Sudden infant death syndrome (SIDS)
This factsheet is for people who want to know more about SIDS (sometimes called cot death).
Sudden infant death syndrome (SIDS) is the sudden and unexpected death of a baby aged less than one year where no specific cause could be found despite a detailed investigation. Although little is known about the causes of SIDS, there is a great deal of proven information on the steps parents can take to help reduce the risk of it happening.
About SIDS
According to the Foundation for the Study of Infant Deaths (FSID), around 500 babies die suddenly and unexpectedly in the UK every year, usually between the ages of one and four months.
When a baby dies, a thorough investigation into the cause of death should be carried out. Possible causes include serious infection, accident, or a previously unknown problem that the baby was born with (congenital abnormality). But in more than half the cases a specific cause of death is not found, even after a thorough investigation including post-mortem examination. When the cause of death remains unexplained after investigation, the death is registered as SIDS, or sometimes as unascertained, cot death or sudden unexpected infant death. A baby's death is not considered SIDS if a specific cause is found.
Although the exact cause isn`t known, researchers think that a combination of factors play a role in SIDS. Some theories implicate breathing failures or problems with the heart not beating regularly. Recent research suggests that babies with SIDS have problems in a part of the brain called the medulla oblongata, which controls breathing. Other theories involve allergy, bacterial toxins, and genetic abnormalities, but none of these have been proven.
Babies who die from SIDS appear to die painlessly in their sleep. It usually happens when the baby is asleep in their cot, but can also happen during any other period of sleep such as when in the pram or even in a parent's arms.
SIDS can happen to any baby, but premature babies, low birth-weight babies and boys are more at risk. SIDS is more likely in the night, between midnight and 9am.
Reducing the risk of SIDS
There is no way to completely protect babies from SIDS. However, there are a number of things that you can do to reduce the risk. It would also be a good idea to talk through these precautions with your childcare providers or babysitters.
Don`t smoke during pregnancy - both mothers and fathers.
Don`t let anyone smoke in the same room as your baby.
If your baby is unwell seek medical advice promptly.
Sleeping
For the first six months, the safest place for your baby to sleep is in a cot in your bedroom.
Lie your baby on their back to sleep.
Place the baby's feet at the bottom of the cot to prevent wriggling down under the covers.
Don`t fall asleep with your baby while sitting or lying on the sofa.
Never let your baby sleep with a pillow. Just use a firm mattress.
Never share a bed with your baby if he or she is under three months old, if the baby was premature or less than 2.5kg, if you or your partner are smokers even if you don`t smoke at home, if you have been drinking alcohol, if you have taken medications that make you drowsy, or if you are very tired.
Some evidence suggests that giving your baby a dummy before they go to sleep might reduce the risk of SIDS. However, experts are analysing the evidence before making a recommendation on their use. Dummies should not be used beyond one year of age as they can increase the risk of dental problems in your baby. For further information talk to your GP.
Temperature
Keep your baby at the right temperature --not too hot or too cold.
12°C
Room temperature Amount of bedding
sheet plus four or more layers of blankets
14°C
sheet plus three or four layers of blankets
16°CC
sheet plus three layers of blankets
18°CC
sheet plus two layers of blankets
20°CC
sheet plus one or two layers of blankets
22°CC
sheet plus one layer of blankets or sheet only
24°CC
sheet only
Source: Department of Health www.doh.gov.uk
Table 1.Bedding guidelines for babies wearing a nappy, vest and babygro.
Try to keep room temperature between 16 and 20°C the ideal temperature is 20°C. Get a thermometer to check the temperature.
Use the right amount of bedding for the temperature of the room (see Table 1). When you check on your baby, if your baby is sweating or their tummy feels hot, take off some of the bedding. It`s normal for babies to have cool hands and feet.
Don`t let your baby sleep with a hot water bottle, an electric blanket, next to a radiator, heater or fire or in direct sunshine.
Don`t use duvets, quilts or pillows if your baby is aged under one.
Don`t put too many clothes on your baby.
Take off the baby's outdoor clothes as soon as you get inside.
Baby monitors
Baby breathing monitors are available that are designed to alert you if they can`t detect breathing for more than 20 seconds. They use sensor pads that are strapped to the baby's tummy, a pressure pad under the baby or an ultrasound beam.
A monitor should only be used under the supervision of a paediatrician or other doctor. Although commonly used, there is no evidence that these monitors prevent SIDS, and many doctors believe they provide a false sense of security.
Coping with SIDS
Sadly, even when reducing the risks as much as possible, babies can and do still die from SIDS.
When a baby dies from SIDS, parents often suffer overwhelming feelings of guilt. It is important that you try to remember that your baby's death was not your fault. If the baby dies while in the care of a babysitter or childminder it is important to try not to blame them and realise that they will also need support.
SIDS deaths are rare and extremely unlikely to occur twice in the same family. While some women may want to become pregnant fairly soon after losing a baby, the decision to have another baby is not an easy one and must be taken only when both partners feel it is right.
Sources of help
Family, relations and friends can be a valuable source of help and comfort. They can also help in practical ways, for example with looking after other children when bereaved parents have to do things like visiting the hospital or making funeral arrangements.
Dedicated charities, support groups and associations, can provide advice and help to families affected by SIDS. For example, FSID provides information and a helpline (see the further information section for more details).
Details of local support groups can normally be found at a local library or in a local phone book. Your doctor or health visitor may also be able to advise you of a group that meets in your area. It may help to talk to a counsellor who specialises in helping people cope with grief. Your GP should be able to help you find a suitable counsellor.
Help with subsequent babies
Parents who have lost one baby to SIDS may have fears during subsequent pregnancies and after the birth.
A heightened need to be protective when the new baby is born is to be expected and parents will probably check their baby's breathing frequently. Other members of the family will have similar fears for the new baby and it may help to discuss these together.
A GP or health visitor can give advice to women who have another baby. Care of the next infant (CONI) schemes are available in many areas, funded by FSID (see further information section) and run by CONI in conjunction with the NHS. They offer advice, support, increased monitoring for the new baby, and frequent check-up visits.
Further information
Foundation for the Study of Infant Deaths (FSID)
020 7233 2090
www.fsid.org.uk
Stillbirth and Neonatal Society
020 7436 5881
www.uk-sands.org
Sources
Sudden infant death syndrome. BMJ Clinical evidence. BMJ.
www.clinicalevidence.com
accessed 9 October 2006
Simon C, Everitt H, Birtwistle J, Stevenson B. Oxford Handbook of General Practice. 3 ed. Oxford, 2004: 158, 766
accessed 10 October 2006
Reduce the risk of cot death - an easy guide. Department of Health, 2005.
www.dh.gov.uk
accessed 10 October 2006
Hauck FR, Omojokun OO, Siadity MS. Do pacifiers reduce the risk of sudden infant death syndrome- A Meta analysis. Pediatrics 2005; 116: e716-e723.
Li De-Kun, Willinger M, Petitti DB, Odouli R, Liu L, Hoffman HJ. Use of a dummy (pacifier) during sleep and risk of sudden infant death syndrome: population based case-control study. BMJ 2006; 332: 18-22.
Task force on SIDS. The changing concept of SIDS: Diagnostic Coding shifts, controversies regarding sleeping environment, and new variables to consider in reducing risk. Pediatrics 2005; 116:1245?1255.
Published by BUPA's health information team,healthinfo@bupa.com, December 2006.
