Commonly Asked Questions About SIDS: A Doctor's Response

By J. Bruce Beckwith, MD

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III. How Is The SIDS Diagnosis Made?

In doing a post-mortem examination, we don't see the lethal mechanism directly. After death, muscles relax, so the pathologists don't find the throat muscles clamped shut. There are little things that we find consistently, such as the pinpoint hemorrhages I mentioned earlier, but none of those things account directly for death. They are only clues to the way the baby died, and helpful to the pathologist in diagnosing the case as SIDS.

The SIDS victim did not die of nothing. The baby died of a very distinctive entity. Any of you who are familiar with sudden infant death will know that the typical case falls into a narrow age range, and seemed to be okay except maybe for a cold, ate his last meal normally, was put to bed and was later found dead. You know when you hear that story what the pathologist is going to say. But when the story is different, then you really want to know what the pathologist found. When there are some unusual features to the case, the post-mortem becomes especially important, as there are many conditions other than SIDS which can kill infants and young children suddenly.

If we take all babies under one year, who have (1) died unexpectedly, (2) during sleep, with (3) no history of alarming symptoms, such as seizures, temperature over 105 degrees, and (4) no external findings to allow one to suspect a cause of death (like a fractured skull or a skin rash), 92% of cases will be diagnosed as SIDS after autopsy. If the infant is 2 or 3 months old, it is not possible to get an autopsy, but one can usually do an x-ray examination to add to these four criteria. With the presence of a normal full-body xray, the chances the death was due to SIDS goes from 92% to 98.2%.

IV. My Baby Wasn't A Typical SIDS Case

Each of you who has personally experienced SIDS probably feels that, in some ways, your baby doesn't fit the classical profile. You read about "high risk" babies and it's very easy to confuse the concept of "high risk" with "typical." For example, a "high risk" baby might be born weighing less than three pounds to a disadvantaged family in the winter months. The risk to that baby is perhaps one in 50. The risk to a random baby is probably in the order of one in 500. If your baby was a full-term, 8-lb. baby who died in the summertime, and was a girl, it doesn't sound typical of the "high risk" baby that you hear about. But, in fact, most SIDS babies are not drawn from the "high risk" population. There are many more babies in our society who are in the "low risk" population, and the majority of SIDS babies are from this "low risk" population.

Thus, the 8-lb. baby is a more "typical" SIDS victim than is a 3-lb. premie, even though that premie had a higher individual risk of dying. Because there are so many full-term babies, they constitute the majority of SIDS babies. The same principal applies to the other so-called "high risk" factors. Therefore, these things you read about "high risk" SIDS babies often lead to confusion and it is important to understand that "high risk" and "typical" are very different concepts.

Any one case is a single dot on the bell-shaped curve and it could fall anywhere on that curve. The description of a population as a whole does not describe each individual member of that population. That's an idea that's often difficult to get across. I don't know if the totally typical case of SIDS ever has occurred. Every baby that ever died was an individual, and every person who has lost a baby identifies SIDS with that particular individual-- the hair color, behavioral patterns, and the medical history of that baby is the profile of SIDS to that parent and family.

It's important for families to be able to appreciate that because that baby seemed different than the other children in that family, it doesn't mean that difference was in any way related to the death. My experience has made it very clear that there is no typical pattern of behavior, for example, in babies who later die of SIDS

V. My Baby Cried Out During The Night He Died, And I Feel So Guilty Because I Didn't Respond

This was a death caused by airway obstruction and babies can't cry when their airway is obstructed. So, when that baby was crying, he could not have been dying. He cried, went to sleep, and then died later. Not responding to that cry had nothing to do with the fact that the baby died. Babies do not die from crying.

VI. Since SIDS Only Occurs During Sleep, If I Had Awakened My Baby, Would He Have Died?

My answer has to be, "No, he wouldn't have died then." But, how in the world could anybody know at what moment it was going to happen? The way to prevent SIDS would never be to let a baby sleep, and that's obviously impossible

VII. Is SIDS Contagious?

Again, the answer is "no." My personal experience with over 1,200 cases includes not one example where a SIDS victim was closely in contact with another SIDS victim (except for three cases of twin SIDS incidences). There are times in every community when there are more SIDS than other times. When viral diseases of certain kinds are sweeping through the community, the incidents of SIDS will climb. But there is no "crib death virus."

VIII. Will It Happen Again In My Family?

SIDS IS NOT A HEREDITARY DISEASE. Early literature on SIDS suggested that subsequent siblings of SIDS babies had a modestly increased risk of SIDS. However, subsequent experience has shown that nearly all cases of apparent familial SIDS, when carefully studied, can be attributed to other causes. Certain genetic or environmental factors can result in sudden death in infancy, and some such deaths have been mistakenly attributed to SIDS in the past. Careful studies of families with more than one case of "SIDS" usually reveals other factors.

Any apparent SIDS victim who has siblings or other close relatives who have died similar deaths should be investigated with great care to exclude genetic or environmental factors. Many of the genetic causes of sudden death will be suggested by the wider age range, and atypical circumstances of death (such as death while awake) of some infants or children.

Since SIDS is one of the most common causes of infant mortality, affecting one in every 1,000 infants, it can rarely strike twice in the same family on random chance alone. However, present evidence suggests that subsequent siblings of true SIDS victims are at no higher risk of this phenomenon than any other babies. When nonspecific risk factors such as prematurity are also present, these will raise the risk of subsequent siblings of SIDS victims to the same degree they do for other infants.

IX. What Can I Do To Protect My Next Baby From SIDS?

While there is nothing now that will guarantee protection of an infant from SIDS, a number of studies suggest that rates of SIDS may be decreased by some simple, inexpensive and safe changes in infant rearing habits:

1. Place your baby on its back or side to sleep during the SIDS age period, as now recommended by the American Academy of Pediatrics. Populations where most infants sleep on their backs (or sides) seem to experience significantly lower SIDS rates that those where most infants sleep in the prone (tummy) position. Intervention studies in several countries suggest that a change from prone sleeping position for infants reduces SIDS rates.

2. Don't expose your baby to tobacco smoke. There is now substantial evidence that SIDS rates are higher in infants whose parents or other persons in the household smoke.

3. Don't let your baby get overheated during sleep. This is perhaps the most controversial recommendation, but several studies have suggested that infants who cannot get rid of body heat because of excessive clothing, blankets or unusually warm room temperature may be at higher risk of SIDS. Until this issue is settled, I feel it is prudent to avoid excessive layers and unusually warm sleeping environments for infants in the SIDS age range.

NONE OF THESE SUSPECTED RISK FACTORS IS THE CAUSE OF SIDS. The vast majority of babies who sleep on their tummies, are exposed to tobacco smoke, or have relatively warm sleeping conditions do not die in infancy, and numerous infants with none of these risk factors have died of SIDS. These recommendations are intended to reduce the risk for your baby, but they cannot guarantee freedom from this tragedy.

Sudden Infant Death Syndrome

Sudden Infant Death Syndrome (SIDS) is defined as the sudden death of an infant under one year of age which remains unexplained after the performance of a complete postmortem investigation, including an autopsy, an examination of the scene of death and review of the case history. (NICHD 1990)

What SIDS Is

• SIDS is a definite medical entity and is the major cause of death in infants during the first year of life.

• Approximately 4,000 SIDS deaths occur annually in the United States' accounting for more than one-third of all deaths between 28 days and one year of age.

• Statistically, one SIDS death occurs for every 1,000 live births.

• The peak incidence is between two and four months of age.

• SIDS occurs in all socio-economic levels.

• SIDS victims appear to be healthy prior to death.

• Though avoidance of some risk factors for SIDS may reduce the incidence of SIDS, no risk factor has been proven to be the cause of death. NO CASE OF SIDS COULD HAVE BEEN PREDICTED OR PREVENTED, even by a physician.

What SIDS Is Not

• SIDS is not caused by external suffocation.

• SIDS is not caused by the type of feeding method used.

• SIDS is not cause by immunizations.

• SIDS is not caused by child abuse or neglect.

• SIDS is not caused by vomiting or choking.

• SIDS is not contagious, nor is it infectious.

• SIDS does not cause pain or suffering to the infant.

Your Donation Can Help

For More Information

• Send an e-mail message to the SIDS Foundation of Washington at sids-wa@zipcon.net

• Visit their website at: http://www.sidsofwa.org

This pamphlet was prepared by the SIDS Foundation of Washington. No part of this brochure may be reprinted or reproduced without written permission from the SIDS Foundation of Washington. copyright 1983 Revised 1996
Printing for the (paper) brochure sponsored by a gift from The Junior League of Seattle, Inc.