It’s been a tough week at work. A 6 month old girl has been brought into your department. To all intents and purposes she appears dead on arrival and despite the best efforts of the nursing and medical staff you were unable to resuscitate her. You’ve been asked to lead the team debrief.
- SIDS and SUDI are both tragic occurrences that are unexpected and can have long term effects on the families involved
- Promoting safe sleeping habits may reduce the risk of SIDS
The Second International Conference on the Causes of Sudden Death in Infants (Seattle, 1969) defines SIDS as
“the sudden death of an infant or young child which is unexpected and in which a thorough post-mortem examination fails to find a cause of death.”
In 1990 the rate of SIDS deaths was 1.8 per 1000 live births. It is now about 0.3 per 1000 live births, possibly as a result of a number of safe sleeping campaigns. To put this in perspective there were 2992 perinatal deaths in 2011 0r approximately 9.9 per 1000 live births.
Sudden Unexpected Death in Infancy is just that. All cases of SIDS are SUDI’s but not all SUDI’s are caused by SIDS. It may occur as a result of a previously unknown congenital abnormality or overwhelming sepsis.
The current theory is the ‘triple-risk’ model in which a child with a biological susceptibility during a critical stage of development (usually around two to four months) is exposed to an external trigger. Research is ongoing to determine if there is a genetic predisposition or channelopathy that may contribute.
A couple of the nursing staff have young children and ask if there is anything they can do to reduce the risk of SIDS?
Back in the 1970s it was thought that putting a baby to sleep on their back was bad for their health but since the introduction of the ‘Back to Sleep’ initiative the incidence of SIDS has dropped in Australia. In practical terms this encompasses:
- Sleeping on the back from birth, rather than prone or on their side
- Sleeping with the head and face uncovered – no hats in bed
- Avoiding exposure to second-hand smoke
- Provide a safe sleeping environment – e.g. a cot free from extra blankets and soft toys
- Providing the baby with their own sleeping place in the same room as the adult caregiver for the first six to twelve months of life
Co-sleeping is hard to define but in essence involves sharing the same sleeping surface as the baby. Concerns have been raised as to the safety of co-sleeping, especially when the parent partakes of alcohol or other sedatives, but there is no definitive evidence to say it increases the likelihood of SIDS or SUDI. Most SIDS deaths that are linked to co-sleeping occur with mothers who smoke and so it should be actively discouraged in this population.
Those of us who are parents have all experienced sleepless nights worrying about our children. The advent of home apnoea alarms has probably led to more anxiety than reassurance. There is no evidence that any alarm will prevent a sudden infant death but there are recorded incidences of alarms not going off in cases of SIDS. Alarms are much more likely to go off as a result of the normal immature infant breathing pattern with its associated apnoeas and tachypnoeic episodes or the child rolling off the sensor mat. There are more sophisticated skin oximeter alarms available but they are pointless unless the parent has been taught the basics of neonatal life support.
The last friday in June is Red Nose Day in Australia. It’s a fundraising day for SIDS and Kids, as well as an opportunity to promote awareness. It is also a day of remembrance for those affected by SIDS and SUDI. Those of us working in emergency departments should take the opportunity to promote good health as well as care for the sick and injured.
This is a highly personal view but I think the most powerful thing that you can do when dealing with the family of a child that has been affected by SIDS is to use their name. If a parent mentions that a previous child has died of SIDS, stop, take a moment to acknowledge the tragedy rather than gloss over it and move on to the next question in the history, and ask their child’s name.
Conflict of Interest
The author is a proud supporter of SIDS and Kids and will be spending Friday promoting awareness in memory of his first daughter, Elizabeth.
References and Resources
SIDS and Kids – a charitable organisation dedicated to supporting families that have been affected by SIDS as well as promoting research in this area.
Young, J et al. Responding to evidence: Breastfeed baby if you can – the sixth public health recommendation to reduce the risk of sudden and unexpected death in infancy [online]. Breastfeeding Review, Vol. 20, No. 1, Mar 2012: 7-15.
Blackman LR et al. (2003). Committee on Fetus and Newborn Policy Statement: Apnea, Sudden Infant Death Syndrome and Home Monitoring. Pediatrics 111(4): 914-917.
Blair PS et al. and the CESDI SUDI research group. (1999) Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome. British Medical Journal 319(7223): 1457-1462.
Trachtenberg, Felicia L., et al. “Risk factor changes for sudden infant death syndrome after initiation of Back-to-Sleep campaign.” Pediatrics 129.4 (2012): 630-638.