✓ SIDS, the Crib Death Syndrome: what it is and causes

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SIDS: what it is and how to prevent it

It is the terror of every parent of a newborn: the SIDS , acronym for Sudden Infant Death Syndrome, that is sudden baby death syndrome, or cot death.

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Little is known about sudden infant death, SIDS, but several studies have shown that certain behaviors can help prevent this syndrome. And the National ...

What is SIDS

It is the sudden and unexpected death of an apparently healthy infant, which remains unexplained even after careful investigations that include a thorough examination of the circumstances of the death, an analysis of the clinical history of the child and his family and an autopsy.

As the website of the SIDS Seeds Association explains, death can occur during sleep at any time: both during the day and at night, both in the cradle, in the stroller or in the car seat, even in the arms of the parents, without any sign of suffering for the child.

Who it strikes, how frequent

By definition it affects babies between birth and one year of age, but it is more frequent between 2 and 4 months of life and among boys (constituting 60% of children who die). On the other hand, SIDS is rarer after six months. The phenomenon is more frequent in the winter period.

As reported by the Ministry of Health, "there are no national data on the incidence of the phenomenon, as there is no homogeneous detection system"; nevertheless "in the past it has been calculated in the order of 1-1,5 cases per 1000 live births, but it is currently in sharp decline and can be estimated at around 1 case per 2000 live births, that is approximately 240-250 cases each year".

The causes

By definition, SIDS is not to be confused with choking, strangling or crushing from the body of an adult. In these cases, in fact, death has an explanation.

At the moment the causes of this terrible condition are not yet definitively clarified, but it is believed that three risk factors come into play that simultaneously participate in precipitating the situation (in fact, we are talking about triple risk model). It is about:

existence of a critical window in the first year of life (and especially between two and four months);
presence of a basic individual vulnerability, how could they be gods defects in respiratory and cardiac regulation, due for example to brain stem anomalies;
action of external triggering factors, such as sleeping on your stomach, especially on soft surfaces, or cigarette smoking: factors that seem to have in common the fact that they lead to a less availability of oxygen in the blood, with increased carbon dioxide levels.

Typically when there is a decrease in oxygen levels in the blood, the body reacts with a series of "life-saving" compensatory mechanisms, such as stabilization of the respiratory and heart rate or the so-called arousal, a kind of pre-awakening. In some vulnerable children, however, this does not happen and if the phenomenon occurs in the critical window the result is unfortunately sudden death.

Read also: I am expecting a baby, will he sleep? All you need to know on the subject of sleep

How to prevent SIDS

Over time, the international scientific community has identified a series of very specific risk factors (for example sleeping on the stomach), knowing which it has been able to develop a list of very effective preventive strategies. Proof of this is the fact that, all over the world, where there is widespread information on these issues, at birth points and with parents, cases of SIDS decrease drastically. Here then all the useful tips to prevent SIDS (bibliographic sources at the bottom):

1. ALWAYS sleep on your back. To reduce the risk of SIDS - an official document from the American Society of Pediatricians recommends - babies must be put to sleep in supine position, i.e. on their back, whenever they sleep (even for short-term afternoon naps), by anyone who takes care of them (parents, nannies, nursery educators, etc.). This throughout the first year of life. Sleeping on the side is not safe and is not recommended.
Obviously, when the baby is awake, it can be kept on his stomach for some time, to help motor development and hinder the onset of plagiocephaly. In these moments the child must always be kept under control.
2. Very firm mattress and the exact size of a cot / bed, without pillow
Soft mattresses (and even those in memory foam, specify American pediatricians) increase the risk of forming "pockets" in which the baby can end up on his stomach and risk suffocation. Also not to let the child sleep on sofas (also due to the danger of falls), pillows, quilts. Another important recommendation is to avoid objects in the cot: no to soft toys, dolls or bumpers.
3. Give preference to breastfeeding. Many studies have documented a protective effect of breastfeeding with respect to the risk of SIDS. In particular, exclusive breastfeeding for six months is recommended, but mixed breastfeeding also appears to have a protective effect, albeit minor.

Read also: Breastfeeding: 22 answers to the most common doubts of mothers

4. Sleep in the parents' room, but generally better in different beds
Many studies document the fact that having a baby sleep in the same room as the parents for the first year of life, or at least the first six months, reduces the risk of SIDS by 50%. However, the recommendation is to avoid sharing Latvian: a recommendation that is often a source of discussion and controversy, because it is not clear how solid the scientific evidence is in its favor.

For sure, it is known that the risk of SIDS increases in the case of sharing a Latvian in some particular circumstances, namely if:

the baby is less than 3-4 months old or was born prematurely;
parents smoke (not necessarily in the bedroom or at home, as long as they just smoke);
mom smoked during pregnancy;
parents have behaviors that reduce alertness, such as the consumption of alcohol or drugs or the intake of particular drugs that cause sleepiness;
Latvian is shared by people who are not parents (for example older siblings);
the surface of the mattress is soft and there are no pillows or blankets.

A recent Australian book on SIDS points out that instead there are no firm conclusions regarding the risk of cot death if the sharing takes place between breastfed babies and parents who do not smoke (and did not smoke during pregnancy), do not consume alcohol. , do not take drugs or drugs. In any case, also due to these uncertainties, many countries advise against sharing a Latvian in the first year of a child's life.

Read also: Premature babies, the possible risks to life

5. Yes to the pacifier. If the baby accepts it, it is proposed only after proper initiation of breastfeeding for breastfed babies. As the document of the American pediatricians recalls, it is not necessary to put the pacifier back in the child's mouth if he loses it during sleep, and obviously to sleep it must be used without laces or chains.
6. Cool environment. The ambient temperature should be kept around at 18-20° C, not more. Excess clothing and heavy blankets which can make the baby sweat excessively should also be avoided. And if he has a fever, remember that he may need to be dressed less, not more.
7. No alcohol and no smoking during pregnancy. See below.
8. No smoking in the house. We must not smoke and we must avoid that even occasional visitors smoke in the house.
9. Yes to vaccines. The idea that some vaccinations may carry the risk of SIDS is a hoax. Conversely, some studies show a protective effect of childhood SIDS vaccinations.

Smoking and alcohol in pregnancy and SIDS risk

No smoking and no alcohol during pregnancy: are among the basic tips for prevention of SIDS. In fact, various studies have shown that smoking or drinking while waiting increases the risk of the unborn child to die in a cot. For example, a survey published in January 2022 in the journal EClinicalMedicine showed that the risk was increased fivefold for children of mothers who continued to smoke beyond the first trimester of pregnancy, and fourfold for children of mothers who continued to smoke. they continued to drink alcohol beyond the first trimester. Not only that: the same study indicated that if the two habits go hand in hand - that is, the expectant mother both smokes and drinks alcohol beyond the first trimester - the risk of SIDS increases by 12 times.

SOURCES for this article: materiale informativo dal sito dell'Associazione Semi per la SIDS; JR Duncan and RW Byard, SIDS Sudden Infant and Early Childhood Death - The Past, the Present and the Future, University of Adelaide Press, 2022 (ebook scaricabile, in inglese); materiale informativo del Ministero della Salute; AAP, SIDS and Other Sleep-Related Infant Deaths: Updated 2022 Recommendations for a Safe Infant Sleeping Environment, Pediatrics, nov. 2022

Questions and answers

What is SIDS?

Sudden Infant Death Syndrome or SIDS (Sudden Infant Death Syndrome or SIDS) is a phenomenon that still has no explanation in the scientific community.

What position should the baby sleep in to avoid SIDS risk?

The baby must be put to sleep in a supine position (belly up) from the first days of life; he should also sleep in a cot or bed, preferably in his parents' room.

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