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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.

The dummy debate, whether to give it to your baby or not, its advantages and disadvantages, has been a long standing discussion between parents and an area where you are most likely to receive conflicting advice. Dummies, whether liked or not, have been used for decades by mothers to pacify their children. To give your child a dummy or not is up to you, however, it is important to have all the information about its pros and cons before making a decision.

Sucking, as mentioned earlier in Benefits of Breast Feeding and Thumb Sucking, is a baby’s earliest reflex. Some ultrasounds show babies sucking on their thumbs inside the mother’s womb. It is easy to reason out a baby’s need to suck even before birth. By sucking on his thumb he develops the ability that is so vital to fulfill his nutritional needs later. Dummies pacify babies by fulfilling this need to suck, but that also requires a wise decision on the parent’s part. Otherwise it might lead to over dependency on the dummy and yield disadvantages discussed later in this article.

What is a dummy?A dummy is a ‘blind’ teat (without a hole in it) attached to a disc that rests against the baby’s lips to keep the teat from being pulled entirely into his mouth. On the back of the disc is a ring by which the pacifier can be held by the baby, or attached to his clothes by a ribbon. Never hang the dummy around a baby’s neck in a ribbon; there is a risk of the baby being strangled by the ribbon if it winds around his neck. (Baby and Child Care by Dr. Benjamin Spock)

When and why do parents use a dummy?

It is noted that dummies are mostly used when the baby is 2-3 months old. Surveys have also shown that parents usually use dummies when it is their first child and more likely, if it’s a boy. Dummies pacify crying babies because sucking on something calms them down. The reason for a baby’s cry could be anything from being colic to wanting to suck at something the whole time. Some babies have a very strong urge to suck so they want to be at the breast or bottle the whole time. This demand can be very hard to fulfill and the baby’s constant crying can be very disturbing and distractive. For such babies, dummies can be very helpful (although a mother must take care of a dummy affecting her milk supply which is discussed later.) A baby often reacts quickly and absolutely to dummies. He either accepts it and enjoys it very much or rejects it completely.

Advantages of a dummy:

• Sleep: A dummy can help in putting a baby to sleep. A pacifier also helps to keep the baby asleep even if he is disturbed at night. He will start to suck on the dummy and has more chances of going back to sleep without opening his eyes.
• Calming: As sucking helps babies to calm themselves and gives them a feeling of security, a dummy can help a baby if he is suddenly frightened by something around him. Parents also widely use dummies through their baby’s colic episodes.
• Dental problems: If a baby is given a dummy he is less likely to develop the habit of thumb sucking. Dummies and thumb sucking, both can lead to dental problems and people argue that both are as aesthetically displeasing. Then why substitute the thumb with a dummy? Their argument is valid but children are often weaned off dummies (or they should be) by the age of 3-4 months. Colic ends by that time too so a dummy is less needed. On the other hand, thumb sucking is likely to persist for a longer period and has more chances of creating dental problems when the baby begins to teeth. A dummy can be thrown away at one point but the thumb cannot. Recent research also shows that children who suck their fingers rather than dummies have higher chances of tooth decay because sucking a dummy produces more saliva which helps combat plaque.
• Lesser risk of smoking as adults: Research shows that adults who have had dummies as babies are less likely to take up smoking. (Click for source)
• Lesser risk of Cot Death: In June 2007 The Foundation for Study of Infant Deaths announced that putting the baby to sleep with a dummy can reduce the risk of cot death or Sudden Infant Death Syndrome (SIDS.) No one reason has been pointed out for SIDS; however, many precautionary measures have been suggested. The use of a dummy while a baby is sleeping is one of them. The dummies’ bulky external handles might prevent babies suffering accidental lack of oxygen from having their faces buried in blankets or underneath adults’ bodies. Sucking dummies also improves development of babies’ airways. It is also thought that sleeping with a dummy positively affects a baby’s sleeping posture and helps prevent SIDS. Another theory also explains that a dummy might keep a baby in a greater state of arousal while sleeping, making him less vulnerable to SIDS. (Click for source:)

Disadvantages of using a dummy:

• Possible link to ear infections: There is thought to be a possible link between prolonged dummy use and middle ear infections. It’s thought that sucking on a dummy increases the chance of an infection back-tracking from the mouth into the Eustachian tube (the air-filled passage connecting the middle ear with the back of the throat.) A study conducted in Netherlands showed that children who used a dummy were slightly more prone to ear infection for the first time. However, the tendency for them to get ear infection repeatedly, when using a dummy, after the first time, increases. The researchers think this might be because the first infection irritates the lining of a child’s ear. This could make them more vulnerable to ear infections in future. So, sucking a dummy might cause ear infections in children who already have irritation in their ear, but not in children who don’t. Although this is only a theory. (Click for source)
• Long-term dummy use and dental problems: Using dummies for a long term can also cause dental problems especially if the child is still using it as a comforter when his milk or permanent teeth appear. That is why it is important to wean a baby off the dummy in the first few months of his life.
• Speech Problems: A dummy prevents babies from babbling, which is the foundation of speech and an important step in learning to talk. It also discourages toddlers from chatting and communicating with others readily, which they need to do to develop their language skills. A dummy may prevent a baby from using all his tongue movements. An older baby’s ability to swallow may also be impaired, and this can result in difficulties with speech. Once he starts to speak, he may talk from the back of his mouth instead of the front. Nadine Arditti, a speech therapist from Manchester, researched children attending her clinic and found that just over half of all dummy-users in her area had been referred for speech therapy. (Click for source)
• Problems with breast feeding: The supply of milk is reduced because of excessive use of a dummy in the initial weeks of a baby’s life. The baby’s sucking on the breasts produces exactly the amount of milk he needs. By reducing that and substituting it with sucking on a dummy, there is a chance of reducing the supply of milk in the mother. Mothers also use dummies to stretch out the period between breastfeeds, thus reducing their supply of breast milk. It is therefore advised not to give the baby a dummy in the first 1-2 months so that he establishes a regular cycle of feeding. Then, occasionally giving him the dummy won’t affect the mother’s supply of milk. It is also thought that dummies alter an infant’s sucking technique. Dummies may cause sucking confusion for a small baby and this can result in early weaning. (Click for source)
• Mouth breathing: Sometimes, babies who use dummies develop the habit of breathing through their mouths which, in turn, results in long-term dribbling. (Click for source)

Important things to keep in mind for using a dummy:

• Before popping a dummy into a baby’s mouth make sure he is not crying because of something else.
• Don’t get in a habit of using a dummy regularly. Keep it as a last resort when the baby is crying or offer it only at bedtime or spells of colic.
• Don’t automatically give a dummy to your baby; wait for him to ask for it.
• Wean your baby off the dummy as soon as possible, especially before he is 10-12 months old. It gets much harder to wean a baby after this age.
• Do not dip the dummy in something sweet like honey, jam or orange juice. It accelerates tooth decay.
• If your child starts to talk while he is still using the dummy, discourage him from talking with it in his mouth.
• If you decide to use a dummy, use an orthodontic one.
• Sterilize the dummy just like you sterilize other feeding bottles and nipples for your baby and keep it as clean as possible.
• Keep a regular check on the condition of your baby’s dummies. Check for cracks, splits and holes that can trap germs. Replace old dummies immediately.
• Do not hang dummies around your baby’s neck with a string or ribbon. It can be dangerous if the ribbon wraps around the neck.

Weaning from the dummy:

When the right time comes, your child might not be very willing to give up his dummy. Some children get very attached to them. Then you can try using the following tips:

• Try putting a complete stop to it. Usually children fret and cry for only 2-3 days before adjusting to a non-dummy life. Try to accomplish this task at a time when you have a little help and rest, for example on a weekend. Choose the right time to give it up, not when you are under pressure to do so.
• If this does not work try gradually reducing the times you allow your baby to have his dummy, for example at bedtime only.
• Tell your child that giving up a dummy is a good thing to do. Persuade them to give their dummies to someone older they love and respect. Also try to get an older child to agree with you that giving up a dummy is a sensible thing to do. Little children love acting like grown ups.
• Reward your child for giving up his dummy but do not reward him with sweets. You can also use a star chart to motivate him.
• Once you have decided to give up the dummy, don’t be tempted to give it back and make sure there are none left lying around the house.