Sudden infant death syndrome, better known as S.I.D.S., is one of the leading causes for the inflated infant mortality rate in this country today. It is often misunderstood or unrecognizable. For the most part, the causes of SIDS are unknown to the general public. This is changing, however, as public awareness is ever increasing. Thus, the purpose of this paper will be to explain sudden infant death syndrome and its known or suggested causes. Also, the history of SIDS, the problems and emotional suffering that results from the loss of a child, the toll it takes on the surviving sibling and possible counseling or other help that is available for parents who may have lost a child to SIDS are such areas that will be explored.
SIDS is also commonly referred to as crib death. It is said to claim approximately in the range of 6,000 to 7,000 babies a year within the continental United States alone, with a slight increase each year (Bergman xi). This would seem to be an astounding figure, but when the figure of the total amount of babies that are born in the United States is compared to that of the number of deaths due to SIDS, it accounts for only a small percentage. It is a small percentage that hopefully can be reduced. And to any parents, the loss of just one child is definitely one too many, despite of the statistics that are currently available. During the first week of life is where most deaths that are associated with prematurity dominate, SIDS is the leading cause of death among infants under one year of age, according to Bergman. It ranks second only to injuries as the cause of death in children less than fifteen years of age. An unknown fact is that SIDS takes more lives than other more common diseases such as leukemia, heart disease or cystic fibrosis (Bergman 24). Ironically it was not until the middle of the 1970’s until SIDS was no longer ignored as being a cause of death. For the most part, no research was being conducted, leaving families and victims left to wonder why their babies died (Mandell 129). For the family and friends of the family, who also are victims, this was definitely a tragedy. Not knowing the cause of death had to have caused physical and emotional distress in their lives. Self blame was something that had to exist, even though there was nothing that most of these parents could have possibly done.
Today where more research in this area is needed, researchers are making strides in combating this disease. But understanding the crucial aspects of SIDS and how to prevent it, are still limited. The leaders in this field are hoping to improve understanding of this disease by providing direction and opportunities for more quality intensified research. According to L. Stanley James, MD, chair of neonatology at Columbian Presbyterian Medical Center in New York City, “The government is now having a rejuvenation of SIDS research, and over the next five years, they are going to be putting in thirty to forty million dollars.” The direction will be supplied through a five year research plan proposed by a panel of experts from The National Institute of Child and Human Development in Bethesda, Maryland (Zylke 1565). In response to a Senate request, there will be representatives from the fields of epidemology, neonatology, cardiorespiratory and sleep research, neuroscience, behavioral medicine, pathology, infectious disease, immunology and metabolism to meet a release a report on current knowledge and research recommendations (Zylke 1565). It was important to this group that people would have a definition of SIDS that would be acceptable to all. The current definition of SIDS, developed in 1969, states SIDS as being “the sudden death of any infant or young child which is unexpected by history and in which a thorough postmortem examination fails to demonstrate and adequate cause of death.” (Bosa 5).
Much has been learned through research in the recent years. Such examples have now been considered to be facts, one being that the peak incidence occurs at about ten weeks of age and that it is uncommon at less than three weeks and greater than nine months (Zylke 1566). What also is commonly known is that death usually occurs during sleep and that most victims do not exhibit any illnesses in any one degree at that time. It must also be important to realize what complications might arise from a broad generalization such as the previous. It may be used by some doctors in the medical profession to cover up what might otherwise be considered to be malpractice. With the good comes the bad as well.
Therefore, the National Institutes of Health assembled a group of experts to come up with a new definition of SIDS. “The sudden death of an infant under one year of age which remains unexplained after a complete postmortem examination, including an investigation of the death scene and a review of the case history. Cases failing to meet the standards of this definition, including those with postmortem examinations, should not be diagnosed as having SIDS. Cases that are autopsied and carefully investigated but which remain unresolved may be designated as undetermined, unexplained, or the like” (Zylke 1566). A few conclusions can be determined from this quote. One is that it gives a more precise, operant definition of the SIDS is in terms of age. Another, is that it provides room for cases that do not have all the symptoms of what is to be considered SIDS to be classified as unexplained or ruled out as being due to SIDS itself. It also takes abuse and neglect into account by examining the scene of death
. Obvious conclusions can be raised if a child’s environment was of poor living conditions where it was not well cared for, which most likely could have resulted in death. Is must be remembered that this definition only meant to serve as a benchmark for other research and cannot be applied to all conditions where a death attributed to SIDS is considered.
There are also other socioeconomic and demographic factors that can be associated with an increased risk of SIDS, but few exact causes have been identified. There have been studied however, that may show a correlation between cigarette smoking and SIDS. It “has not been determined whether or not a history of maternal smoking during pregnancy is biological in nature or a proxy for maternal behavior is not clear” (Malloy 1380). Research done by Haglund and Cnattingius have shown that infants born to women who smoke during pregnancy die earlier because of SIDS than do those infants whose mothers did not smoke during pregnancy (Malloy 1381). Their report supports the plausibility of a biological mechanism. What they did find, was that it was not possible to conclude that there was a relationship between the age of death and a history of maternal smoking during pregnancy, but there was a relationship between quantity of cigarettes smoked with an increased risk of SIDS (Malloy 1381). These affects that mat
ernal smoking has on the SIDS baby have not gone without others taking notice. According to other researchers, respiratory disorders during sleep have been thought to be one of the major causes of SIDS. With a distinct link to breathing abnormalities in many SIDS cases, suffocation has also been linked to mothers who smoke during pregnancy.
Another study has shown that Chronic Fetal Hypoxia may predispose infants to SIDS as well (Raub 2731). This is due to low hematrocrit during pregnancy (Raub 2731). This study has been supported by the National Institute of Child Health and Human Development. Researchers analyzed 130 SIDS cases and 1,930 members in their control group that survived the first year of life. They found that infants whose mothers smoked ten or more cigarettes a day had increased their infant’s chance of SIDS by almost 70% (Raub). So it can be seen from this that the more cigarettes a mother smoked per day while pregnant would do nothing but increase their infants chance of SIDS, according to this research. These researchers also see that maternal smoking may predispose infants to SIDS by impairing their normal development of the fetal central nervous system (Raub). The central nervous system is in control of such bodily functions such as breathing, which goes back to the theory of suffocation during sleep in SIDS babies
(Martin 194). In breathing disorders have been theorized to cause SIDS, and maternal smoking has been shown to impair development of the fetal central nervous system, there is an obvious link that exists between the two. Mothers should become increasingly aware of smoking as a cause of SIDS, along with other drugs and carcinogens as well. Sometimes the best solution to this problem boils down to the obvious which is prevention. In this case, it is prevention of smoking during pregnancy.
Another possible cause of SIDS may be due part to a defect in the autonomic nervous system. Increases in cardiac sympathetic activity may induce malignant arrhythmia’s even in the absence of heart disease ( Stramba 1514). There has been a consensus that SIDS might be multifactoral and that in most SIDS cases, death may be attributed to either cardiac or respiratory problems (Stramba 1515). There are still not any preventive measures for SIDS as of this time.
It is know that the development or maturation of cardiac and respiratory functions continue after birth, and that the chance of the infant having malignant arrhythmia’s during this time are different from that of an adult ( Stramba 1514). To understand the mechanisms that cause SIDS, a fuller understanding of what goes on in this postnatal period is crucial. There is also the possibility that SIDS victims may have a cardiac instability during the first months of life (Stramba 1521). This idea supports the notion of heart rate problems in such infants. According to recent data, the risk for SIDS increases by almost 30% for babies with heart rates that deviate from the mean ( Stramba 1541). All of these ideas open up a new area in the understanding of SIDS. Maybe there is a way to predict or to test for SIDS by checking such measures as heart and breathing rates. But there is still the problem that physicians cannot be totally confident in the use of such tests as they have not proved to be reliable in accurately predicting SIDS. This is why further research and testing must be done in not only this but in all areas.
There has been recent research in the risk of SIDS associated with vaginal breech delivery. A study done by Germain M. Buck, PhD., clinical assistant professor in the Dept. of Social and preventative medicine in Buffalo, NY, has also shown that there is more than twice the risk of SIDS when mothers were in labor for approximately sixteen hours or longer (Bergman 214). According to Buck, “The majority of breech SIDS infants were single footling deliveries (a rare type of breech presentation with the baby emerging with on foot first). The more common form of delivery called ‘frank’ presentation, with the baby exiting buttocks first was not associated with an increase in SIDS.” (Bergman 215). What can be concluded from this is that a breech birth may be an indicator of an earlier problem in the development of the fetus, and problems in the development of proper heart rate and breathing. Oxygen and blood flow may be restricted to the fetus, which can be a contributing factor in improper fetal development (Bosma 107). It is important to realize that a breech delivery is not the direct cause of this syndrome, which may be a false conclusion that can be drawn from this.
Although today SIDS is what can be considered essentially a diagnosis of exclusion, there is currently no apparent consensus about the extent of the investigation that must be undertaken in order to eliminate other possible causes of death ( Thatch 126). There is supposed to be a thorough examination of the death scene by a medical examiner as stated previously, but this is at their own discretion and does not happen very often (Gregory 2731). Simply put, most coroners either do not have the time nor are they willing at times to go out and investigate the death scene for other possible reasons of death. By examining the death scene, they also bring themselves into conflict with the parents of the child as well as outside support groups (Thatch 127). It is the purpose of those who are to counsel those coping with the loss of a child due to SIDS to diminish the pain and guilt that is associated with the death ( Cruan 53). Any outside investigation by the police or medical examiner does nothing but to induce guilt, which is extremely hard on the parents especially if they are not truly at fault.
The consideration of such an investigation may yield some unwanted results. It will from time to time reveal potentially preventable causes of death that may have otherwise been diagnosed as SIDS. Such causes that are mistaken for “true SIDS” are namely overeating, overlying and most often, accidental suffocation (Thatch 126). The harsh reality is that nobody is a perfect parent, and no matter how much care is given, accidents do happen. Another implication is that accidental suffocation by overlying during sleep can rarely, if ever, be conclusively proved by an examination (Bergaman 152). Once the parent awakens the baby from the sleeping position, the evidence is destroyed. The problems that arise from this are clear, making it obvious that death by suffocation may be unprovable. Which brings up the question of whether or not SIDS does actually exist. It is equally as hard to conclude the suffocation was not the cause of death, however.
There has been a presumed association between that of SIDS and apnea, which has led to the use of home apnea monitors for “diagnostic and preventive” purposes (Ahmann 719). They are located in homes where it is thought there is a risk of SIDS for the infant. According to the Congressional Office of Technology Assessment, as many as 45,000 infants are on home apnea monitors, which translates into 11.5 infants on monitors per every 1000 birth (Ahmann). The problem that is associated with the home apnea monitor is that most likely will cause distress within the family unit. It has been suggested to cause parental fatigue, anxiety, social isolation, and depression ( Defrain 215). This also leads to conflicts with others outside of the family such as friends, relatives, and those in the workplace that indirectly result from this problem in the home.
A Study was done by Elizabeth Ahmann to look for how home apnea monitors disrupted family life. Data from telephone interviews and mailed questionnaires were used to examine twelve aspects of family life such as parental depression, health, and attachment to the infant in ninety-three families that had infants who were considered to be at a high risk for SIDS, and who were on home apnea monitors. There was also a matched comparison of eighty-six families with infants that did not require monitoring. The results showed that the mothers of monitored infants were of poorer health than of those in the control group. Poor health, fatigue and somatic complaints were reported from mothers of monitored infants (Ahmann 722). Prior mental health was not considered in this study which may or may not account for those mothers of monitored infants that complained or showed poorer health. This could have possibly swayed the results, but the evidence still shows that those infants who were monitored had parents that clearly exhibited more stress. When the point of view of the mother of the monitored infant is taken, the results may be easier to see. It must be difficult having a child that needs to be monitored because of a possible chance of death within the home. This most likely would make it hard for the parents to have any rest while their infant is sleeping for they may feel that if they do not keep a constant eye on the child, it will be their fault for the child’s death, if it should so happen.
When a baby dies, each person in the family is going to experience it in a unique way. When a child dies from SIDS, this can be an even more tragic event because for the most part the death goes unexplained. It has been said that the death of a baby due to SIDS is extremely hard on the parents, for they feel a great amount of self blame. It takes approximately three years or more for the parents to recover from the death of a baby due to SIDS (Defrain 229). What is clear is that people are really never the same not only after a death due to SIDS, but also a stillbirth or miscarriage as well. The parents must learn that they can heal emotionally and that they can and must go on for their future and their own good (Defrain 229). They need to learn that life will get better even though the memory that they will always have of the child will exist in their hearts and minds. Seeking professional help to cope with such an event is a good idea. Deep emotional feelings that are bottled up need to be expre
ssed and brought out into the open. This is very beneficial not only for the parents but for the entire family as well.
The death of an infant due to SIDS may also cause parental unconscious conflicts. Parents have been shown to have the preoccupation with death in their dreams and their spouses ( Arno 53). Parents also may exhibit a mode of rejecting their child’s aliveness, independence or uniqueness ( Arno 54). These can be attributed to the obvious stress load that SIDS puts on the family. It shows that the pain and loss of a child reaches deep into the emotions of parents. During this time husband and wife may become closer to one another and show more feelings and compassion for one another. These are defense mechanisms that are used to ease the pain of the passing of the infant. Denial may bring the parents closer to one another as they concentrate on other matters in order to lessen the loss of the child. These can be considered to be normal psychologically as long as they do not get out of hand to the point where it may go on to such drastic measures such as suicide. This is a harsh reality that sometimes is best dealt with by seeking professional help.
The surviving child in the SIDS family is an important factor. The mental health of a child that is part of such a loss is very important. Children grieve, often deeply, and the unexpected loss of a sibling due to SIDS elicits feeling from other family members that changes the family structure (Mandell 217). It is of utter importance to bring out the child’s feelings into the open and to see how they feel about it. Negative feelings that are kept inside by the child may hurt the child’s development and how he grows up. It is important to remember that the child is being discussed. An older child or teenager still has a great amount of sorrow but is more understanding and realistic to what has transpired.
It is now obvious that the impact that sudden infant death syndrome has on the family and friends can be considered to be tragic and shocking to say the least. Other health professionals also are at times struck by how SIDS can so suddenly take an infants life away. The role of the family’s doctor and health care professionals are important in coping with this loss of life (Limerick 147). Providing early explanations and reassurance to the family along with the support of counselors and parents’ organizations are helpful especially when there are legal investigations, and when there are no clear causes of death. It is up to such health professionals to provide families with the support and the advice that they need in order to cope with their loss. Losing an infant to SIDS can be one of the most devastating events in the lives of many parents, especially when they might feel that the death was their fault, when a lot of times it was due to outside circumstances that are beyond their control. There are some things that parents can have no control over, and SIDS is one of these tragic events that can happen to a family unit.
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