1. Sudden Unexpected Infant Death & Sudden Infant Death Syndrome
Southwest SIDS Research Institute
230 Parking Way, Lake Jackson, Texas

2. Sudden Unexpected Infant Death (SUID) & Sudden Infant Death Syndrome (SIDS)
A simple child That lightly draws its breath And feels his life in every limb What should it know of death? -William Wordsworth
Nex Slide: Introduction

3. Welcome and Introduction
Welcome to the Southwest SIDS Research Institute’s SIDS Educational Program.
Today we will be reviewing what SUID & SIDS are and the latest theories of why they occur.
This program will offer simple yet vital information in the areas of infant care and prenatal care to help reduce the risk of infants succumbing to SUID/SIDS.
Introduce Presenter
Next Slide: Program Outline

4. Program Outline SIDS- Clinical Definition and what SIDS is NOT.
Who SIDS affects-
Infants susceptible to SIDS.
Individuals affected by SIDS.
Theories-
Latest theories on why SIDS occurs.
Reducing the risk
Back to sleep Campaign
Safe Sleep
Other addressable risk factors
Tips for child-care providers.
Program outline- what we will be reviewing today.
Next Slide: What Is SIDS?

5. What is Sudden Infant Death Syndrome?
Sudden Infant Death Syndrome (SIDS) is the sudden, unexpected death of an apparently healthy infant, for which no cause can be identified even after:
A thorough death scene investigation
An autopsy
A review of the infant and family’s medical records.
(Willinger et al., NSIDRC, 1991)
After reading Slide: Some medical terminology commonly associated with SIDS:
Apnea- An apnea is a period of time during which breathing stops or is markedly reduced.
Sleep Apnea- temporary cessation of breathing during sleep. (Merriam Webster)
Arrhythmia- an alteration in rhythm of the heartbeat either in time or force. (Merriam Webster)
Bradycardia- relatively slow heart action whether physiological or pathological (slow arrhythmia).(Meriam Webster)
Tachycardia- relatively rapid heart action whether physiological (as after exercise) or pathological . (Merriam Webster)
Next Slide: Characteristics of SIDS

6. SIDS Characteristics SIDS is: SIDS is not:
Sudden and silent- Infants appear healthy
Caused by vomiting, choking, or by minor illnesses such as colds or infections
Currently unpredictable
Designated as a diagnosis of exclusion
Contagious
Child abuse
(NSIDRC 2004)
Before reading Slide:
Typical SIDS event:
Mother/father places infant to sleep, 5 min, 10 min, or the next morning they find the infant has died. The death remains unexplainable after all investigation.
Read while reading bullets on slide:
Some common characteristics dealing with SIDS:
Children appear seemingly normal.
The cause is unknown so there’s no sure way of prevention. We can only try and reduce the risk of a SIDS death.
SIDS is diagnosed after all other causes of death are excluded and a define reason is not evident.
Sids is not:
These causes would have been evident from the autopsy.
Next slide: Stats on SIDS?

7. Statistics on SIDS
Year
Infant
Mortality
Total
Infant Mortality Rate
SIDS
SIDS Rate
1990
38,351
9.2
5,417
1.30
1991
36,766
8.9
5,349
1992
34,628
8.5
4,890
1.20
1993
33,466
8.4
4,669
1.17
1994
31,710
8.0
4,073
1.03
1995
29,505
7.6
3,397
0.87
1996
28,419
7.3
3,050
0.78
1997
27,968
7.2
2,991
0.77
1998
28,325
2,822
0.71
1999
27,864
7.0
2,648
0.66
2000
27,960
6.9
2,523
0.62
2001
27,523
6.8
2,234
0.55
2002
28,034
2,295
0.57
2003
28,025
2,162
0.52
2004
27,936
6.7
2,246
In 2004, 2,246 infants died from SIDS making it the number 1 cause of death for infants between 1 month and 1 year of age.
SIDS claims more American babies every year than all childhood cancers, leukemia, heart disease, cystic fibrosis, AIDS, and child abuse combined.
Before Slide: So, how common is SIDS?
After reading Slide:
From 2002 to 2003 the rate decreased. However from 2003 to 2004 it increased.
Next Slide: Who is Susceptible to SIDS?
(HRSA 2004)

8. Infants Susceptible to SIDS
SIDS occurs across all racial, ethnic and socio-economic boundaries. ANY BABY IS SUSCEPTIBLE TO SIDS!
SIDS rates are higher among African Americans and American Indians.
SIDS rates are lowest among Asians and Hispanics.
Most SIDS deaths, 70%, occur before four months and another 20% occur before six months.
Males are 50% more likely to die of SIDS than females.
(Horchler and Morris, 1994)
First to sixth month are the most susceptible.
Next Slide: SIDS risk Factors

9. SIDS Risk Factors Risk factors for SIDS include: Overheating
Placing an infant in an at risk sleeping environment and/ or position
Smoking or abusing drugs or alcohol during or after pregnancy
Exposure to secondary smoke after pregnancy
Prematurity
Sibling of a SIDS infant or high risk infant
Teen pregnancy
Late or no prenatal care
ANY CHILD, REGARDLESS OF THE PRESENCE OF RISK
FACTORS, IS SUSCEPTIBLE TO SIDS.
Read after each bullet:
Overheated:
Different factors have shown to have an effect on the occurrence of Sids including:
Infants heads being covered
Bed Sharing
Swaddling with prone sleeping
Excessive sweating
Excessive room temperature
Infection with fever
Excessive bedclothes
Next Slide: Who SIDS affects?

10. Individuals Affected by SIDS
It is estimated that one hundred individuals are affected by every SIDS death including:
Parents and siblings
Relatives-
Grandparents
Aunts and uncles
Friends
Church family
Medical care providers
Child care service providers
Next Slide: So why Does SIDS occur? Latest theories on SIDS

11. Theories on SIDS
There are over 400 theories on what causes SIDS (Horchler and Morris, 1997)
Two Popular Schools of Thoughts suggest:
Infants are born abnormal and are predisposed to SIDS.
(Filiano and Kinney, NSIDRC, 2004)
Infants are normal yet succumb to SIDS through an abnormal event in their phases of development.
(Horchler and Morris, 1997)
First School of Thought Theory example
Brain stem abnormalities that are responsible for sleep arousal. And a diminished maturation of nerve tissue causing a delay in the transmission of signals controlling infant breathing, and heart rate. (Dr. Hannah Kinney, Boston Children’s Hospital)
Second School of Thought Theory example
Of An error in the cerebral messaging system that mistakenly sends the wrong message to the throat to close instead of to open.
However neither theories can explain all causes of SIDS.
Next Slide: The popular Triple Risk Model

12. Critical Development Period
The Triple-Risk Model
Critical Development Period
Outside Stressor(s)
Vulnerable Infant
Many scientists are adopting this model in their search for the cause of SIDS. When all three elements interact a sudden infant death may occur.
Vulnerable Infant- An infant with an underlying defect or abnormality making the baby vulnerable.
Critical Development Period- The first 6 months of an infant are filled with developmental changes that may temporarily effect the infant’s biological systems.
Outside Stressor(s)- Environmental factors that may effect an infant. (ex. Overheating, prone sleeping, smoke exposure).
(Filiano and Kinney, NSIDRC, 2004)
SIDS
Ex. Of Vulnerable Infant- Brainstem abnormality, diminished maturation of individual nervous tissue which causes delays in transmission of signals in the areas of breathing and heart rate.
Ex. CDP developmental changes – (sleeping patterns, variations in breathing, heart rate, blood pressure, body temperature) Some of these changes destabilize the internal systems.
When all three elements interact a sudden infant death is likely to occur. The infant’s vulnerability is undetected until the infant enters the critical developmental period and is exposed to an outside stressor(s).
So these are some of the theories on why SIDS occurs. Unfortunatley SIDS is not preventable. However, we have found ways to
Next Slide: REDUCING THE RISK of SIDS

13. Reducing The Risk! Back To Sleep Campaign
In 1992, the American Academy of Pediatrics recommended that babies be placed on their backs while sleeping.
Reason’s why babies sleep safest on their backs is not entirely clear yet but some findings suggest:
Prone sleeping may lead to overheating and may affect breathing.
Next Slide: Back to sleep Data
(National Institutes of Health 2005)

14. Back To Sleep
The recommendation was adopted in However it’s effect rose dramatically once the Back to Sleep Campaign was launched two years later.
This campaign is sponsored by the National Institute of Child Health and Human Development, the Maternal and Child Health Bureau, the American Academy of Pediatrics, the SIDS Alliance (now First Candle), and the Association of SIDS and Infant Mortality Programs.
Many parents are concerned about “flat head”.
Next Slide: Tummy time
In 1994, the National Institute of Health began it’s “Back To Sleep” campaign promoting that all infants be placed on their backs while sleeping. SIDS rates fell 50 % in the U.S. alone following the campaign.

15. Back to Sleep to Reduce the Risk
Provide the infant with “tummy time” while awake and observed to avoid “flat” heads and so the infant may develop strong shoulder muscles.
Change the direction that your baby lies in the crib from one week to the next. For example, have the baby’s feet point toward one end of the crib for a few days, and then change the position so his or her feet point toward the other end of the crib.  This change will help make sure the baby is not resting on the same part of his or her head all the time.
Avoid too much time in car seats, carriers, and bouncers while awake.  Also, get “cuddle time” with the baby by holding him or her upright over one shoulder often during the day.
Babies will not choke if he/she sleeps on his/her back.
Healthy babies automatically swallow or cough up fluids. There has been no increase in choking or other problems for babies who sleep on their backs.
What else can reduce the risk other than sleep position?
Next slide: SAFE SLEEP: Creating a Safe Sleep environment…

16. Safe Sleep to Reduce the Risk
The sleeping environment of an infant can have a drastic effect on reducing the risk of SIDS. Reduce risks by:
Keep the infant’s room temperature comfortable for YOU (avoid overheating).
Keep the environment SMOKE-FREE before and after pregnancy.
Placing the baby’s crib in the same room with you (but NOT bringing the baby in your bed to sleep with you)
Offer a pacifier at nap or bed-time (never coat the pacifier with Karo syrup or honey).
Placing the baby on a FIRM mattress with TIGHT fitting sheets and no cracks or
Avoid commercial positional devices designed to reduce the risk of SIDS.
crevices he/she can get trapped in.
NEVER placing bumper pads quilts, pillows, or fluffy toys in the baby’s cribs.
DON’T place your baby on a couch, water bed, or bean bag chair to sleep.
Overheating issues with co sleeping…and the danger of overlay
Tight fitting sheets that won’t crawl up and wrap around the baby or trap air and keep it from circulating.
Same as issues 1 and 2.
Overheating danger
Smoke has shown to increase breathing difficulties in infants.
The exact mechanism for this protective effect is unclear, but lowered sleep arousal thresholds is one possible explanation. The AAP Task Force recommends that, for infants younger than one year of age, parents and caregivers consider using a pacifier when placing the infants down to sleep. Parents and caregivers should offer the pacifier, but not force the infant to take it if she or he refuses it. Pacifiers should be clean and dry and should not be reinserted after the infant is asleep. If a mother is breastfeeding, parents should wait until the infant is one month old or until breastfeeding is established before introducing a pacifier.
Karo Syrup and Honey have been shown to cause botulism in infants.
Commercial positional devices can not clinically prove to reduce the risk of SIDS. Any additional object added to the crib increases the risk of SIDS.
Next Slide: Example of a Safe Sleep environment.

17. A Safe Sleep Environment
Next Slide: Other ways to Reduce the Risk!

18. Tips for Child Care Providers
Educate staff on SIDS
Always place infants Back to Sleep
Create a Safe Sleep Environment for infants
If you follow these measures you will reduce – but not totally eliminate - the risk of a baby dying of Sudden Infant Death Syndrome.
Invite SWSRI to do an educative presentation to your organization or refer to our organization to other providers. Have SIDS literature on hand in your centers (contact SWSRI for free literature!)
Have your entire staff always place infants on their backs to sleep.
Have a poster showing what a safe sleep environment looks like (provided free by SWSRI.
Always remember SIDS is unpreventable and it is nobody’s fault when it happens.
Next Slide: References

19. Sudden unexpected infant death

20. Accidental Suffocation
Unintentional suffocation is the leading cause of injury death among children under 1 year old in the United States.
Since 1984, an estimated fourfold increase has been observed in accidental suffocation and strangulation in bed, with many of these deaths linked to unsafe sleep environments. (CDC)
After ruling out confounding factors, the apparent cause of most infant deaths due to accidental suffocation was bed- sharing, also known as co-sleeping.

21. Review of statistics shows the distribution of potentially preventable unsafe sleep practices:

22. IN THE 80’S A DEADLY TREND STARTED SPREADING RAPIDLY ACROSS THE UNITED STATES.
THE PRACTICE OF CO-SLEEPING WAS RISING – AND INFANTS WERE DYING IN INCREASING NUMBERS WHEN SLEEPING WITH THEIR PARENTS OR CARETAKERS.

23. AFTER REVIEWING NATIONAL STATISTICS, THE TEXAS DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES STUDIED INFANT DEATHS IN OUR STATE AND DISCOVERED A FRIGHTENING REALITY…

25. Like U.S. statistics,
AN INCREASING NUMBER OF TEXAS BABIES WERE DYING WHILE CO-SLEEPING.

26. ~EVERY 2 DAYS. THESE DEATHS ARE LARGELY
A CO-SLEEPING BABY DEATH OCCURS IN TEXAS
~EVERY 2 DAYS. THESE DEATHS ARE LARGELY
PREVENTABLE.

27. Total Texas Infant Deaths Where Bed-Sharing was a Factor
YEAR (Fiscal Year: 9/01 -8/31)
NUMBER OF FATALITIES
2015 (As of 11/03/14) 16
2014
197
2013
169
2012
167
2011
174
2010
166

28. In an effort to reverse this trend, The American Academy of Pediatrics (AAP) recommends room-sharing without bed-sharing, stating that: “there is evidence that this arrangement decreases the risk of SIDS by as much as 50%.” (Pediatrics Vol. 128 No.5 Nov 1,2011 pp e1341 – e1367)

29. The AAP further states: “There is insufficient evidence to recommend any bed-sharing situation in the hospital or at home
as safe; devices promoted to make bed-sharing “safe” are not recommended.”

30. Risk Factors vs. Age
A study of 8,207 deaths: 73.8% of deaths in infants less than 4 months of age occurred with bed-sharing.

31. Risk Factors vs. Age
A study of 8,207 deaths: Older babies (greater than or equal to 4 months of age) were more likely to have an object (stuffed toy, bumper pads) in their sleep environment.

32. In Conclusion….
We can reduce the risk of SIDS AND SUID by implementing safe sleep practices.
Alone, on their Back, and in their Crib is the safest way to position an infant.
Together, we look forward to that day when all babies at risk are identifiable and their deaths preventable.

34. SOUTHWEST SIDS RESEARCH INTSTITUE
Contact Information
The Southwest SIDS Research Institute is dedicated to assisting those who are victims and to search for the cause(s) of sudden death during infancy, identify ways to reduce the risk, disseminate this information, and, ultimately, to prevent these tragic losses.
With your help we can make this mission a reality.
For more information or to order literature on SIDS, contact Brenda Onopa at:
SOUTHWEST SIDS RESEARCH INTSTITUE
230 Parking Way
Lake Jackson, TX 77566
(979)

35. References
Center Of Disease Control & Prevention (CDC). Infant Mortality Statistics From the 2004 Period Linked Birth/Infant Death Data Set. Trends in Preterm-Related Infant Mortality by Race and Ethnicity: United States. News release, CDC
Horcheler, J., Morris, R. The SIDS Survival Guide: Information and Comfort for Grieving Family & Friends & Professionals Who Seek To Help Them. SIDS Educational Services Inc, Second ed, 1997.
Guntheroth, W., Spiers, P. Thermal Stress in Sudden Infant Death: Is There an Ambiguity With the Rebreathing Hypothesis? PEDIATRICS Vol. 107 No. 4, April 2001,
National Institute of Child Health and Human Development. Safe Sleep For Your Baby: Reduce the Risk of Sudden Death Infant Syndrome (SIDS). National Institute of Health, Pub No , November 2005.
National Institute of Child Health and Human Development. What Does a Safe Sleep Environment Look Like? Lower the Risk of Sudden Infant Death Syndrome. National Institute of Health, Pub. No , January 2006.
National SIDS/Infant Death Resource Center (NSIDRC). Sudden Infant Death: What Is SIDS? Health resources and Services Administration. Revised 2004.
“Sleep Environment Risks for Younger and Older Infants”, Jeffrey D. Colvin, Vicki Collie-Akers, Christy Schunn and Rachel Y. Moon, Pediatrics; originally published online July 14, 2014; DOI: /peds

36. Resources American Academy of Pediatrics. www.aap.org
American SIDS Institute.
Association of SIDS and Infant Mortality Programs.
C.J. Foundation for SIDS.
First Candle/SIDS Alliance
National Center for Cultural Competence.
National SIDS Resource Center. 1–
National SIDS and Infant Death Program Support Center.
National SIDS and Infant Death Project IMPACT.
National Institute of Child health and Human Development /NIH Back to Sleep Campaign.