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Sudden Infant Death Syndrome is one of the leading causes of death for infants less than one year of age. The cause remains unknown, but usually happens during sleep. As stated in Egan’s Fundamentals of Respiratory Care, the diagnosis of SIDS is not made until an autopsy is performed. A previously healthy infant less than one year of age who dies suddenly and unexpectedly during sleep, and on autopsy shows no apparent reason for death, is diagnosed as a victim of SIDS. This is why it is also named “Crib Death” or “Cot Death”. Since SIDS usually happens when the infant is sleeping, it is important to understand safe sleeping habits. Recent studies have shown the risk of SIDS decreased by those who practice infant positioning and healthy sleep environments. There are many other theories that researchers believe can cause SIDS, including infant development, sleeping habits, and even hyperthermia.
Theories suggest that SIDS may reflect an abnormality or delay in nerve cells to the brain. This is critical to the heart and lung function. Infants who have died of SIDS show delay in the formation of serotonin. Serotonin is a chemical produced by the body that enables brain cells and other nervous system cells to communicate with one another. It is crucial to regulating heart rate, breathing pattern, blood pressure, and arousal during sleep. If the baby has low serotonin levels, it is very difficult for a baby to regulate their body, and wake up to cry when something is wrong. This is why it is very crucial to place your baby safely in their crib when they sleep. Performing all the right precautions to help reduce the risk of SIDS is vital to the baby’s well-being.
In 1992, the American Academy of Pediatrics published prevention guidelines that prone positioning was a potential risk factor for SIDS. Additionally in 2005 they also added side-lying, and soft items laying in the crib where another hazard. This could be due to accidental suffocation, or strangulation while in bed. Simply positioning a child in the crib the right way, can significantly reduce the risk of SIDS. In 1994, a campaign was launched called “Back to Sleep”. This campaign was produced to help educate parents, caregivers and healthcare professionals. It is important to educate the nurses and healthcare professionals on safe sleep habits, so in turn, they can educate the parents as well.
Educating the parents is the most important. Always place your baby on his or her back to sleep, naptime, or bedtime. This position is known as supine. The baby should be on a firm mattress, with a tight fitting sheet, in a safety-approved crib. These factors are important because a loose sheet has potential to suffocate a baby. According to Guttmacher, research has shown that placing a baby to sleep on soft mattresses, couches, sofa cushions, waterbeds, or other soft surfaces can increase the risk of SIDS.
A common concern when placing a baby on his or her back to sleep, is that the baby may choke. It is proven that babies who throw up on their back automatically swallow it or cough it up. This is a reflex they have to always keep their airway open. Babies actually clear their secretions better while lying on their back. According to Guttmacher, when babies are in the back sleep position, the trachea lies on top of the esophagus. Anything regurgitated or refluxed from the esophagus must work against gravity to be aspirated into the trachea.
Another important factor is to remove any toys, fluffy bedding, and pillow out of the crib. Always make sure that the baby’s head and face are uncovered when they are sleeping. The blankets should be away from the baby’s nose and mouth. Many parents think they need to cover their baby with a blanket while they are sleeping, but that is not the case. It is recommended that the parent dresses their baby in warm clothes, perhaps a long sleeve shirt, pants, and socks. The parent needs to make sure the baby isn’t too warm, there is a fine line, not too hot, not too cold. When a baby gets too hot, their normal response is to wake up and cry. When a baby has a defective brainstem or something neurologically wrong, they will not have that ability, leading to SIDS. Some parents think that the baby’s room needs to warmer than the rest of the house, which is not true. The baby’s room should be at a temperature an adult would be comfortable at.
Bed sharing is another risk factor of SIDS. Parents believe the baby is safest when he or she is right beside them, but they are actually at greater risk of SIDS. Many mothers share their bed with their baby because it makes breastfeeding much easier and strengthens their bond. As claimed by Guttmacher bed sharing is shown to increase SIDS when the mom smokes, drinks or even too exhausted. If there are multiple please in the bed, this increases the risk as well. If mom is breastfeeding in bed, and the baby falls asleep, when he or she is finished nursing the baby should be placed in their own crib.
Research suggests that when a baby is sleeping on their stomach, and in a soft bed that the baby can re-breath their own exhaled air. This allows the exhaled air to get trapped between the baby and the bed. Exhaled air is mostly carbon dioxide, so when a baby is constantly re-breathing that air, their oxygen levels decrease while their carbon dioxide levels increase. This can lead to SIDS. Normally, when the brain is not getting enough oxygen, the baby would wake up and begin to cry. A baby with a defective brainstem does not have this ability, and is at greater risk for SIDS. If parents take all the right actions in hopes to reduce SIDS, the mortality rate will decrease.
Pacifiers do not just help babies with colic anymore. Studies have shown that pacifiers help reduce the risk of SIDS. “American Academy of Pediatrics guidelines suggest offering pacifiers to infants when they begin to feel sleepy, to reduce the risk of sudden infant death syndrome. The guidelines recommend not introducing pacifiers to breastfeeding infants until one month of age because later onset of pacifier use appears to have fewer negative effects on breastfeeding. Pacifiers should not be forced on the infant or reinserted during sleep if the infant spits it out. The exact mechanism of benefit for reducing rates of SIDS is not fully understood, but pacifier use may decrease the likelihood of rolling into the prone position, increase arousal, maintain airway patency, decrease gastroesophageal reflux and resultant sleep apnea, or increase respiratory drive with carbon dioxide retention (Sexton).”
Despite all the research that has been done, frighteningly little is known about SIDS. “SIDS usually hits during winter and at night, the most common ages are two to four months with males being affected more frequently than females. Even with knowledge of risk risk factors, it remains impossible to identify those infants who will become a victim of SIDS. The incidence of SIDS remains at approximately 2 out of 1000 births and continues to frustrate attempts to establish its cause (Kacmarek).” The common event in all SIDS cases is the cessation of breathing during sleep. Although the etiology of this disorder is unknown, much has been learned about how to reduce the risk of SIDS. In order to prevent the risk of SIDS, the precautions listed are necessary.

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