Sudden Infant Death Syndrome (SIDS), also known as crib death, is the sudden unexplained death of a child in infancy. Such a diagnosis is made when the death of the baby remains inexplicable even after a thorough autopsy and a detailed investigation of what happened. This article will tell about this tragic phenomenon.
Definition of concept
The named syndrome is a diagnosis of exclusion and should only be applied to cases where the death of an infant is sudden, unexpected and remains unexplained after an adequate post-mortem investigation has been performed, including:
- autopsies (by an experienced pediatric pathologist if possible);
- examination of the place of death and clarification of the circumstances of death;
- Child and family history studies.
So, for example, according to the results of the study, some of these cases wereare caused by accidental suffocation, hyperthermia or hypothermia, neglect of a newborn's living conditions, or some other specific cause that cannot be characterized as sudden infant death syndrome (up to what age and why it occurs, we will tell later in the article).
Interestingly, Australia and New Zealand are moving to the term "sudden unexpected death in infancy" for professional and scientific clarity. The named diagnosis is now often used in place of "sudden infant death syndrome" as some investigators prefer to use the term "indeterminate" for deaths previously thought to be SIDS. This change is caused by a diagnostic shift in data on the causes of mortality. In addition, the US Centers for Disease Control and Prevention recently proposed that such deaths be referred to as sudden unexpected infant deaths.
Causes of sudden infant death syndrome
The exact causes of SIDS are still unknown. Medical scientists believe that they are based on a combination of various factors:
- Studies have shown that babies who die as a result of SIDS have serotonin-induced dysregulation of the autonomic nervous system. This increases the baby's vulnerability to external factors, such as incorrect sleeping position, overheating.
- According to studies published in 2013, a possible cause of SIDS may be the absence of the ATOH 1 gene, which codes for the protein. This protein should be responsible for neuronalconnections and transmission of signals from neurons that contribute to a change in the rhythm of breathing when carbon dioxide accumulates in the lymph.
- There is also a hypothesis that SIDS may be caused by improper functioning of the autonomic nervous system, in particular its departments associated with the respiratory system and the work of the heart muscle, as well as insufficient serotonin.
- There is also a theory that sudden infant death syndrome is closely related to the underdevelopment of the respiratory center, in combination with some other factors. Important in this regard is the birth of a child before the 39th week of pregnancy.
In some cases, child abuse in the form of intentional strangulation can be misdiagnosed as SIDS. It is thought to account for less than 5% of cases.
Prevention measures
So far, the most effective method of reducing the risk of SIDS has been to place a child under one year of age on its back. The fact is that sleeping on your stomach is the only risk factor for SIDS that causes the least doubt. Other measures to prevent respiratory distress and suffocation are:
- use of a solid object that will separate parent and baby during sleep;
- lack of soft base and pillows in the crib;
- maintaining a certain temperature during sleep;
- using a pacifier;
- no child exposure to tobacco smoke.
Breastfeeding and immunization can also be classified as preventivemeasures. At the same time, baby monitors and other means of monitoring a child are not a sufficient measure to prevent his death.
Support for families affected by SIDS is very important, as the death of an infant occurs suddenly and without witnesses and is often investigated.
Statistics
In 2015, there were about 19,200 described deaths worldwide, which, compared with 22,000 deaths in 1990, indicates a gradual decrease. SIDS was statistically the third leading cause of death for young children in the United States in 2011.
It is also the most common cause of infant death in the world. Scientists, speaking about the age until which the sudden infant death syndrome occurs, argue that this phenomenon is observed in newborns up to a year old. And about 90% of cases occur before they reach the age of six months, and most often this happens between two and four months. And more common in boys than girls.
Risk factors
To reiterate, the causes of SIDS are unknown. Although studies have identified risk factors such as sleeping on the tummy, there is no unequivocal understanding of the biological process of the death of the baby or its potential causes.
Social, economic and cultural factors such as maternal education, race orethnicity, and income level. Such a death, doctors believe, occurs when an infant with a basic biological vulnerability, at a critical developmental age, is exposed to an adverse external influence. The following risk factors usually play a large role in mortality:
- Tobacco smoke. It is especially dangerous for babies of mothers who smoke during pregnancy. Nicotine and its derivative chemicals cause significant changes in the development of the fetal nervous system.
- Sleep baby on stomach or side. It is at its most dangerous between the ages of two and three months.
- Increased or decreased room temperature.
- Too much bedding, clothes, soft surfaces in the crib.
- Sharing a bed with parents or siblings. This risk is highest in the first three months of life. If the mattress is too soft and one or more people share the baby's bed, there is a risk of suffocation for the baby. Especially when parents use drugs or alcohol or smoke in bed.
The American Academy of Pediatrics, for example, advises against co-sleeping with an infant in a bed, saying it can reduce a baby's risk of death by nearly 50%. In addition, the Academy recommended safety devices - bed divider frames.
Ill-treatment and SIDS
There are fatal cases that were originally diagnosedas Sudden Infant Death Syndrome, but the autopsy and investigation found that the infants were victims of abuse or negligence by parents or guardians. As a rule, they attract particularly acute attention of society and the media.
These include those when children were deliberately strangled by their parents. However, such cases, which have led to high-profile articles in newspapers and television stories, are very rare, the exception rather than the rule. Their exact frequency cannot be estimated, but they may be less than 3%.
Other Features
It is still not clear whether co-sleeping with breastfeeding mothers is associated with the risk of developing the syndrome described. By the way, it decreases with increasing maternal age, and it is greatest among teenage mothers.
Inadequate prenatal behavior of the mother greatly increases the risk. The small weight of the baby at birth is also a significant factor. For example, in the United States in 1995-1998, the rate of SIDS among children weighing 1000-1499 g was much higher than in larger newborns.
Preterm birth increases the risk of death by about 4 times. Newborns who were born before 37-39 weeks of gestation are more at risk of dying from sudden death syndrome. Difficult childbirth is also a dangerous factor.
Mean age for SIDS, as already mentioned, is 2 to 4 months. And somehow discover the inclination to itSyndrome scientists have not yet succeeded. Even an autopsy of the body does not give doctors a hint at the cause of death. The study of the syndrome was begun in 1951, but it was not until 1968 that the medical term described appeared, and such a diagnosis was made for the first time.
Sudden Infant Death Syndrome, according to doctors, may be caused by genetic characteristics.
Opinion of pediatrician Yevgeny Komarovsky
A well-known doctor in the country with twenty years of experience also expressed his dissenting opinion. According to pediatrician E. O. Komarovsky, sudden infant death syndrome has no direct connection with sleeping on the stomach or side.
For twenty years, he examined at least 100,000 children and encountered the described syndrome several times. Komarovsky believes that a child can die while sleeping on his back from blockage of the upper respiratory tract after vomiting or regurgitation. There is also such a disease as aspiration pneumonia. Aspiration is the entry of foreign matter into the airways. When vomit gets into them, pneumonia occurs, which is very difficult to treat, gives a large number of complications and often causes the death of a child.
Proceeding from this, Evgeny Komarovsky believes that the practice of sleeping on the stomach is very useful. Also, in his opinion, this is just the position of medical extras and scientists who are trying to find links between SIDS and sleeping on the stomach, but cannot find the real cause of death, because this relationship has not yet been fully proven.
Komarovsky declares that,when analyzing the problem, one should take into account such factors as the type of pillow, air humidity and temperature, the number of dust accumulators, changes in atmospheric pressure, the number of people in the children's bedroom and much more.
Prevention plan
How to stop being afraid of sudden infant death syndrome? There is no sure way to prevent these deaths, but you can help your child sleep soundly by following the rules:
- Sleep on your back. Put your baby to sleep on their back, not on their stomach or side. But this is not necessary when your baby is awake. It can roll both ways.
- The baby's crib needs to be as flat as possible. Use a firm mattress and don't put your baby on a thick, fluffy blanket made from camel or sheep wool. Do not leave pillows, fluffy toys or animals in the crib. They can interfere with the breathing of a newborn baby when he falls asleep.
- Don't overheat the baby. Use a sleeping bag or sleepwear to keep your baby warm. Do not cover the baby's head.
- Put him to sleep in your room. Ideally, your baby should sleep in your room in a crib or crib for at least six months, and if possible up to a year.
- Adult beds are not safe for babies. A newborn can become trapped and suffocate between the bars of the front headboard, the space between the mattress and bed frame, or the space between the mattress and the wall.
- Child may also suffocate if a parent accidentally rolls over and covers the child's nose and mouth.
- Breastfeed your baby whenever possible. Breastfeeding for at least six months reduces the risk of developing various diseases. This is a very important preventive measure.
- Don't get your hopes up on baby monitors and other surveillance devices that are advertised to reduce the risk of the syndrome because they are ineffective and unsafe.
- Sucking on a non-stringed pacifier at night and at bedtime may reduce the risk of SIDS. One word of caution - if you are breastfeeding, wait until your baby is 3-4 weeks old before giving him a pacifier.
- If your baby doesn't like the pacifier, don't force him. Try giving it the next day. If the nipple comes off the baby's lips when he sleeps, do not put it back in.
- Give your child routine vaccinations. There is no evidence that they increase the risk of SIDS. Some evidence suggests that immunization may help prevent this syndrome.
By adhering to these recommendations, you can save your child from this terrible sudden death. But do not panic all the time, it is better to be attentive and caring parents and take proper care of your kids. Only in this case will you be able to protect your family from the trouble described here.
Statistics for the Russian Federation
According to statistics, in Russia from the syndrome of suddeninfant deaths are 0.50% per 1,000 newborns (i.e. 5 newborns per 10,000 babies). After the organization of a foundation that deals with this problem, mortality decreased by 70%, but it was not possible to completely overcome this syndrome.
Researcher Vorontsov in 1998 gave parents of newborns and pediatricians certain recommendations on how to reliably avoid such a disaster as sudden infant death syndrome. All techniques are specifically described in the scientific medical literature, but we have brought to your attention only the basic principles of caring for a baby.
