SIDS can be expanded as “Sudden Infant Death Syndrome”. What is it? Sometimes, an infant, who appears to be healthy in normal circumstances, may die during sleep. This is a rare medical condition. In most of these cases, the infant’s parent or caregiver would have placed the infant down to sleep and would later find that the baby has died. As a nurse or a nursing student, it’s important for us to learn about this syndrome, even though it is a rare medical condition.

SIDS Description:

Although SIDS is often described as a rare medical condition, it’s to be noted that it still remains one of the most common causes of death in infants between one and twelve months of age. Also, the statistics say that most of the infants who die because of this syndrome are between two and four months of age.

This syndrome has been listed in the “International Classification of Diseases”. The first set of research about this syndrome was published in the middle of the 19^th century. Since then, researchers as well as healthcare providers have been trying to define the syndrome and determine the causes. As such, they have been able to define the key characteristics of the syndrome as follows:

• The syndrome affects infants less than one year of age.
• The affected infant will seem to be healthy with no preceding symptoms.
• A complete investigation like a postmortem has failed to find the cause of the death.
• These infants don’t seem to be associated with child abuse or any illnesses.

Causes of SIDS:

As mentioned earlier, the actual cause of SIDS remains unknown. However, it is widely accepted that this syndrome could be the result of several interacting factors like the following:

Infant Growth:

There is a common hypothesis in place that SIDS may be the reflection of delay or abnormality in the growth of nerve cells that are important in the normal functioning of the heart and lungs.

Re-breathing Stresses:

When a baby sleeps by facing downwards, then the air movement around the mouth could be impaired. This could cause the infant to re-breathe carbon dioxide gas that is exhaled out. Besides sleeping pattern, the following external objects could also impair the normal air passage around the infant’s mouth and nose if the baby is positioned downwards:

• Soft bedding
• Blankets
• Comforters
• Waterbeds
• Soft mattresses
• Stuffed or plush toys

Hyperthermia:

Infants who are overdressed or wrapped with excessive coverings, thereby leading to an increased air temperature, might cause an increased metabolic rate. Thus, there will be eventual loss of breathing management.

Signs and Symptoms of SIDS:

Live infants may be seen following “BRUE”. BRUE can be expanded as ‘Brief Resolved Unexplained Events’. Formally speaking, BRUE is the apparent life-threatening event (ALTE). In general, the survivors of BRUE are found to be sharing several factors for SIDS. As such, the events are found to be one of the following:

• Cyanosis
• Breathing difficulties
• Abnormal limb movements

As mentioned above, the classic presentation of SIDS would begin with an infant who has been put to sleep after breastfeeding/bottle feeding. Therefore, efforts must be made to differentiate this death from death by suffocation or child abuse. So, the circumstances would play a major role here. Also, care must be taken to investigate the scene of the death for the signs of environmental factors that might have contributed to the death.

Physical Findings:

Physical findings would help differentiate the suspected infanticide. Note that the findings in line with SIDS would include:

• Watery, frothy, or mucus discharge from the infant’s mouth or nose
• Reddish-blue mottling on the face and other dependent portions of the infant’s body
• Marks found on the pressure points of the infant’s body
• Well-cared-for outlook without any significant skin trauma
• Zero environmental factors contributing to the unexpected death

How to Recognize SIDS?

Typically, SIDS is found to be a silent event and hence, the infant affected will not cry. Also, the death will be very rapid when the infant is sleeping. The cause of the infant’s death can be determined by us only by following a complex process of collecting information and conducting some forensic tests and procedures. It’s to be noted that the identifiable causes of an infant’s death are to be investigated before diagnosing SIDS.

There are four major avenues that could help determine a SIDS death. They are as follows:

Postmortem laboratory tests: These are conducted to rule out the other causes of death. However, in the case of SIDS, this evaluation is not very revealing.

Autopsy: This would provide us some clue to the cause of death. In some cases, death will be due to some specific abnormalities or infection. However, these results will be very subtle and thus, will yield supportive findings rather than conclusive ones.

Death-scene investigation: A thorough investigation involving the questioning of parents and/or caregivers might reveal the cause of death that is identifiable and possibly preventable. In several cases, these kinds of investigation have helped to find the factors in the sleep environment of the infant that are probably unsafe.

Family medical history: You should always check the family’s medical history as well as the patient’s. This would include any details about the history of the following things:

• Unexplained infant death
• Sudden cardiac death
• Metabolic disorders
• Genetic disorders