Preventing SIDS an Overview of the Evidence

Sudden Infant Death Syndrome (SIDS)

The causes of Sudden Infant Death Syndrome (SIDS) still remain poorly understood. Although there has been a dramatic decrease in its incidence, it still remains a leading cause of infant death in babies older than 30 days and younger than a year (Carolan, 2015, p.1). SIDS occurs when a previously healthy infant goes to sleep and for no apparent reason dies before waking. One of the most common hypotheses is developmental or that some infants "may experience abnormal or delayed development of specific critical areas of their brain. This could negatively affect the function and connectivity to regions regulating arousal during sleep" (Carolan, 2015, p.2). A lack of neurological response to temporary obstruction of the infant's breathing could cause sudden death. Undiagnosed birth defects or abnormalities (teratogens) may be the cause of at least a small but significant percentage of SIDS cases. "In 15%-25% of sudden, unexpected infant deaths specific abnormalities of the brain or central nervous system, the heart or lungs, or infection may be identified as the cause of death" (Carolan, 2015, p.3).

It is clear that positioning of the infant during sleep can dramatically reduce SIDS and encouraging parents to avoid allowing babies to sleep face down has been considered one of the most important factors in reducing the likelihood of developing the condition. "When an infant is in the facedown position, the rate of swallowing is decreased. Protective arousal responses to these laryngeal reflexes are also diminished in active sleep when infants are in the facedown sleep position" (Carolan, 2015, p.2). The American Academy of Pediatrics (AAP) 1992 Back to Sleep public health campaign that recommended a supine versus a face-down position for all infants when sleeping has been linked to the rate of SIDS plummeting by "more than 50%" (Livingston 2014). Even if the direct cause of SIDS remains uncertain, this empirical evidence suggests that prevention is possible through relatively simple actions.

Besides sleeping face down, other factors associated with SIDS include exposure to cigarette smoke, being formula fed versus breast-fed, and prenatal drug use. When mothers smoke during pregnancy, their children are three times more likely to develop SIDS and secondhand smoke exposure after pregnancy doubles an infant's risk of developing the condition (Livingston 2014). "Researchers speculate that smoking might affect the central nervous system, starting prenatally and continuing after birth, which could place the baby at increased risk" for SIDS, possibly due to neurological developmental delays (Livingston 2014).

Interestingly enough, in an early study by Downey, Silver, & Wortman (1990), parents whose children have died from SIDS, despite the tremendous grief of losing a child often feel they have little control over the phenomenon. "A large minority of parents (45%) were unconcerned with assigning responsibility for their infant's death" (Downey, Silver, & Wortman, 1990, p.17). The event was viewed as a kind of act of God out of their hands, and thus they did not attribute blame to themselves or other events. While parents should not blame themselves in any way for SIDS given that it can occur in the case of any infant, this also suggests the difficulty of communicating possible proactive steps to prevent the condition. The successful AAP campaign to change sleeping habits began in 1992, however, so it is possible that a more recent study would show different results.