Understanding the Risks of Sudden Infant Death Syndrome
Published: 26 February 2020
Published: 26 February 2020
About 20% of sudden and unexpected infant deaths (SUID) have a clear cause, including severe and unequivocal infection.
The other 80% that remains unexplained after a thorough investigation of the circumstances of death and post-mortem results are classified as SIDS (Kinney and Thach 2009).
Although SIDS can occur whilst a baby is awake, most deaths occur whilst the baby is asleep, with a peak incidence between one and four months old (Psaila et al. 2017).
In the UK it’s thought that more than 200 babies die suddenly and unexpectedly each year (NHS 2018), whilst in Australia, approximately 100 deaths are reported annually (Horne 2019).
Despite the success of prevention campaigns, SIDS remains a leading cause of infant mortality and the search for preventable risk factors continues.
As Goldwater (2003) comments, it’s generally accepted that low birth weight and premature babies are at greater risk of SIDS, with slightly more cases noted in boys compared to girls.
The list of factors thought to be associated with SIDS is extensive, some of them can be avoided but many cannot. For example:
Current evidence suggests that SIDS involves a convergence of stressors that can result in asphyxia in a vulnerable infant.
As Kinney and Thach (2009) explain, SIDS occurs when there is ‘a simultaneous juxtaposition of multiple events that, when taken individually, are far less powerful than the result of their chance combination’.
Building on this idea of multiple factors interacting together to cause SIDS, Degnan (2013) suggests the triple-risk model, first described in 1994 can be used to identify the most vulnerable infants.
The three risk factors are:
Some of the strongest evidence about reducing the risks of SIDS relates to safe sleep guidance and the use of pacifiers.
Carpenter et al. (2013) point out that the risks associated with bed-sharing are greatly increased when combined with parental smoking, maternal alcohol consumption or drug use.
They also suggest that a substantial reduction in the number of SIDS cases could be achieved if parents avoided bed-sharing.
Risks can also be considerably reduced by making sure new parents have a good understanding of the following guidelines related to safe sleeping:
Bates (2014) makes the point that the incidence of SIDS has decreased by about 70% since the 1990s, largely due to the understanding that babies are much safer when placed on their back to sleep.
It’s a point worth noting as many grandparents or older relatives may unwittingly pass on unsafe advice about laying babies to sleep face down, or on their sides.
Psalia et al. (2017) ask the question: ‘Does the use of infant pacifiers reduce the risk of sudden infant death syndrome?’
They go on to suggest that whilst in their opinion there is no evidence pacifiers work, neither are there any well-designed trials, suggesting that more research is needed before a definitive answer is found.
Hauck (2005) on the other hand, conducted case-control studies demonstrating a significant reduction in the incidence of SIDS with pacifier use, particularly when used for both daytime and nighttime sleep.
For breastfed infants, pacifiers should be introduced after breastfeeding has been well established and continued for up to a year which includes the peak ages for SIDS risk and the period in which the infant's need for sucking is strongest.
Midwives, nursery nurses, health visitors and other maternity care staff are in an ideal position to educate and influence parenting practices.
As Bredemeyer (2004) says, there are many opportunities from antenatal care to postnatal check-ups for midwives to set an example and reinforce the message about the use of the supine position when laying a baby down to sleep.
Parental education should also include information about environmental factors that are known to increase the risk of SIDS, such as exposure to cigarette smoke and other potentially unsafe sleeping practices such as co-sleeping and bed-sharing.
Of course, when health visitors and midwives talk to new parents the last thing they want to think about is SIDS.
It’s a scary topic that can be difficult to talk about but as Bates (2014) states, after over 40 years of research, we now know how to significantly reduce the risk of it happening and how to keep babies safer.
Anne is a freelance lecturer and medical writer at Mind Body Ink. She is a former midwife and nurse teacher with over 25 years’ experience working in the fields of healthcare, stress management and medical hypnosis. Her background includes working as a hospital midwife, Critical Care nurse, lecturer in Neonatal Intensive Care, and as a Clinical Nurse Specialist for a company making life support equipment. Anne has also studied many forms of complementary medicine and has extensive experience in the field of clinical hypnosis. She has a special interest in integrating complementary medicine into conventional healthcare settings and is currently an Associate Tutor, lecturing in Health Coaching and Medical Hypnosis at Exeter University in the UK. As a former Midwife, Anne has a natural passion for writing about fertility, pregnancy, birthing and baby care. Her recent publications include The Health Factor, Coach Yourself To Better Health and Positive Thinking For Kids. You can read more about her work at www.MindBodyInk.com. See Educator Profile