. Even the baby’s parents are not likely to experience the same feelings at the same time. This can make sharing one’s feelings especially hard, and lead to a sense of great isolation, causing even more difficulties for each grieving person (NCHS, 1990).
Many old wives tales, superstitions, and just plain stupidity abound about SIDS. From chiropractors claiming ‘stress on the atlas while transversing the birth canal’ to stories about suffocation from the ammonia in urine, SIDS has suffered from the ignorant (NCHS, 1988)
Articles and reports about SIDS often appear in the news media. Periodically such reports imply that “the cause” has been discovered. It is important to restate that SIDS continues to be an unsolved problem. Even with current scientific knowledge, SIDS victims cannot be identified beforehand (NCHS, 1988).
The National Center for Health Statistics recommended that in 1992 that infants be placed on their back, as studies have shown this has reduced the rate of SIDS in some areas. Death from aspiration of vomit is much rarer than SIDS. Not all doctors are convinced, and babies have died of SIDS while sleeping on their side or back. While the infant is awake and observed, some “tummy time” is necessary for developmental reasons. Side sleeping is less risky than stomach sleeping, and there are several devices to help you keep your infant propped up, but as soon as they start squirming a lot you probably cannot use them (NCHS, 1992).
Constant worrying about the possibility of SIDS and constant checking on the baby will not safeguard a child from SIDS. It will only serve to exhaust the parents and to increase their worries. The first few months and beyond is a time best spent by enjoying, loving, and watching your child grow and develop. Recognize the fact that you are not alone in your concern for your child. Remember that SIDS is not a common occurrence – of every 1000 babies born, 998 infants will NOT become SIDS victims (NCHS, 1992).
Any sudden, unexpected death threatens one’s 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 (Corr, et al., 1990).