SIDS, SIUD

I had been planning to write about SIDS (more correctly SIUD, sudden infant unexplained death) and how to attempt to prevent its occurrence. That plan had come to mind a while back when the pacifier recommendation splashed in the media. As usual I was reminded of the topic with a few recent “events”. The American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome revisited and reissued (Nov. 2005) their recommendations to prevent this silent killer.

Their recommendations include:

Back to sleep. First recommended in 1992 and made into a campaign by NIH in 1994 seems to have contributed to a 50% reduction in SIDS deaths (I should also mention that the overall infant death rate decreased 27% over the same time period, so it is somewhat difficult to attribute the SIDS decline all to changes in sleep position).

Use a firm sleeping surface along with keeping soft objects (pillows, comforters, and the like) and loose bedding out of the crib. Rebreathing expired air and positional asphyxia may be contributors to infant “crib death”.

Do not smoke during pregnancy and avoid infant exposure to second-hand smoke. Maternal pre-natal smoking has always stood out in studies of SIDS.

Separate but proximate sleeping environment. There seems to be a decreased incidence in infants who sleep in their crib in the same room as mother during the first 6 months of life. However, bed-sharing seems to be a risk factor for infant death (particularly when the “sharer” is overly tired or impaired by medication or other substances). Breastfeeding infants may be an exception to this bed-sharing caveat (breast-fed infants may be more easily arousable as a partial explanation for this).

A pacifier at bedtime, for the 1st year of life (this one is new). The mechanism by which this is protective is not well understood, but the data is compelling.

Avoid overheating the infant. Again not well understood, but light sleepwear and comfortable room temperature seems to be best.

Commercial devices marketed to reduce the risk, including cardiac and apnea monitors have not demonstrated effectiveness in preventing SIDS.

Sing the praises of the “Back to Sleep” program. Even though the program seems to have been effective in decreasing the incidence of tummy sleeping and SIDS, many do not know about this important bit of information. Particular populations in need of the information are mothers who don’t get prenatal care and secondary caregivers (e.g. child care providers, grandparents, babysitters).