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SIDS, Sudden Infant Death Syndrome, as the name suggests, is the unexpected death of a baby less than 1 year of age without an apparent cause of death. The exact cause of SIDS remains unknown even after years of research. The mystery attached to SIDS and its causes is what makes it so frightening for parents. There are no answers to their questions, only theories and conjectures. The death of an infant is always tragic for parents, however, the death of a baby due to SIDS, without any symptoms of ailment or time for parents to prepare themselves for what is to come, can be extremely traumatic. SIDS has claimed the lives of infants since the beginning of the human race. It is still the leading cause of death amongst children from 2-6 months. No definite causes of SIDS are known but there are many precautionary measures that are recommended to parents to reduce the risk of SIDS. However, sometimes SIDS occurs even when all possible measures have been taken.

SIDS can occur in children from all races, socio-economic and ethnic backgrounds from urban and rural areas. Its likelihood is not determined by any factor accept adherence to the precautionary measures suggested by doctors and researchers. There are no symptoms of SIDS. It occurs in healthy babies who feed normally. SIDS mostly occurs during sleep which is why it is also known as Cot or Crib death and the baby shows no signs of suffering. SIDS has only recently been established as a separate disease entity and can be given as an official cause of death. If the child’s death remains unexplained even after a formal investigation into the circumstances of death (including performance of a complete autopsy, examination of the death scene, and review of the clinical history), the death is then attributed to SIDS.

Possible Causes of SIDS:

• Sleeping on Stomach: The most widely accepted cause of SIDS is putting the baby to sleep on his stomach. Numerous studies and researches conclude that most SIDS deaths have occurred in babies who sleep on their stomachs. It was formerly thought that babies should be put to sleep on their stomach as they rest better and sleep more soundly in that position. However, after research results have shown that stomach sleeping increases the risk of SIDS, parents are advised against it.According to researchers’ hypothesis stomach sleeping puts pressure on the baby’s jaws that hampers breathing by narrowing the airway.

  Another theory suggests that stomach sleeping can increase an infant’s chances of re-breathing his own exhaled air, particularly if he is sleeping on a soft mattress or with bedding, stuffed toys, or a pillow near his face. These soft surfaces can create a small enclosure around the baby’s mouth and trap exhaled air. As the baby breathes exhaled air, the oxygen level in the body drops and carbon dioxide accumulates. This lack of oxygen can contribute to SIDS. (Click for source)

• Abnormality in the Arcuate Nucleus: Infants who have some kind of a breathing disorder might be more likely to succumb to SIDS. For example, they may have an abnormality in the arcuate nucleus, a part of the brain that may help control breathing and awakening during sleep. If a baby is breathing stale air and not getting enough oxygen, the brain usually alarms the baby to wake up and cry. That movement changes the breathing and heart rate, making up for the lack of oxygen. But a problem with the arcuate nucleus could deprive the baby of this involuntary reaction and put him at greater risk for SIDS.
  (ibid.)
• Apnea (lack/cessation of breathing): Many young infants have an uneven breathing pattern. Some even have periods, known as apneic episodes, when they do not take a breath for up to 20 seconds or longer. One theory of SIDS suggests that for some babies, the respiratory system is so underdeveloped that they do not take a breath after an apneic episode. Infants with apnea may be monitored with electronic monitors prescribed by doctors that track heart rate and respiratory activity, though these monitors cannot prevent SIDS. Prolonged apnea may put a baby on a greater risk of SIDS but most apneic babies do not die of SIDS and most SIDS babies do not have apnea.
• Choking: Sometimes regurgitated food is found in the mouth or nasal passage of a baby who has died of SIDS. In these cases physicians or investigators believe that choking on these substances was the cause of SIDS. However, vomiting frequently occurs at the time of death. So these findings might not be the cause of death but its result.
• Allergy: An allergy, especially to cow’s milk, was also once thought to be a cause of SIDS. As SIDS mostly occurs in babies from 2-6 months (a time when they are gradually being weaned from the breast to the bottle) cow’s milk was thought to be the culprit. However, research shows that babies who have been breast-fed exclusively also die of SIDS. Breast feeding however may help to prevent infections that could possibly lead to SIDS.
• Smoking: Studies show that a baby’s risk of SIDS rises if he is exposed to second hand smoke. Each additional smoker in the household, the number of cigarettes smoked around him each day, and the length of his exposure to cigarette smoke, all contribute to a possible SIDS death.
• Premature Birth or Low Birth Weight: Babies who are born prematurely or those who have a lower birth rate are also at a higher risk of SIDS.
• Overheating while Sleeping: Research shows strong evidence that overheating by too much clothing, putting a blanket over the baby’s head or overheating the room can substantially raise the risk of a SIDS death.
• Suffering an Apparent Life Threatening Event (ALTE): It is also thought that babies who suffer apparently life threatening events such as abrupt changes in breathing, color and muscle tone and requiring resuscitation are at a greater risk of SIDS. However, no definite scientific evidence links ALTEs as events that may lead to SIDS.
• For Mothers: SIDS is not hereditary, however babies are at a higher risk of SIDS death if the mother:
  • Has had inadequate parental care
  • Is younger than 20 years
  • Has had low weight gain during pregnancy
  • Has smoked or used drugs during pregnancy
  • Has had placental abnormalities — such as ‘placenta previa,’ a condition where the placenta lies low in the uterus, sometimes covering the opening of the cervix. (click for source)

Measures That Can be Taken to Reduce the Risk of SIDS:

Although SIDS can occur without any known reason and besides taking preventive measures, based on research and the possible causes of SIDS, following are measures that can reduce the risk of its occurrence.

• Back Sleeping: Researchers have claimed that putting the baby to sleep on his stomach is the most likely cause of SIDS. Since then the American Academy of Pediatrics (AAP) has included putting a baby to sleep on his back in its guidelines. Some parents worry that sleeping on the back might cause their baby to choke on spit-up or vomit. However, according to AAP, healthy babies are at no more risk of chocking on their backs than they are on their stomachs. If your baby has chronic gastroesophageal reflux disease [GERD] or certain upper airway malformations, consult your doctor about the best position for your baby to sleep. It might be a better idea to put such babies to sleep on their stomachs.If you are worried about the baby spending too much time on his back and developing a problem because of that, allow the baby more ‘tummy time’ when he is awake. When babies learn to roll over it might become difficult to keep them on their back all night. At this stage the baby is already 4-7 months and it is quite alright to let him decide a sleeping position for himself.
• Good Prenatal Care: Take good care of yourself and your baby during pregnancy. Have regular checkups to ensure normal weight gain and baby growth. After delivery, have your baby checked up regularly, especially if he is premature or had a low birth weight.
• Avoid Smoking: Avoid smoking, drinking and using drugs during pregnancy. Babies born to mothers who have smoked during pregnancy are thrice more likely to die of SIDS than those whose mothers have not smoked. It is thought that smoke affects a baby’s nervous system. Avoid a baby’s exposure to second hand smoke as it doubles the risk of SIDS. Do not allow people to smoke around your child.
• Prevent Suffocation and Overheating: Make sure the baby is not over heated when sleeping. Make sure to keep the baby’s head exposed while sleeping. Keep a room temperature that feels comfortable for an adult in short sleeves. Being too warm while sleeping makes babies go into a deeper sleep which is hard to arouse from.
  Always put your baby to sleep on a firm mattress, never on a pillow, waterbed, sheep skin or other soft surfaces. Do not place quilts, blankets, stuff toys and pillows near the baby as these may lead to suffocation and re-breathing of stale air.
• In case of GERD: If your baby has GERD, consult your doctor about his sleeping and feeding positions.
• Using a Pacifier: In the first few months of his life, put your baby to sleep with a pacifier. Research has linked pacifiers with lower risk of SIDS. Start giving him a pacifier after the first month so that he establishes breast feeding and the pacifier does not hinder with it. However, if your baby rejects a dummy, do not force him to take it.
• Safety Measures for Co-Sleep: Whether to sleep with the baby in the same bed or put him in a crib or bassinet, is still debated. In biblical times SIDS was known as ‘overlaying’ (because it was thought the mother had lain atop the baby while sleeping.) This surely is a risk if you sleep with your baby (sometimes called co-sleeping) so it is a good idea to put a baby in his crib when he is about to sleep. The cribs or bassinets should be in the parent’s room so that they can keep checking on the baby regularly. The parents’ bed also contains soft beddings, cushions and pillows, all that can lead to suffocation. There is a higher risk of overheating with the quilts and blankets and the presence of the mother.But, on the other hand, some people are of the opinion that babies should sleep with mothers in their beds. This allows the mother to respond quickly to any movement or change in their breathing patterns.

  The choice is to be made by the mother. If she decides to take her baby to bed there are a number of things she should keep in mind. The mattress should be firm and flat, tightly fit against the headboard leaving no gaps. There should be no fluffy pillows or heavy bedding that can cause breathing problems for the child. And the baby should be put to sleep on his back.

Why are the Causes of SIDS Unknown?

The efforts to determine the causes of SIDS are greatly hampered by underreporting and misreporting of SIDS deaths. As SIDS has no symptoms its cause can only be investigated into after the death has occured. This requires an autopsy, which, in many places of the world, requires parental permission. Many parents do not agree to it and the death may be registered due to some other cause. Even if the autopsy is carried out different children, from different areas of the world, have different reports. This lack on inconsistency makes it very hard to determine the cause of SIDS. The parents of SIDS babies, often victims of guilt and self-blame, also think of reasons for their child’s death to console themselves. Absolute absence of answers can be unacceptable. Thus SIDS can be registered as a death caused by the reason imagined by the parents.

Dealing with SIDS:

Parents of a SIDS baby suffer a great loss. Unlike parents of a baby who suffers from a disease, parents of a SIDS baby are taken aback by the suddenness of the death and do not have any warning or time to emotionally prepare themselves. Not only the parents, other caregivers such as grandparents, a baby sitter and the baby’s siblings (especially if they are old enough to help with taking care of him and have developed a special bond) suffer too. Their loss is often overlooked while focusing on the parents only.

In face of such a loss the bereaved parents usually experience feelings of guilt, anger, fear, blame and despair. As the causes of SIDS are unknown, parents often come up with their own explanations for the tragedy and blame themselves. This is a very common reaction; however, it is important to keep in mind that SIDS is not the parents’ fault. Besides taking the preventive measures there is nothing they can do to prevent it.

SIDS can affect a marital relationship and family life in general. It is good to talk to others about your feelings instead of bottling them up. There are support groups available for parents and families who have suffered from a SIDS death. You can also consider counseling or talking to other parents who have been through the same experience. However, the best support always comes from one’s own friends and family.