Sudden infant death syndrome

WHAT IS IT?
- Sudden infant death syndrome (SIDS), commonly referred to as cot death, involves the sudden unexpected death of a baby aged from birth to two years who appeared to be in perfect health. Most cases occur in babies less than six months old.

- The death is registered as SIDS when a postmortem fails to identify the cause. A baby's death is not classified as SIDS when a cause is identified.

- Approximately 350 babies die from SIDS in the UK each year. It is the leading cause of death in babies over one month old.

CAUSES
The specific cause of a sudden infant death is revealed in under 50 per cent of postmortems. It is thought that many SIDS deaths are caused by a breathing failure but precisely how or why this failure occurs is not known. Causes are thought to include:

- Accidents, such as carbon monoxide poisoning or suffocation;

- Infection;

- Congenital abnormality;

- Metabolic disorder;

- Overheating;

- Choking.

SIDS can affect any baby but premature and low birthweight babies are more at risk. It happens more often in the winter months than at other times of the year.

PREVENTION
There is no way to prevent SIDS entirely. However, health care professionals can advise parents on steps to reduce the risk. General precautions include:

- Avoiding smoky environments;

- Not smoking during pregnancy;

- Medical advice should be sought immediately if the baby is unwell.

There are particular measures that parents can take when their baby is asleep:

- Parents should never have the baby in their bed if she or he is under eight weeks old, if either of the parents is a smoker (NICE, 2005), if either has been drinking alcohol or has taken medications that induce drowsiness, or if either is excessively tired;

- The baby should be placed on its back to sleep;

- The baby's head should be kept uncovered while asleep;

- The baby should never be given a pillow until at least two years old. A firm mattress is sufficient;

- For the first six months the baby should sleep in a cot in the parents' bedroom;

- The cot should not be filled with soft toys;

- Parents should not fall asleep while on the sofa with the baby.

Temperature is a factor in preventing SIDS. Parents should be advised to:

- Try to keep room temperature between 16 degsC and 20 degsC;

- Avoid letting the baby sleep in a draught, for example next to an open window;

- Remove the baby's outdoor clothes when inside;

- Avoid letting the baby sleep with or near artificial sources of heat, for example with hot water bottles, next to radiators or in direct sunshine.

RESEARCH
Research into SIDS is being undertaken by many organisations including the Scottish Cot Death Trust and the Foundation for Sudden Infant Deaths. Topics under investigation include: l Whether genetics is a factor;

- Prematurity, maternal smoking and infant sleeping position;

- The impact of depression and maternal personality disorder on the care of infants;

- Early spontaneous labour;

- Antenatal and postnatal physiological development.

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