Understanding sudden infant death syndrome: Causes, prevention and protecting our babies

Fellow mums, let’s dive into a topic that can be a little scary and heartbreaking, but one that we absolutely need to talk about – sudden infant death syndrome, or Sids.

We understand that even the thought of it can send shivers down our spines. It’s so heartbreaking to hear news about babies dying in their sleep. But arming ourselves with the right information is crucial for the well-being of our precious little ones.

So, grab a cup of tea, take a deep breath, and let’s explore what Sids is all about and how we can keep our babies safe.

What is Sids?

Sids is part of a larger classification of unexpected infant deaths called Sudden Unexpected Death in Infancy.

Sids, also known as crib or cot death, is the sudden and unexplained death of a baby between one and 12 months old. This usually happens while the baby is asleep. It is also considered one of the leading causes of death among infants.

Sids kills nearly 3,000 babies each year. Its victims are babies, who appear to be perfectly healthy when their parents put them down for a nap or at bedtime, but never wake up. Needless to say, it’s a devastating and horrific tragedy that can happen to anyone at any time.

In 2016, the American Academy of Pediatrics modified its recommendations for preventing Sids and sleep-related newborn fatalities.

Despite the ongoing communication efforts, there appears to be a gap between public health recommendations to prevent Sids and promote safe sleeping environments, and what parents actually practise with regard to infant sleeping environments, as evidenced by the continued infant mortality statistics.

Here on the island, Sids is not a commonly discussed topic. However, it’s important to know what measures families can take to help reduce their baby’s risks.

How is Sids identified?

Sids is a diagnosis of exclusion, meaning that it is identified by ruling out other possible causes of infant death.

When investigating a sudden and unexplained infant death, medical professionals will perform a thorough examination, review the infant’s medical history and conduct a series of tests.

These tests may include a detailed autopsy, analysis of the death scene, and a review of the family’s medical history.

The absence of any underlying medical conditions or external factors that could have caused the infant’s death helps in identifying it as Sids.

While the exact cause of Sids remains unknown, this diligent investigation helps to distinguish it from other causes and provides closure for the affected families

What causes Sids?

No one knows for sure what causes Sids. What we do know, however, is that victims of Sids stop breathing and lack the ability to alert themselves to start breathing again.

Many researchers and clinicians affirm that Sids might be associated with abnormalities in the part of the infant’s brain. That is responsible for regulating breathing and sleep-wake function. However, this claim has yet to be proven beyond doubt.

In 1994, Filiano and Kinney proposed the Triple-risk model for Sids to explain how it occurs. The model poses that Sids happens when these three conditions exist at the same time:

1. The infant is exposed to exogenous stressors such as a prone sleeping position, soft and loose bedding, exposure to secondhand smoke, or an upper respiratory infection;
2. The baby has an underlying abnormality such as defects in the part of the brain that controls cardiac function and respiration;
3. These conditions prevail during a vulnerable stage in the child’s development, especially during the first six months of life.

Does Sids have symptoms?

Even with years of research given to find more about Sids, there are still no easy answers when it comes to clearly identify symptoms. Although the exact cause of Sids is unknown, certain risk factors have been identified: 

Parental risk factors

• Babies who receive poor prenatal care
• Whose mothers smoked, drank alcohol and consumed drugs during their pregnancy
• Babies born to mothers who are under the age of 20

Environmental and physical risk factors

• Babies born prematurely or at very low birth weight
• Babies exposed to certain stressors (such as sleeping tummy-down or on too soft bedding)
• Infants who become too hot or too cold while asleep
• Babies with prolonged tobacco smoke exposure even after birth
• Who had an apparent life-threatening event (e.g. babies who have turned pale and required resuscitation)
• Babies who recently suffered from respiratory infections might experience breathing problems.

Biological factors

• Sids is most prevalent in babies between the ages of two and four months, but there are more than a few cases each year in babies up to one year of age.
• Sex may be a factor as three out of five victims are boys.
• Babies born with underlying vulnerabilities and abnormalities (like brain and heart abnormalities and respiratory infections)
• Babies who have siblings or blood relatives who died from Sids.

Why does Sids peak at two to four months

Sids is a devastating and unexplained phenomenon that peaks between two to four months of age. While the exact cause of Sids remains unknown, researchers have identified several factors that contribute to this peak period.

One reason is that infants around this age begin to transition from a deep sleep to a lighter sleep, making them more vulnerable to certain risks. Additionally, babies at this stage may start to roll over during sleep, increasing the chance of suffocation if they are not placed in a safe sleeping position.

The development of their autonomic nervous system, which controls vital functions like breathing and heart rate, may also play a role.

Sids prevention

It is so heartbreaking to hear news about a baby who dies in their sleep for unknown reasons. No parent should ever go through the pain of losing their newborn without much explanation.

While there is no clear way to prevent Sids from happening, there are a number of practical precautions parents can take to lower the risk of Sids:

1. Put your baby to sleep on his back

Babies placed on their stomachs or sides to sleep may have more difficulty breathing than those placed on their backs. This is because when infants sleep tummy-down, they’re more likely to overheat, breathe incorrectly, and re-breathe carbon dioxide air they’ve exhaled, which lacks oxygen.

If you’re worried about your baby developing a flat spot on his head after too much back time, you can always give your baby adequate amounts of tummy time while she’s awake and under your watchful eye.

So the next time some elders insist on having the baby sleep on his tummy, gently take charge and say “no", and tell them to wait until your baby is older and has more control over his body.

2. Choose your bedding wisely

When buying baby bedding, go with the basics: a firm mattress, a fitted sheet, and as few blankets, quilts, and fluffy padding as possible. Choosing appropriate bedding for infants will prevent smothering or suffocation.

Make sure to clear the crib of any linens, pillows, or stuffed toys that can accidentally move and block the baby’s airways during sleep. Should you give your baby a blanket, make sure it’s breathable, in case your baby wiggles under it or pulls it over his head.

3. Remove the bumper pad

And most importantly, avoid using bumper pads in cribs. Doing so will decrease the risk of strangulation and entrapment, increase airflow into the crib, and let you see your baby without any obstruction.

4. Co-sleep with your baby

There has been a lot of debate about co-sleeping and Sids, but recent studies show that the rate of Sids is lowest in cultures, such as in Asia, that traditionally share sleep. The best and safest option would be to room-sharing with your infant. Put your baby’s bassinet or crib closer to your bed so you can keep a close watch on her at all times.

If you’re set on co-sleeping, make sure your mattress is firm, that there’s enough space for you and your child, and that there’s nothing that will obstruct your baby’s breathing.

Always remember to trust your parental instinct – your bodies are so attuned to your newborn that you’ll wake up with even the slightest bit of uneasiness in your child.

5. Do not overheat your baby

In a tropical country like ours where it’s hot most of the year, there’s really a risk of overheating a newborn, especially when we alternate between air-conditioned and non-air-conditioned rooms.

It’s best to watch for signs of overheating like sweating and damp hair. Another way to tell if you’re bub is overheating is to put your hand on the back of his neck and feel if it is sweaty or warm.

Make sure your baby’s room is cool, and not too warm or stuffy. Hot stuffy air makes it more difficult to breathe.

Unless your baby’s a preemie, do not over-layer baby clothing and swaddles. Dress your baby in comfortable and light clothes for sleeping.

You may use onesies or pyjamas to cover arms, legs, hands, and feet if your concern is about keeping your baby warm. Instead of using a regular blanket, place them in a sleep sack or a wearable blanket.

Don’t cover your baby’s head. And to be sure, take your baby’s temperature now and again and make sure their body heat stays at a constant 36 degrees Celsius.

6. Breastfeed, breastfeed, breastfeed

You all know about the benefits of breastfeeding, and reducing the risk of Sids is actually one of them. The protective effect is strongest if you breastfeed your baby exclusively for six months.

But even some breastfeeding is better than none – exclusively breastfeeding until one month of age already cuts the risk of Sids in half.

Combining all these precautions with proper immunisations, infant care, regular paediatrician visits, and a good, clean environment (free of tobacco smoke, alcohol, and drugs) will give you the upper hand when it comes to avoiding Sids. In Sids’ case, prevention is definitely key.

7. Offer a pacifier

The sucking reflex from using a pacifier aids in consistent breathing. It also helps soothe your baby to sleep.

For breastfeeding mothers, it is best to wait until the infant is regularly breastfed (not less than one-month-old) before using a pacifier. Your baby might experience nipple confusion if you introduce a pacifier too soon. Your child then would rather have the pacifier’s nipple instead of your own.

You may put the pacifier on the infant’s mouth when you put them to sleep. After they fall asleep, it is best not to put it back in their mouth.

Make sure that you keep the pacifier clean by sterilising it. Buy a new one if it is already damaged. Avoid putting any coating in the pacifier. Don’t compel your baby to use a pacifier if they don’t like it.

ALSO READ: How to treat your baby's fever: The dos and don'ts parents must know

Common concerns related to Sids

Flat head syndrome (positional plagiocephaly)

Some parents might worry if their babies would develop a flat spot on the back of their heads because of spending too much time lying on their backs.

However, this can be treated easily. You can change your baby’s position and allow more supervised “tummy time” while your baby is awake.

Spitting up or vomiting

Spitting up or vomiting while babies are sleeping on their backs is one of the things that parents also worry about. Take comfort in knowing that there is no increased risk of choking for healthy infants who sleep on their backs.

The same goes even for most babies with gastroesophageal reflux (Ger). On the other hand, experts suggest that babies experiencing some types of rare airway problems sleep on their stomachs.

Sids can happen in the best of circumstances

While it is important for you to follow the safety guidelines for the prevention of Sids, the fact is that some babies who die from Sids die in spite of their parents doing everything right. Hopefully one day, we will know a definite cause for this tragic disease, which will lead to a definite cure.

While Sids is undoubtedly a heartbreaking topic, it’s important to remember that knowledge is power. By being informed about Sids and implementing safe sleep practices, we can significantly reduce the risk and provide a safer environment for our little ones.

As parents, we have the strength and determination to do everything we can to protect our babies. So let’s support each other, share information, and create a community where we can lift each other up, offering encouragement and hope in our journey of motherhood.

This article was first published in theAsianparent.