SIDS is…

• the major cause of death in infants from 1 month to 1 year of age, with most deaths occurring between 2 and 4 months
• sudden and silent–the infant was seemingly healthy
• a death often associated with sleep and with no signs of suffering
• a recognized medical disorder
• determined only after an autopsy, an examination of the death scene, and a review of the infant’s and family’s clinical histories
• a diagnosis of exclusion
• an infant death that leaves unanswered questions, causing intense grief for parents and families

SIDS is not…

• preventable, but the risk can be reduced by placing the baby on his or her back to sleep on a firm surface, by making sure the baby has a smoke-free environment, and by keeping the baby from being overheated
• suffocation
• caused by vomiting and choking or by minor illnesses such as colds or infection
• caused by the diphtheria, pertussis, tetanus (DPT) vaccines or other immunizations
• contagious
• child abuse or neglect
• the cause of every unexpected infant death

What Are the Most Common Characteristics of SIDS?
SIDS is unexpected, usually occurring in healthy-appearing infants under 1 year of age. A SIDS death occurs quickly and usually during sleep. SIDS is rare during the first month of life. Although SIDS can occur in older infants, most SIDS deaths occur by the end of the sixth month, with the greatest number occurring in infants between 2 and 4 months of age (AAP, 2000).

In the United States, more SIDS cases are reported in the fall and winter than in spring or summer. SIDS occurs more often in boys than in girls (approximately a 60- to 40-percent male-to-female ratio). African-American and American-Indian infants are two to three times more likely to die from SIDS as other infants (AAP, 2000; NICHD, 2001). Several Government agencies are intensifying efforts to reach these populations with the latest information about SIDS.

How Many Babies Die from SIDS?
Each year between 1983 and 1992, the average number of reported SIDS deaths ranged from 5,000 to 6,000. Over the past few years, especially since the mid 1990s, the number of SIDS deaths has declined significantly. The National Center for Health Statistics (NCHS) reported that in 2001 in the United States, 2,236 infants under 1 year of age died from SIDS (NCHS, 2003). Still, when considering the number of live births each year, SIDS remains the leading cause of death in the United States among infants between 1 month and 1 year of age and the third leading cause of death overall among infants less than 1 year of age (NCHS, 2003).

Although the overall SIDS rates have declined in all populations throughout the United States, disparities in SIDS rates and prevalence of risk factors remain in certain groups. SIDS rates are highest among African Americans and American Indians and are lowest among Asians and Hispanics (NICHD, 2001).

SIDS Deaths by Race and Hispanic Origin of Mother, 2001*

*Per 100,000 live births by group. Source: NCHS, 2003. Mathews, T.J., Menacker, F., MacDorman, M.F.,. Infant Mortality Statistics from the 2001 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports; Vol. 52, No. 12. Hyattsville, Maryland: National Center for Health Statistics. September 15, 2003.

How Do Professionals Diagnose a SIDS Death?
By definition, a SIDS diagnosis requires a complete autopsy, a thorough death scene investigation, and a clinical history. A death is diagnosed as SIDS only after all probable alternatives have been eliminated-in other words, SIDS is a diagnosis of “exclusion.” Often, the cause of an infant death can be determined only through a process of collecting information; conducting sometimes complex forensic tests; and by talking with parents, other caregivers, and physicians.

Medical and legal experts rely on three methods to determine a SIDS death:

• a thorough death scene investigation
• autopsy
• review of infant’s and family’s medical records and histories.

When a death is sudden and unexplained, investigators, including medical examiners and coroners, call on forensic experts, who apply their expertise in medicine and the law to help determine a cause of death. SIDS is no exception.

In most cases, the death investigation is led by the medical examiner or coroner for the county, district, or State in which the death occurred. Deaths suspected to be SIDS usually require law enforcement officers to conduct a thorough death scene investigation. The medical examiner/coroner gathers information from the death scene and case histories and presents this information to the pathologist (usually board certified or with credentials in forensic pathology). The pathologist conducts or supervises the autopsy and assesses results of the autopsy, death scene investigation, and case histories to determine whether a SIDS death has occurred. The pathologist issues a SIDS diagnosis when there is no other apparent cause for the infant’s death (Valdes-Dapena, 1995).

A Thorough Death Scene Investigation
Although it may be emotionally painful for the family, a death scene investigation will help shed light on the cause of death by providing a detailed record of the location and circumstances of the death. Therefore, the investigator will attempt to learn as much as possible about the events leading up to the death, even the very moment that the death occurred.

The Centers for Disease Control and Prevention (CDC) have developed guidelines for death scene investigation of a sudden, unexplained infant death (CDC, 1996). Local jurisdictions may use these guidelines or develop their own protocols for investigating sudden unexpected infant death.

Investigators will interview the parent or other individual who was caring for the child at the time of the death, as well as any other family members or adults who were present at the time of the death or before the death occurred. The investigator will ask open-ended, neutral questions such as, “Can you tell me what happened?” “How old was the baby?” “What did the baby weigh?” “What time was the baby put to bed?” “When did the baby fall asleep?” “Who last saw the baby alive?” “Who discovered the baby, and what did that person do?” “What position was the baby in when he/she was found?” “Were there covers over the baby’s head?” “Was CPR attempted?” “Did the baby share a bed with anyone else?” “What was the general health of the baby?” “Had the baby been ill recently?”

The individual investigating the death will take notes about the appearance of the room where the death occurred; condition and characteristics of the crib or sleeping environment; objects, if any, in the crib; medications at the death scene; and any unusual or dangerous items in the room, such as sharp objects or plastic bags. The investigator may make notes about the behavior of those present at the death scene. The investigator will also photograph the death scene and record the temperature of the room. It is likely that investigators will collect the infant’s bedding (e.g., sheets, blankets, etc.), any objects in the crib (e.g., toys or bottles), or any unusual or dangerous items found near the death scene.

Autopsy
An autopsy provides evidence of the cause of death through microscopic examination of tissue samples and examination of the body and vital organs. An autopsy is particularly important when a SIDS death is suspected because a definitive diagnosis cannot be made without a thorough postmortem examination. It is estimated that in 15 percent of cases suspected to be SIDS, the autopsy identifies another cause of death, such as a disease or genetic disorder, as well as unintentional injury or unnatural death (Valdes-Dapena, 1995). Also, if a cause (or causes) of SIDS is ever to be uncovered, it is likely that the cause will be detected from evidence gathered from a thorough pathological examination.

An autopsy may help parents and other caregivers deal with the death. According to noted authority Marie Valdes-Dapena, M.D., parents whose child has died need to know why the death occurred; they need to be reassured that their baby’s death could neither have been predicted nor prevented (Valdes-Dapena, 1995). Moreover, an autopsy leading to a diagnosis of SIDS will help remove the parents (or caregiver) from potential suspicion of wrongdoing by the legal system and by society in general.

Parents are usually anxious to consult with the pathologist after the autopsy. Discussing the autopsy results often helps most parents accept the reality of their infant’s death. The pathologist reviews the autopsy results, explaining in terms the parents can understand how these findings point to a determination of cause of death. The pathologist should also take the time to answer parents’ questions, responding with “compassion, understanding, and respect for the parents’ dignity and grief” (Valdes-Dapena, 1995).

Review of the Infant’s and Family’s Medical Histories
A comprehensive medical history is essential for a SIDS diagnosis. Along with a death scene investigation and an autopsy, a careful review of the infant’s and family’s history of disease, previous illnesses, accidents, and behaviors often helps to corroborate what is detected from the death scene investigation and the autopsy.

SIDS Deaths Require Special Understanding
Any sudden, unexpected death disturbs the sense of normalcy and security for the victim’s family. These deaths force family members and those around them to confront their own mortality (Corr et al., 1991). This is particularly true in the case of a sudden infant death. Simply put, babies are not supposed to die. Because the death of an infant is a disruption of the natural order, it is especially traumatic for parents, other family members, and friends (Arnold et al., 1997).

Like any sudden death, a SIDS death leaves a family with a sense of shock and loss and an urgent need to understand what happened. Lack of a discernible cause, the suddenness of the death, and possible involvement of law enforcement authorities make a SIDS death even more difficult. A SIDS death also leaves the family with a need for understanding from those close to the family-even the surrounding community.

A SIDS death is as tragic as a death from any readily definable disease or cause. Thus, investigators compiling or reviewing the case histories should be especially sensitive and recognize that the family may view this process as an intrusion, even a violation, of their grief. The interviewer should also be sensitive to the family’s cultural practices and traditions. The interviewer should point out to the family that although obtaining the case histories may be stressful, this information may reveal that the death could not have been prevented, which may provide some solace to a grieving family.

Are There Ways to Reduce the Risk of SIDS?
Currently there is no known way to prevent SIDS, but there are things that parents and caregivers can do to reduce the risk of a SIDS death. For example, researchers now know that the mother’s health and behavior during her pregnancy and the baby’s health before birth seem to influence the occurrence of SIDS.

Scientists also know that certain environmental and behavioral influences (called risk factors) can make an individual more susceptible to disease or ill health. Although risk factors are not necessarily the cause of a condition, by studying risk factors, scientists are able to better understand a disease or condition, which often leads to detecting a cause.

SIDS researchers and clinicians continue to try to identify risk factors that can be modified or controlled to reduce an infant’s risk for SIDS. For example, SIDS experts now know that the baby’s sleep position, exposure to smoke, and becoming overheated while asleep can increase the infant’s risk for SIDS.

Infant Sleep Position
In April 1992, the American Academy of Pediatrics (AAP) Task Force on Infant Sleep Position issued a statement recommending that infants be placed on their backs to sleep to reduce the risk of SIDS. Then, in 1994, the U.S. Public Health Service, AAP, the SIDS Alliance, and the Association of SIDS and Infant Mortality Programs cosponsored the Back to Sleep campaign, a national public service initiative to disseminate AAP’s recommendation that infants be placed on their back to sleep.

Between 1992 and 1998, among U.S. infants, stomach (prone) sleeping decreased from more than 70 percent to approximately 20 percent. During that same time frame, the number of SIDS deaths declined by more than 40 percent (Willinger et al., 1998; AAP, 2000; NICHD, 2001). Not surprisingly, most researchers, policymakers, and SIDS professionals agree that this significant decline occurred largely as a result of changing sleep position (AAP, 2000).

Rates of SIDS are over twice as high among American Indians and African Americans compared with Whites. Prone sleeping was found to be a significant risk factor for SIDS in an African- American urban sample (Hauck et al., 2002). These authors recommend educational outreach to the African-American community.

Another recent study of the relationship between infant sleep position and SIDS concluded that infants placed in an unaccustomed prone or side sleeping position are at a higher risk of SIDS (Li et al., 2003). This ethnically diverse, population-based, case-controlled study was conducted in 11 counties in California. The health message from this research is that babies should be on their backs for all sleep, including naps.

Exposure to Smoke
Researchers have concluded that if a mother smokes during or after pregnancy, she is placing her infant at a greater risk for SIDS (AAP, 2000). Some studies suggest that exposure of the newborn to tobacco smoke (whether or not the mother smokes) may be associated with increased risk for SIDS. In a 1997 policy statement, AAP cautioned, “Exposure of children to environmental tobacco smoke is associated with increased rates of lower respiratory illness and increased rates of middle ear effusion, asthma, and SIDS” (AAP 1997).

Overheating
According to AAP (2000), some evidence points to an association of the amount of clothing or blankets on an infant, room temperature, and the time of the year with an increased risk for SIDS. The increased risk associated with overheating is particularly clear when infants are placed on their stomachs (prone).

AAP cautions that the possible relationship between clothing and climate as stand-alone factors (or as a cluster of environmental risk factors) is less clear. Moreover, although the number of recorded SIDS deaths has been higher in the winter months, that increase may be due to the greater frequency of colds, flu, and other infections during the winter.

Infant Bedding
Researchers and consumer safety advocates continue to look for a possible link between SIDS and soft bedding (Scheers, Dayton, and Kemp, 1998). During 2000, seven major retailers joined with the U.S. Consumer Product Safety Commission (CPSC) to kick off a nationwide campaign promoting safe bedding practices for infants. Many retailers are developing public service campaigns to spread this message to parents and other infant caregivers.

The hope is that by circulating this information, infant deaths will be reduced and that those responsible for infant care will receive one consistent message about ensuring a safe sleeping environment for babies.

In recent safety alerts, CPSC has warned parents to guard against unfounded claims from manufacturers of some infant bedding materials that the use of certain products can reduce SIDS. Parents and other caregivers need to be aware that there is no product currently available that can guarantee prevention of a SIDS death.

Other Risk Factors
Although sleep position, smoke exposure, overheating, and infant bedding have been identified as risk factors for SIDS, researchers have identified a number of other factors that may put an infant at increased risk for SIDS.

Infant Care Practices and SIDS Risk Reduction
Several studies have examined various environmental influences or child-rearing practices that may help protect an infant from SIDS (Valdes-Dapena, 1995; Hoffman et al., 1996; NICHD, 2000). It is important to point out, however, that these factors, in and of themselves, are not reliable in predicting how, when, why, or if SIDS will occur.

For example, although researchers conclude that breastfeeding is beneficial, there is no clear-cut link between breastfeeding and reduced risk of SIDS. Other studies have found a lower rate of SIDS among infants who used pacifiers compared with infants who did not use pacifiers. Although results of these studies tend to be consistent, there is still no evidence that pacifier use prevents SIDS (AAP, 2000).

Maternal Risk Factors
Still other risk factors, called maternal risk factors, are associated with how the mother’s behavior and health affect the infant before and after birth.

Maternal risk factors include:

• age less than 20 at first pregnancy
• a short interval between pregnancies
• late or no prenatal care
• smoking during and/or after pregnancy
• placental abnormalities
• low weight gain during pregnancy
• anemia
• alcohol and substance abuse
• history of sexually transmitted disease or urinary tract infection (NICHD, 2001).

How to Lower Your Baby’s Risk of SIDS:

• Back Sleeping and Safe Bedding*
• make sure that everyone who cares for your baby puts the baby on his or her back to sleep
• use a firm, tight-fitting mattress in a crib that meets current safety standards
• remove pillows, quilts, comforters, sheepskins, stuffed toys, and other soft products from the crib
• dress your baby in sleep clothing so that you will not have to use any other covering over the baby
• place your baby so that his or her feet are at the bottom of the crib
• tuck a thin blanket around the bottom of the crib mattress, reaching only as far as the baby’s chest
• make sure the baby’s head remains uncovered during sleep
• keep your baby warm, but not too warm
• make sure that everyone who cares for your baby understands the dangers of soft bedding
• avoid adult beds, waterbeds, sofas, or other soft surfaces for sleep

*from AAP, CPSC, and NICHD AAP: www.aap.org CPSC: www.cpsc.gov NICHD: www.nichd.nih.gov

Current Research Findings and Theories
Most scientists now believe that babies who die of SIDS are born with one or more conditions that make them especially vulnerable to the internal and external stresses that occur in the life of any infant. Currently, many researchers argue that the clue to finding the cause(s) of SIDS lies in a further understanding of the development and functions of the brain and nervous system of SIDS infants.

These scientists theorize that some babies at risk for SIDS have defects in those parts of the nervous system that control breathing and heart rate. Maturation of the brainstem may be delayed in SIDS infants. Myelin, a fatty substance that facilitates nerve signal transmission, appears to develop more slowly in SIDS infants than in other babies.

“The detection of subtle abnormalities in SIDS brains indicates that not all SIDS infants are ‘normal’ despite their lack of clinical abnormalities. The occurrence of brain abnormalities supports the concept that a vulnerable, and not a normal, infant is at risk for SIDS. The idea of a vulnerable infant forms a key part of a triple-risk model for the pathogenesis of SIDS” (Filiano and Kinney, 1994).

The Triple-Risk Model
Pathology studies of SIDS infants support the view that these infants possess underlying vulnerabilities that put them at risk for sudden death, a concept advanced by the triple-risk model in describing the sequence of events leading to the death of an infant. A number of scientists are currently applying this model in their search for a cause(s) of SIDS.

Vulnerable Infant
The first key element of the triple-risk model depicts an infant with an underlying defect or abnormality, which makes the baby vulnerable. In this model, certain pathophysiological factors (e.g., defects in the parts of the brain that control respiration or heart rate, and that occur during early life) explain vulnerability to sudden infant death.

Adapted from Filiano and Kinney 1994.

Critical Developmental Period
The second element in the triple-risk model refers to the infant’s first 6 months of life. During this critical developmental period, rapid growth phases occur and changes in homeostatic controls take place. These changes may be evident (e.g., sleeping and waking patterns), or they may be more subtle (e.g., variations in breathing, heart rate, blood pressure, and body temperature). It may be that some of these changes may temporarily or periodically destabilize the infant’s internal systems.

Outside Stressor(s)
The third element of this model involves outside stressors. These may include environmental factors (e.g., exposure to tobacco smoke, overheating, or prone sleep position) or an upper respiratory infection that most babies can experience and survive, but that an already-vulnerable infant may not be able to overcome. In and of themselves, these stressors do not cause infant deaths, but in a vulnerable infant, “may tip the balance against an infant’s chances of survival” (Filiano and Kinney, 1994).

According to this model, all three elements must interact for a sudden infant death to occur-the baby’s vulnerability is undetected until the infant enters the critical developmental period and is exposed to an outside stressor or stressors.

Brain Abnormalities in SIDS Infants
A team of researchers funded by the National Institute of Child Health and Human Development (NICHD) has discovered that infants who die of SIDS may have abnormalities in several parts of the brainstem. This finding builds on the results of an earlier study that identified abnormalities in the region of the brain known as the arcuate nucleus in babies who died of SIDS.

“These findings show that SIDS infants have a more global biological deficit than we previously believed -one that may originate in fetal life,” explained Marian Willinger, Ph.D., of NICHD’s Pregnancy and Perinatology Branch, in a May 2000 press release. In the NICHD study, SIDS infants were found to have decreased binding of serotonin in the nucleus raphe obscurus, a brain structure linked to the arcuate nucleus, as well as four other brain regions. These areas of the brain are thought to play a crucial role in regulating breathing, heart beat, body temperature, and arousal (Panigrahy et al., 2000).

Back to Sleep Campaign
Since its inception in 1994, the Back to Sleep campaign has focused on heightening awareness among parents, health care providers, and other caregivers about the benefits of putting a baby to sleep on his or her back. Over the course of the campaign, almost 80 million brochures, posters, public service announcements, and informational videos have been distributed. The Back to Sleep campaign continues as a nationwide public health effort, with NICHD having major responsibility for disseminating information and educational materials on this crucial health topic.

Back in 1994 when the Back to Sleep campaign was first initiated, there were almost twice as many SIDS deaths among African-American infants than among White infants. Despite the almost 50 percent drop in the number of SIDS deaths in both groups, a significant disparity still exists (NICHD, 2002). To continue efforts to reach minority and hard-to-reach populations about the importance of placing an infant on its back to sleep, NICHD has partnered with community groups to provide outreach to minority and underserved communities.

SIDS Deaths in Child Care Settings
Twenty percent of SIDS deaths occur in a day care setting (Moon, Patel, and Shaefer, 2000). Although media and mailings have been largely effective in communicating BTS information to many child care centers, nonprone positioning and other risk reduction measures are not universally practiced among child care providers (Moon and Biliter, 2000). To promote these messages in child care settings, the Health Resources and Services Administration’s Maternal and Child Health Bureau is sponsoring the Healthy Child Care America Back to Sleep campaign. The campaign, which was officially launched in January 2003, is a nationwide effort to unite child care, health, and SIDS prevention partners to reduce the risk of deaths in child care settings (AAP, 2003).

Over the past 9 years, the Back to Sleep campaign has been extremely effective in helping reduce the number of SIDS deaths. AAP cautions, however, that while continuing to emphasize the “importance of infant positioning for sleep as an effective modifiable risk factor for SIDS,” it is also important to “focus increased attention on other modifiable environmental factors, to describe complications that may have arisen from modifying risk factors, and to make recommendations about other strategies that may be effective for further reducing the risk of SIDS” (AAP, 2000).

Partners in the Back to Sleep Campaign Outreach to Underserved Populations
Alpha Kappa Alpha Sorority
Chi Eta Phi Sorority
Chicago Department of Public Health
Congress of National Black Churches
District of Columbia Department of Public Health
National Association for the Advancement of Colored People
National Black Child Health Development Institute
National Coalition of 100 Black Women
National Medical Association
National Association of Black Owned Broadcasters
Pampers Parenting Institute
Zeta Phi Beta Sorority
Acknowledgments
Review panel members

Michael Corwin, M.D.
Co-Director
Massachusetts Center for Sudden Infant Death Syndrome

Anne Harvieux, C.I.C.S.W.
Program Administrator
Infant Death Center of Wisconsin

Jeffrey Jentzen, M.D.
Medical Examiner, Milwaukee County, Milwaukee, WI

John Leggatt, M.D.
Deputy Chief Medical Examiner, Milwaukee City, Milwaukee, WI

Mary McClain, R.N., M.S.
Massachusetts Center for Sudden Infant Death Syndrome

Marian Willinger, Ph.D.
Special Assistant for SIDS
National Institute of Child Health and Human Development

For Additional Information on SIDS and Infant Death, and for a List of State SIDS Coordinators, Please Contact:

National SIDS/Infant Death Resource Center (NSIDRC)
8280 Greensboro Drive
Suite 300
McLean, VA 22102
Phone: (866) 866-7437, (703) 821-8955
Fax: (703) 821-2098
E-mail: sids@circlesolutions.com
www.sidscenter.org

Other SIDS Resources
American Academy of Pediatrics (AAP)
The best way to contact the AAP is to access the Academy’s Web site: www.aap.org. To locate news releases and policy statements, search the site using “SIDS” as keyword.

Association of SIDS and Infant Mortality Programs (ASIP)
c/o Marie Chandick, ASIP President
New York State Center for Sudden Infant Death
School of Social Welfare/Stony Brook University
Stony Brook, NY 11794-8232
Phone: (631) 444-3690
Fax: (631) 444-6475
E-mail: marie.chandick@stonybrook.edu
www.asip1.org

C.J. Foundation for SIDS
Barry Bornstein, Executive Director
The Don Imus-WFAN Pediatric Center
Hackensack University Medical Center
30 Prospect Avenue
Hackensack, NJ 07601
Phone: (201) 996-5111, 1-888-8CJ-SIDS
Fax: (201) 996-5326
E-mail: barrycjf@aol.com
www.cjsids.com

First Candle/SIDS Alliance
1314 Bedford Avenue
Suite 210
Baltimore, MD 21208
Phone: (800) 221-7437, (410) 653-8226
Fax: (410) 653-8709
E-mail: info@sidsalliance.org
www.sidsalliance.org

National Center for Cultural Competence (NCCC)
SIDS/ID Component
Georgetown University Center for Child and Human Development
3307 M Street NW
Suite 401
Washington, DC 20007-3935
Phone: (800) 788-2066, (202) 687-5387
Fax: (202) 687-8899
E-mail: cultural@georgetown.edu
www.georgetown.edu/research/gucdc/nccc

National SIDS and Infant Death Program Support Center
Kathleen Graham, Director
1314 Bedford Avenue
Suite 210
Baltimore, MD 21208
Phone: (410) 415-6628, (800) 638-7437
Fax: (410) 415-5093
E-mail: kgrahamsids@yahoo.com
www.sids-id-psc.org

National SIDS and Infant Death Project IMPACT
8280 Greensboro Drive
Suite 300
McLean, VA 22102
Phone: (703) 902-1260, (800) 930-7437
Fax: (703) 902-1320
E-mail: lcooper@sidsprojectimpact.com
www.sidsprojectimpact.com

U.S. Consumer Product Safety Commission
4330 East-West Highway
Bethesda, MD 20814-4408
Phone: (800) 638-2772
(Consumer Hotline: Call toll-free to obtain product safety information and to report unsafe products.)
Fax: (301) 504-0124
E-mail: info@cpsc.gov
www.cpsc.gov

Contact Information for the Back to Sleep Campaign
The National Institute of Child Health and Human Development
Back to Sleep Campaign
31 Center Drive, Room 2A32
Bethesda, MD 20892-2425
Public Information: (301) 496-5133
Fax: (301) 496-7101
www.nichd.nih.gov
To order campaign materials, call toll-free: 1-800-505-CRIB

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American Academy of Pediatrics, Healthy Child Care Back to Sleep Campaign, 2003. www.healthychildcare.org.

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Li, D.K., Petitti, D.B., Willinger, M., McMahon, R., Odouli, R., Vu, H., and Hoffman, H.J. “Infant Sleeping Position and the Risk of Sudden Infant Death Syndrome in California, 1997-2000.” American Journal of Epidemiology 2003 March 1; 157(5):446-55.

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Moon, R.Y., Patel, K.M., and Shaefer, S.J.M. “Sudden Infant Death Syndrome (SIDS) in Child Care Settings.” Pediatrics 2000; 106 (2) 295-300.

National Institute of Child Health and Human Development, National Institutes of Health. From Cells to Selves. Targeting Sudden Infant Death Syndrome (SIDS): A Strategic Plan. Bethesda (MD): National Institute of Child Health and Human Development, 2001.

National Institute of Child Health and Human Development, National Institutes of Health. NICHD-funded Researchers Uncover Abnormal Brain Pathways in SIDS Victims. News Release. Rockville (MD): May 14, 2000.

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Panigrahy, A., Filiano, J., Sleeper, L.A., Mandell, F., Valdes-Dapena, M., et al. “Decreased Serotonergic Receptor Binding in Rhombic Lip-Derived Regions of the Medulla Oblongata in the Sudden Infant Death Syndrome.” Journal of Neuropathology and Experimental Neurology 2000 May; 59(5): 377-84.

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U.S. Consumer Product Safety Commission, Office of Information and Public Affairs. Recommendations Revised to Prevent Infant Deaths from Soft Bedding. News Release #99-091. Washington, DC. April 8, 1999.

U.S. Consumer Product Safety Commission, Office of Information and Public Affairs. Retailers Join CPSC in Promoting Safe Bedding Practices for Babies-Each Year 900 SIDS Deaths May be Caused by Soft Bedding. News Release #00-078. Washington, DC. March 14, 2000.

Willinger, M., Hoffman, H.J., Wu, K-T., et al. “Factors Associated with the Transition to Nonprone Sleep Positions of Infants in the United States: The National Infant Sleep Position Study.” Journal of the American Medical Association 1998; 280:329-335.

Willinger, M., James, L.S., and Catz, C. “Defining the Sudden Infant Death Syndrome (SIDS): Deliberations of an Expert Panel Convened by the National Institute of Child Health and Human Development.” Pediatric Pathology September-October 1991; 11(5): 677-84.

Valdes-Dapena, M. “The Postmortem Examination.” Pediatric Annals 1995 July; 24(7): 365-372.

There are many ways to co-sleep. Baby product manufacturers actually make co-sleepers that attach to the bed and keep your baby within arms reach. These make it easy for a mother to lie in bed and nurse her baby while not worrying about her baby accidentally rolling over from the weight of the parents in bed. They also have sleep positioner’s that you can place your baby in, so that they stay either on their side or back and are unable to move. These are also good when your baby can roll, because they are blocked on either side and can not roll off the bed.

Co-sleeping is practiced widely by parents who parent on demand or consider themselves doing a form of attachment parenting. It is a way for parents to keep their babies close by at all times, in hope that the baby will feel more secure and have his needs met quickly. It many ways it is just a matter of convenience for parents and their new baby.

Safety
In order for co-sleeping to work both parents have to be aware and in agreement that they will do co-sleeping. If a parent is aware, then subconsciously, even when they are asleep, they will tend to make room for the baby and know they are there so that they do not move around too much in bed.

Decide How Long
From the beginning you want to know how long you will be co-sleeping. There is nothing wrong with co-sleeping indefinitely, or planning to do it till your baby is big enough for a real bed. However, if you plan on only doing it for a few months you will want to know that too and prepare for it. Have a crib ready for your baby already to help the transition. Once you start the transition, try not to go backwards as it might be confusing for the baby.

Nap Time
If you plan on co-sleeping indefinitely then when it comes to nap time you will want to have a positioner or rails on your bed to keep your baby from rolling off. If you do not plan on co-sleeping indefinitely, you can actually lay your baby in his bed for naps, in an effort to get him used to sleeping there and hopefully make the transition later easier.

Sleeping Through the Night
For parents who co-sleep, they may find that it seems like it takes longer for their baby to start sleeping through the night. Mothers are very tuned into their baby’s wants and needs, especially at night when they are half asleep. Any small whimper may cause a woman to think that her baby is awake and needs something, leading her to respond. In many of these cases, especially as the baby gets older, it is possible that the baby is just settling himself and isn’t really “awake”. In these cases, if left alone the baby would probably fall back into a deep sleep on their own. If the baby is in his own bed, in a different room, mom and dad would probably never hear him making noise and he would be sleeping through the night.

There is no right or wrong place to bed your baby. It is a decision that has to be made by weighing the pros and cons of the situation and making the best choice for your family.

Having a baby is the most wonderful experience a woman can have as it is a fulfillment of the biological function of the female species. After the giving birth process, the real work begins. Feeding bottles, diaper changes, immunization records are just a few of the things the new mom have to learn quickly. And one important thing to consider in the arrival of the baby is the kind of baby bedding he or she will use. According to Dr. Mark Brandenburg (www.baby-place.com/crib_safety.html), the number one rule to follow in choosing the right baby bedding for your precious infant is safety. The second rule says safety and the third rule emphasizes safety. We are to conclude that it is not enough to say it, it must be emphasized that baby bedding is critical for the comfort of the baby.

In his article on how to find the perfect baby bedding, it must be neither too hard nor too soft. In the past, sudden infant death syndrome or SIDS was attributed to very soft baby bedding. This happened when the baby’s mattress is too soft that his nose and mouth gets covered and the air he exhales is the air he breathes. This is dangerous for him since he would breath carbon dioxide rather than oxygen and the effects could lead to drowsiness, coma or even death.

There are a lot of styles and makes in choosing the baby’s bed. And with that, it follows that the baby bedding must be a perfect fit with the chosen equipment. The three major selections are: a bassinet, a crib or a cradle. What differentiates one from the other? A bassinet is an oblong-shaped basket that serves as a bed for an infant. But sometimes, round bassinets are also available. A crib is a bed that is flanked with high side bars for a baby or young child’s safety. Cribs are usually more economical since the baby can use it from infancy to two years. While a cradle is a small low bed that an infant uses that has rockers on its stand. In all these, the material used to make the equipment should alert and signal to the mom how much safety precautions are needed.

Bassinets are usually lacey and full of trimmings. The baby bedding must fit the bassinet so that the baby’s space is enough for him or her to be able to roll from side to side. The crib is usually square, thus, mattresses can be fitted to the size of the crib. The baby bedding usually is a set of coverlet and small pillows. Hotdog pillows can also be placed inside. However, the pillows should not be more than two or three lest the baby can stand on them and could fall over. The cradle can come in various sizes and shapes. Some moms prefer cradles so that when the baby is cranky, he or she can be rocked to be calmed down. The baby bedding for a cradle should follow the shape of it. Not much can be placed inside it since it is used mainly to rock the baby to sleep. However, one need not the three to keep the baby safe, warm and secure. One will do and this would depend on the parent’s preference. The most preferred would be the crib since it can be used for a long time.

Now that we’ve covered the basic equipment, how do we furnish it with baby bedding? We have already established that the baby bedding should fit the sleeping equipment to avoid accidents and other untoward incidents. The most suitable material to use is cotton as it is absorbent and cool to the baby’s skin. Different designs must be used to stimulate the baby’s color and pattern recognition. Therefore, the baby bedding is a crucial factor in keeping the baby happy and healthy.

About the Author:
Olga Sysoef is founding author at Baby Formula Advisor – a one stop informational resource on baby formula nutrition and first year baby care.

The majority of crib mattresses today contain polyurethane foam, vinyl (PVC), phthalates, chemical fire retardants, and an extensive list of added industrial chemicals. While the effects of these chemicals on your baby are largely unknown, these chemicals, in large amounts, have been linked to various childhood health problems. Some believe that they may play a role with the occurrence of SIDS in some babies. This information has been cause for many new parents to seek other product options for the mattress their child will spend a large amount of their infant to toddler years resting upon.

Organic crib mattresses are produced without any of the harmful chemicals traditional non-portable and portable crib mattresses contain. They’re made of 100% organic material, most of which is organic cotton. Organically grown cotton is great for the environment and absolutely the healthiest choice you can make for you and your family.

Just like with food and dairy products, organic mattresses must meet federal regulations and standards. The material must meet standards like being produced from renewable resources and include the conservation of soil and water to ensure the health of the environment for the future. If a product is stamped as 100% organic, by federal law, it cannot contain ingredients that harm the environment or are synthetically produced.

While you may have trouble finding organic crib mattresses in your local baby stores there are numerous sites on the internet where you can find organic mattresses as well as other organic products created to make your baby healthier and his environment safer.

Today SIDS is much less prevalant in society than it was 25 years ago. In 1980 1.53 of every 1000 births ended in the death of the baby blamed on SIDS. By 2001 that number was down to just .56 deaths which is great news for parents and doctors like.

Most commonly, a parent would put their baby to bed at night, only to wake up in the morning and check on him, finding him cold and not breathing. This situation is the worst that a parent can find themselves in and often leads to the feeling of anger and self-blame, or in some cases one parent blaming another. That can lead to the demise of relationships which can then hurt other members of the family.

What Causes SIDS? The answer to that question is still being searched out. No one really knows what exactly causes SIDS or how to keep it from occurring. Researchers found a link to babies sleeping on their stomachs and the occurrence of SIDS but other than that, no link links or exact causes have been discovered. There is some evidence that babies who are born premature are at a higher risk for SIDS because they aren’t as strong as babies who are born at term.

Prevention
Why did the numbers go down and how can you prevent SIDS from coming into your home. Once the researchers discovered the link between SIDS and belly sleeping, they began suggesting that babies only be placed to sleep on their backs. It is called the “Back to Sleep” campaign and it gains strength every year. There are other things that can help prevent SIDS.

1. During pregnancy, make sure you get regular medical care helping to avoid the chance of having a premature birth.
2. Stay away from alcohol and drugs during pregnancy.�
3. Avoid pregnancy during the teen years. As a woman gets older the chance that she will have a baby that suffers from SIDS drops drastically. The highest number of SIDS cases happens to teenage moms.�
4. Wait at least a year after you have a baby to get pregnant again.�
5. Always place your baby to sleep on his back.�
6. Make sure your baby has a firm mattress without pillows, comforters, blankets and stuffed animals.�
7. Keep light clothing on your baby and the temperature at a comfortable level to avoid overheating.�
8. Avoid exposing your baby to people who smoke or environments where tobacco smoke is prevalent.�
9. Breastfeed your baby if possible. Breastfeeding may reduce the risk of SIDS.�
10. If your baby was a preemie, exposed to any substances while in the womb, was born to a teenage mother, or had a sibling who died of SIDS, consider getting a monitor that keeps track of your child’s breathing.

If you are concerned about your baby’s health or want more information about SIDS call your pediatrician or mention it at your next well-check.

If you do smoke you should step outside and not smoke in your house, where the smoke can linger for your baby to breathe in. You should make anyone in your household who smokes go outside. You should not smoke in the car, even with the windows cracked or down, as the smoke can still fill the small area. If you can’t stop smoking for your baby, you should at least do everything you can to keep your baby away from the majority of the smoke.

Smoking can be dangerous for your baby in many ways. Living in a house with a cigarette smoker has been linked to the occurrence of SIDS, which is the sudden, unexplainable death of an infant. Besides SIDS, it has also been linked to causing allergies and asthma in a baby. The asthma can then stick with your baby, causing attacks as a child and in severe cases lead to death.

It can also lead to a problem not as widely known in kids, gum problems. Parental smoking can lead to periodontitis (inflammation of the gums) and dental caries (cavities) in children. It can also cause darkening of your child’s gums, in some cases making them look black. This can be irreversible for your child.

Other health problems your smoking could cause your baby and toddler as he gets older include pneumonia, bronchitis, and other lung problems. Being exposed to second hand smoke while young, can lead to cancer later on in life.

If you smoke and you can not quit, then try to not smoke in front of your baby. It is one thing for you to make the choice to breathe in the nicotine, your baby doesn’t have the option for making that choice for himself. Try to take all steps necessary to keep your baby safe and healthy.

Most babies are born with an abnormally shaped head from their travel during the birth canal. The skull is formidable at this point and can change to accommodate its’ surroundings. This is good for labor, but not necessarily good for baby as he gets older. If your baby’s head shape doesn’t change to look more “normal” by six weeks, or if you see an increased, flat area, ask your pediatrician if he thinks it looks ok or if you should see a specialist. Prominent foreheads and misaligned facial features may be a sign of true plagiocephaly in your baby. Plagiocephaly can often be mistaken for craniosynostosis which is a more serious condition where the bones of the skull close too early not allowing enough room for brain to grow, leaving the head looking deformed.

In addition to the effort to cut down on the cases of SIDS, misshapening of the head can also happen in the womb from a baby being too cramped, either because of a lack of amniotic fluid or his position in the womb. It is common to see in breech babies and multiple births as the amount of space in the womb is drastically decreased as the baby gets bigger. The simple “back to sleep” cause of a flat head will most often reverse itself when the baby is sitting up, crawling and walking around during most of the day.

If your pediatrician refers you to a pediatric neurosurgeon there are several steps he might take. In most cases a simple x-ray can be taken to distinguish between plagiocephaly and craniosynostosis, however sometimes the doctor will choose to have your baby get a CT Scan instead. If the doctor confirms that it is positional plagiocephaly he will probably suggest that you begin changing the babies position when he is on his back to his sides, or if the flat area occurring on one side, he may suggest you keep him off that side and lay your baby on his other side and back. He may also suggest that you greatly up the amount of tummy time your baby has each day.

If the positional therapy does not work on your baby the doctor may decide to go with a band or helmet that is designed to fit and round out your babies head while keeping it out of immediate contact with the floor, mattress and other hard spaces. This helmet will generally be worn for 2-6 months, depending on when the problem was noticed and how severe it is, and your baby will need to be in the helmet almost 24 hours a day. When discovered early, the success rate of the helmet rounding out the head is very high.

Again, if you think that there is something wrong with the shape of your baby’s head, take him to see his pediatrician or ask during the next well-check. You doctor may tell you your baby’s head is perfect and normal, but it is always better to be safe than sorry and early detection drastically improves the chance of reversing the condition.

Now it seems as if scientists have discovered a possible cause of SIDS that involves more than just a baby sleeping on their stomach or back. There are new tests that link a brain abnormality to some babies who have died of SIDS. It involves the part of the brain that controls breathing, arousal and other essential parts of awakening for a baby.

The abnormality is found in the base of the brain stem involving cells that creates the chemical serotonin. Serotonin transmits messages between the brain and nerve cells, and helps to tell the body when to breathe, as well as helping control blood pressure and body temperature. It is thought that when a baby has an abnormality in these cells they are not as quick to respond and it is not as easy to do things like turn their head when they are asleep which is where the increase of SIDS while babies sleep on their belly appears.

It is assumed that when a baby sleeps face down or is covered by blankets that they breathe back in exhaled carbon dioxide that they have just breathed out. Normally this would trigger the nerve cells in the brain stem and stimulate the respiratory and arousal areas of the brain to help the baby turn their head or uncover themselves. When the abnormality is present babies nerves are not triggered and they can then not adjust so that they can breathe clean air. It is thought that too much carbon dioxide in their system causes their little bodies to shut down.

The finding of this new possible cause of SIDS in babies is a huge encouragement to parents and experts around the country. Once a definite cause of SIDS is discovered then it will be possible for tests showing who is at risk to be created and a possible cure to be discovered for this terrible aspect of parenthood. Not having the fear of your baby dying while you sleep would surely help many parents, and babies sleep better and feel more rested in the long run.