SIDS : What it is, is NOT, and what all nurses need to know

JanineKelbach, RN

What is SIDS?

SIDS or Sudden infant death syndrome remains the leading cause of death in infants less than one year of age.

SIDS is not suffocation.
SIDS is not choking.

Instead, SIDS is an unexplained death of an infant less than one year after a thorough case investigation. Though we don't know what causes SIDS, there are risk factors linked to higher SIDS death rates. Evidence has shown that 92.2 percent of SIDS deaths were infants who were sleeping on their stomachs, co-bedding, or not in a safe sleep position.

Pathophysiology

Right now, the triple-risk model, which is a combination of three factors may explain SIDS. First, the infant but have some sort of underlying vulnerability present, which is unknown right now. Then, there must be a risk factor that is present, like sleeping on their stomachs. Finally, the risk factor must be present during the first year of life.

Topics that are currently being researched include ion channel abnormalities, autonomic nervous system disturbances, and the effects of nicotine on the developing brain.

Another common factor parents affected by an infant's death related to SIDS say is that the "infant did not act like themselves hours before the event." Typically, infants are found the same way they were put to sleep.

Risk Factors Linked to SIDS

As nurses, we need to know these risk factors, whether you work in the Maternity Ward, or if you are a mother or a caregiver. It is our job as nurses to educate parents about safe sleep. Those risk factors include:

Overheating

Parents think their babies are always cold and need to be bundled up. Though, overheating has been shown to kill babies.

TIP: Educate your patients to only dress the baby in one more layer than what the parents are wearing. For example, if the parent is wearing a t-shirt, the infant can have on a long sleeved shirt.

Maternal Alcohol Use (during and after pregnancy)

Mothers who drank alcohol when pregnant and continued to do so after having their babies have a higher risk of SIDS. Sometimes, this may include falling asleep with their babies after drinking alcohol.

TIP: Tell the mother the risk factors of drinking while pregnant (Fetal alcohol syndrome, lower IQ etc.) Most nurses do not educate a mother about having an occasional drink after having the baby is born. SIDS occurs within the first year of life; it is common that the new mother may want to have a drink or two throughout the first year of life. What nurses need to instill in the mother is that no matter if she had one or several drinks, she should never hold the baby if she is feeling sleepy. Infants should be put into their own bed, not with the parents.

Tobacco Use (during pregnancy and in the household)

Smoking during pregnancy has been shown to increase the rate of SIDS. There is also a higher risk for SIDS in infants who live with smokers. Many believe it is because of the lack of oxygen in the environment.

TIP: Encourage parents to smoke outside, wash their hands, and then change their clothing before holding the infant. Smoking cessation courses can be offered to the parents as well. If there are caregivers for the infant that smoke, smoking should not be permitted around the baby.

Co-sleeping

Co-Sleeping with the infant in the same bed is not recommended due to a higher rate of SIDS, and suffocation. It is recommended that the infant stays in the parent's room in a bassinet, up to one year, to decrease the risk for SIDS.

Tips for the nurse: Tell your parents that co-sleeping is not encouraged. Instead, put a bassinet near the bedside for easy transfer of the infant.

Laying on the Stomach

Infants that are not put on their backs to sleep carry between 1.7 times and 12.9 times the SIDS risk. Therefore, "Back is Best."

TIP: Always tell the parents "Back to sleep," and to ignore family members who say differently. It is the recommendation now, since 1994 and has lowered the death rate 50%. Always put the infant on their back, even at nap times. Lying on the stomach should be used during tummy time under supervision.

Fluffy bedding or soft mattresses

Infants do not need to be on an adult preferred, comfortable mattress. It is recommended that the infant sleeps on a firm mattress with no toys or fluffy blankets with them. Another popular slogan is "ABC Alone. Back. Crib." to help parents remember safe sleep. Infants should never sleep with other children. It is recommended that infants sleep close to their parents, but not with their parents.

TIP: Always take things out of the infant's bed that do not belong. Infants do not need pillows. Wrapping the newborn infant is recommended for comfort, but do not restrict them from moving.

How To Decrease Infant's Risk Of SIDS

Pacifiers

It has been shown that the use of pacifiers lowers the risk of SIDS. Offer the infant one if breastfeeding is well established. If the infant spits it out, don't force it back in.

Breastfeed

Infants who breastfeed have lower mortality rates caused by SIDS. If possible, encourage the mother to breastfeed the infant exclusively at least the first six months of life.

Offer different bedding options

A variety of states have adopted the idea of hospitals providing a safe place for an infant to sleep when the parents go home. This may include sending the patients home with a box safe enough for a baby to lay in. Due to funding, many hospitals cannot provide a crib for every family, but a box is safe enough, allowing a firm area for the infant to sleep in.

As nurses, it is our job to educate our patients and our community on the severity of unsafe sleep for infants. Don't assume everyone puts infants on their backs to sleep; most don't. Be proactive in your community to help babies see their first birthdays.

Resources

Safe to Sleep

Sudden Infant Death Syndrome

Sudden Infant Death Syndrome: Practice Essentials, Background, Pathophysiology