SIDS Sudden Infant Death Syndrome American Academy of

SIDS - Sudden Infant Death Syndrome American Academy of Pediatrics Islamic University Nursing College

SIDS Defined o 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.

Epidemiology o Unknown cause o Responsible for more infant deaths than any other cause (USA) n despite >50% reduction since 1992 o Rare during the 1 st month o Peaks between 2 -3 months

SIDS – USA o 2001 o 2002 0. 56 deaths per 1000 live births 0. 57 deaths per 1000 live births o Consistently higher rates are found in black and American Indian/Alaska Native children* n 2 -3 x national average *less likely to position baby supine

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

AAP - Recommendations 1. Back to sleep n n Infants should be placed for sleep in a supine position for every sleep Side sleeping is not as safe as supine sleeping p Not advised

AAP - Recommendations 2. Use a firm sleep surface n n Firm crib mattress, covered by a sheet Soft materials (pillows, quilts, comforters, etc. ) should not be placed under a sleeping infant

AAP - Recommendations 3. Keep soft objects and loose bedding out of the crib n If bumper pads are used, should be thin, firm and well-secured n Use sleep clothing with no other coverage or infant sleep sacks

AAP - Recommendations n If blankets are used, they should be tucked so that the infant’s face is less likely to be covered n With infant’s feet to the foot of the bed, tuck blankets in so that they only reach the infant’s chest

AAP - Recommendations 4. Do not smoke during pregnancy n Major risk factor n Also avoid infant exposure to second hand smoke

AAP - Recommendations 5. Separate but proximate sleeping environment n n Risk is reduced when infant sleeps in the same room as the mother Bed sharing is not recommended p Breastfeeding/comforting - return to crib/basinet when parent is ready to return to sleep

AAP - Recommendations 6. Offer a pacifier at nap and bedtime n Pacifier use during sleep reduces risk of SIDS p 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…

First Year – Pacifier Use o Pacifier should be used when placing the infant o o 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 n Ensure breastfeeding is firmly established

AAP - Recommendations 7. Avoid overheating n n 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

AAP - Recommendations 8. Avoid commercial devices marketed to reduce the risk of SIDS n None have been tested sufficiently to show efficacy or safety

AAP - Recommendations 9. Do not use home monitors as a strategy to reduce SIDS n No evidence that they decrease the incidence of SIDS

AAP - Recommendations 10. Avoid development of positional plagiocephaly n Encourage “tummy time”* p n n n 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

AAP - Recommendations 11. Continue the Back to Sleep campaign n Public education should be intensified p Secondary care-givers n n p Child care providers Grandparents Foster parents Babysitters Black and American Indian/Alaska Native populations