A medical mystery of early infancy, sudden infant death syndrome (SIDS), also called crib death, is the unexpected, sudden death of an infant or child younger than age 1 year. Reasons for the death remain unexplained even after an autopsy. Typically, parents put the infant to bed and later find him dead, commonly with no indications of a struggle or distress of any kind. Incidence has decreased with the practice of teaching parents to place an infant on his back to sleep.
SIDS is the third leading cause of death in infants between age 1 month and 1 year. It occurs more commonly in winter months. The incidence is higher in males, premature neonates, and those who sleep on their stomachs or in cribs with soft bedding. Incidence is also higher among neonates born in conditions of poverty and to those who were one of a single multiple birth, such as twins and triplets, and to mothers who smoke, take drugs, or failed to seek prenatal care until late in the pregnancy. SIDS may also result from an abnormality in the control of ventilation that allows carbon dioxide to build up in the blood, thereby causing prolonged apneic periods with profound hypoxemia and serious cardiac arrhythmias. It’s also thought to be associated with problems in sleep arousal.
Although parents find some victims wedged in crib corners or with blankets wrapped around their heads, autopsies rule out suffocation as the cause of death. Autopsy shows a patent airway, so aspiration of vomitus isn’t the cause of death. Typically, SIDS babies don’t cry out and show no signs of having been disturbed in their sleep. However, their positions or tangled blankets may suggest movement just before death, perhaps due to terminal spasm.
Depending on how long the infant has been dead, a SIDS baby may have a mottled complexion with extreme cyanosis of the lips and fingertips or pooling of blood in the legs and feet that may be mistaken for bruises. Pulse and respirations are absent, and the diaper is wet and full of stool.
Diagnosis of SIDS requires an autopsy to rule out other causes of death. Characteristic histologic findings on autopsy include small or normal adrenal glands and petechiae over the visceral surfaces of the pleura, within the thymus, and in the epicardium. Autopsy also reveals extremely well-preserved lymphoid structures and certain pathologic characteristics that suggest chronic hypoxemia such as increased pulmonary artery smooth muscle. Examination also shows edematous, congestive lungs fully expanded in the pleural cavities, liquid (not clotted) blood in the heart, and curd from the stomach inside the trachea.
If the parents bring the infant to the emergency department (ED), the physician will decide whether to try to resuscitate him. An “aborted SIDS” infant is one who’s found apneic and is successfully resuscitated. Such an infant, or any infant who had a sibling stricken by SIDS, should be tested for infantile apnea. If tests are positive, a home apnea monitor may be recommended. Because the infant usually can’t be resuscitated, however, treatment focuses on providing emotional support for the family.
❑ Make sure that parents are present when the child’s death is announced. They may lash out at ED personnel, the babysitter, or anyone else involved in the child’s care — even each other. Stay calm and let them express their feelings. Reassure them that they weren’t to blame.
❑ Let the parents see the baby in a private room. Allow them to express their grief in their own way. Stay in the room with them if appropriate. Offer to call clergy, friends, or relatives.
❑ After the parents and family have recovered from their initial shock, explain the necessity for an autopsy to confirm the diagnosis of SIDS (in some states, this is mandatory). At this time, provide the family with some basic facts about SIDS and encourage them to give their consent for the autopsy. Make sure that they receive the autopsy report promptly.
❑ Find out whether your community has a local counseling and information program for SIDS parents. Participants in such a program will contact the parents, ensure that they receive the autopsy report promptly, put them in touch with a professional counselor, and maintain supportive telephone contact. Also, find out whether there’s a local SIDS parents’ group; such a group can provide significant emotional support. Contact the National Sudden Infant Death Foundation for information about such local groups.
❑ If your facility’s policy is to assign a public health nurse to the family, she will provide the continuing reassurance and assistance the parents will need.
❑ If the parents decide to have another child, they’ll need information and counseling to help them through the pregnancy and the first year of the new infant’s life.
❑ Infants at high risk for SIDS may be placed on apnea monitoring at home.
❑ All new parents should be informed of the American Academy of Pediatrics’ recommendation that infants be positioned on their back, not on their stomach or side, for sleeping.
Read excerpts from these other book chapters related to Death:
Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2008 Williams & Wilkins.
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Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X 
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