SIDS - Sudden Infant Death SyndromeAmerican Academy of Pediatrics Policy StatementThe Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk. Pediatrics, 2005. 116(5): 1245-55.

SIDS DefinedThe sudden death of an infant under 1 year of age, which remains unexplained after thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history.

EpidemiologyUnknown cause

Responsible for more infant deaths than any other cause (USA)despite >50% reduction since 1992 Rare during the 1st monthPeaks between 2-3 months

SIDS USA20010.56 deaths per 1000 live births20020.57 deaths per 1000 live births

Consistently higher rates are found in black and American Indian/Alaska Native children*2-3x national average

*less likely to position baby supine

Risk FactorsProne sleep positionSleeping on a soft surfaceMaternal smoking during pregnancyOverheatingLate or no prenatal careYoung maternal agePreterm birth and/or low birth weightMale gender

AAP - RecommendationsBack to sleepInfants should be placed for sleep in a supine position for every sleepSide sleeping is not as safe as supine sleepingNot advised

AAP - RecommendationsUse a firm sleep surfaceFirm crib mattress, covered by a sheetSoft materials (pillows, quilts, comforters, etc.) should not be placed under a sleeping infant

AAP - RecommendationsKeep soft objects and loose bedding out of the cribIf bumper pads are used, should be thin, firm and well-secured

Use sleep clothing with no other coverage or infant sleep sacks

AAP - RecommendationsIf blankets are used, they should be tucked so that the infants face is less likely to be covered

With infants feet to the foot of the bed, tuck blankets in so that they only reach the infants chest

AAP - RecommendationsDo not smoke during pregnancyMajor risk factor

Also avoid infant exposure to second hand smoke

AAP - RecommendationsSeparate but proximate sleeping environmentRisk is reduced when infant sleeps in the same room as the motherBed sharing is not recommendedBreastfeeding/comforting - return to crib/basinet when parent is ready to return to sleep

AAP - RecommendationsOffer a pacifier at nap and bedtimePacifier use during sleep reduces risk of SIDSMechanism unknown?

NOTE: Evidence that pacifier use inhibits breastfeeding or causes later dental complications is not strong enough at this time to outweigh this benefit

First Year Pacifier UsePacifier should be used when placing the infant down for sleep and not be reinserted once the infant falls asleepIf the infant refuses, s/he should not be forcedPacifiers should not be coated in any sweet solutionPacifiers should be cleaned often and replaced regularlyFor breastfed infants, delay pacifier introduction until 1 month of ageEnsure breastfeeding is firmly established

AAP - RecommendationsAvoid overheating

Should be lightly clothed for sleepBedroom temperature should be kept comfortable for a lightly clothed adultOverbundling should be avoidedInfant should not feel hot to touch

AAP - RecommendationsAvoid commercial devices marketed to reduce the risk of SIDS

None have been tested sufficiently to show efficacy or safety

AAP - RecommendationsDo not use home monitors as a strategy to reduce SIDS

No evidence that they decrease the incidence of SIDS

AAP - RecommendationsAvoid development of positional plagiocephaly

Encourage tummy time* infant is awake and observedEncourage upright cuddle timeAvoid excess time in car-seat carriers and bouncersAlter supine head position during sleep

*also enhances motor development

Whats wrong with this picture?

AAP - RecommendationsContinue the Back to Sleep campaignPublic education should be intensifiedSecondary care-giversChild care providersGrandparentsFoster parentsBabysittersBlack and American Indian/Alaska Native populations

Other theories related to SIDS?

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