SIDS - Sudden Infant Death Syndrome

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SIDS - Sudden Infant Death Syndrome

• American Academy of Pediatrics Policy Statement
• The 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.

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SIDS Defined

• The 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.

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Epidemiology

• Unknown cause
• Responsible for more infant deaths than any other
  cause (USA)
• despite gt50 reduction since 1992
• Rare during the 1st month
• Peaks between 2-3 months

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SIDS USA

• 2001 0.56 deaths per 1000 live births
• 2002 0.57 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

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Risk Factors

• Prone sleep position
• Sleeping on a soft surface
• Maternal smoking during pregnancy
• Overheating
• Late or no prenatal care
• Young maternal age
• Preterm birth and/or low birth weight
• Male gender

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AAP - Recommendations

• Back to sleep
• Infants should be placed for sleep in a supine
  position for every sleep
• Side sleeping is not as safe as supine sleeping
• Not advised

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AAP - Recommendations

• Use a firm sleep surface
• Firm crib mattress, covered by a sheet
• Soft materials (pillows, quilts, comforters,
  etc.) should not be placed under a sleeping
  infant

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AAP - Recommendations

• Keep soft objects and loose bedding out of the
  crib
• If bumper pads are used, should be thin, firm and
  well-secured
• Use sleep clothing
• with no other coverage
• or infant sleep sacks

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AAP - Recommendations

• If 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

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AAP - Recommendations

• Do not smoke during pregnancy
• Major risk factor
• Also avoid infant
• exposure to second
• hand smoke

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AAP - Recommendations

• Separate but proximate sleeping environment
• Risk is reduced when infant sleeps in the same
  room as the mother
• Bed sharing is not recommended
• Breastfeeding/comforting - return to crib/basinet
  when parent is ready to return to sleep

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AAP - Recommendations

• Offer a pacifier at nap and bedtime
• Pacifier use during sleep reduces risk of SIDS
• Mechanism unknown?
• NOTE Evidence that pacifier use inhibits
  breastfeeding or causes later dental
  complications is not strong enough at this time
  to outweigh this benefit

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First Year Pacifier Use

• Pacifier should be used when placing the infant
  down for sleep and not be reinserted once the
  infant falls asleep
• If the infant refuses, s/he should not be forced
• Pacifiers should not be coated in any sweet
  solution
• Pacifiers should be cleaned often and replaced
  regularly
• For breastfed infants, delay pacifier
  introduction until 1 month of age
• Ensure breastfeeding is firmly established

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AAP - Recommendations

• Avoid overheating
• Should be lightly clothed for sleep
• Bedroom temperature should be kept comfortable
  for a lightly clothed adult
• Overbundling should be avoided
• Infant should not feel hot to touch

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AAP - Recommendations

• Avoid commercial devices marketed to reduce the
  risk of SIDS
• None have been tested sufficiently to show
  efficacy or safety

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AAP - Recommendations

• Do not use home monitors as a strategy to reduce
  SIDS
• No evidence that they decrease the incidence of
  SIDS

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AAP - Recommendations

• Avoid development of positional plagiocephaly
• Encourage tummy time
• infant is awake and observed
• Encourage upright cuddle time
• Avoid excess time in car-seat carriers and
  bouncers
• Alter supine head position during sleep
• also enhances motor development

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Whats wrong with this picture?
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AAP - Recommendations

• Continue the Back to Sleep campaign
• Public education should be intensified
• Secondary care-givers
• Child care providers
• Grandparents
• Foster parents
• Babysitters
• Black and American Indian/Alaska Native
  populations

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Other theories related to SIDS?