FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

STEPS CAN BE TAKEN TO REDUCE THE RISK OF SUDDEN INFANT DEATH

Question: My sister is pregnant and expecting her first child. She is very worried because of stories she's seen in the press about babies who die while asleep in their cribs. Our mother used to tell us about her brother who died when he was 2 months old, so I'm sure that this helps make my sister extra worried about this happening to her baby. What can I tell her to make her feel less worried?

Answer: The condition you describe is called Sudden Infant Death Syndrome or SIDS for short. This terrible condition is currently responsible for the death of about 6,000 babies a year in the United States. It is the leading cause of death for babies between two weeks and one year old and most commonly strikes those between two and four months of age.

SIDS is a mysterious condition. It kills seemingly healthy babies without warning, and often an autopsy cannot conclusively uncover the cause of death. It is important to remember that SIDS is a syndrome, and like all syndromes, it is a collection of symptoms rather than a single specific disease.

Many experts feel that the position in which a baby sleeps might play a role in some cases of SIDS. In 1992, the American Academy of Pediatrics suggested that babies under the age of six months be placed on their sides or their backs at bedtime, not on their stomachs. This simple change has resulted in a greater than 50 percent reduction in the frequency of SIDS deaths.

Researchers aren't sure why placing young babies to sleep on their stomachs increases the risk of SIDS, but there are at least two plausible theories. From the stomach-sleeping position the baby has more trouble regulating his or her body temperature, and it is felt that this may be a factor in some who died from SIDS. Also, young infants sleeping in this position may have more trouble clearing vomit from their mouth and airway and, thus, may actually choke to death on their "spit-up."

To minimize the risk of SIDS, babies should be put to bed on a firm mattress. A mattress soft enough that the baby's head can make an indentation on the surface can cause the baby breathing problems. This caution against soft surfaces holds true not only in the evening but also when putting the baby down for a nap. At nap time, be particularly careful not to lay the child on soft surfaces like bean bag chairs, or sofa pillows. Also, be sure to keep soft pillows and stuffed animals out of the child's crib at all times.

Further, to help keep body temperature within the normal range, don't overdress the infant. A good rule of thumb is to dress baby in the same amount of clothing that makes you feel comfortable in the same temperature and humidity.

There are a few conditions that increase the risk of SIDS. Having a previous baby who died of SIDS is a risk, but having an aunt or uncle that did (as is the case in your family) doesn't. Premature birth and maternal smoking also increase the risk of SIDS, as does low birth weight among full-term babies.

The use of an apnea monitor, a device that signals if the baby has quit breathing for more than a few seconds, can be successful in preventing SIDS in children who are at risk. This treatment has a high price in terms of lost sleep and emotional stress because of frequent false alarms, though. Fortunately, the apnea monitor is usually only necessary for a few months and worth the emotional wear and tear on the parents.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.