Sudden infant death

Sudden infant death, too Sudden infant death syndrome Called (SIDS), it is the sudden, unexpected death of an infant or young child. The cause of death cannot be ascertained during a subsequent autopsy.

Signs of sudden infant death syndrome

Unfortunately, there are no signs that point directly to the approach of sudden infant death syndrome. However, there are risk factors whose importance has emerged from numerous studies over the past few years.
Above all, this includes maternal smoking during pregnancy and the prone position of the child during sleep. Overheating of the child during sleep, too much covering of the head and a lack of breastfeeding are also risk factors.
Even if there are no sure signs of the approaching sudden infant death syndrome, there are signs that can mean a particularly high risk for the general occurrence of sudden infant death syndrome. These include pauses in breathing in the child (apnea phases), very profuse sweating in the child during sleep, unusually pale skin in the child during sleep or bruises or blue tinting of the arms and legs during sleep. If any of these signs occur, the pediatrician should be consulted and informed. Children who have already had a similar experience are also considered to be particularly at risk of sudden infant death syndrome. Likewise children whose sibling has died of sudden infant death.

Action to be taken if breathing has stopped being suspected

First, you should try to awaken the child. Under no circumstances should this be shaken, as this can trigger cerebral haemorrhage. If the child cannot be awakened, resuscitation measures should be initiated until the emergency doctor arrives. The child is directly ventilated twice via mouth-to-mouth resuscitation and then given 30 chest compressions. This change is carried out continuously until an emergency doctor arrives or the child shows functioning vital functions again.

Diagnosis

First, the exact history should be collected and the "Death Scene“, Ie the sleeping situation must be considered. However, an autopsy according to standardized guidelines is necessary to confirm the diagnosis of sudden infant death syndrome. The first thing to do is to rule out other causes of the child's death. If no precise diagnosis can be made here either, there are some clues, such as bleeding on the pleura and thymus, as well as changes in the brain and a comparison with previously collected data that indicate sudden infant death syndrome. These changes indicate an earlier oxygen deficiency, which however could not be proven by anamnestic. Sudden infantile death itself cannot, however, be proven with certainty by an autopsy.

Preventive action

Basically, some of the exogenous risks can be avoided by parents. This particularly includes the fact that babies should not sleep on their stomachs. This is the most important and most effective preventive measure. In addition, overheating of the child should be avoided. Soft sheepskins should also be avoided, as well as exposure of the child to nictoins in the sense of passive smoking. Infants should not sleep alone in the room, but rather in the parents' room, but in their own bed. Regular checkups and breastfeeding are also important for the children, as is early treatment of infections. However, it is particularly important to educate parents so that they do not make simple mistakes with potentially devastating consequences.
Please also read our article on this Dangers in the cot.

Children with endogenous risk factors should see a pediatrician regularly. Care and health measures are very important here. A home monitor for sleep monitoring can be given to children at high risk. However, this is only indicated in children with a tendency to respiratory arrest, premature babies with malformations of the lungs and infants after a previous event. However, the preventive effect of these monitors is not guaranteed. Parents must be trained in how to use the device correctly and learn appropriate resuscitation measures. For this reason, the monitors available on the market are not suitable for preventing sudden infant death syndrome, but only give the impression of greater security. Monitoring without medical supervision does not make sense.

The best preventive measure parents can take on their own is the right size sleeping bag for children. They should also sleep on their back or side. The sleeping bag prevents you from being wrapped in the blanket, keeps the temperature constant and leaves your arms free. Pillows, cuddly toys or duvets can also represent potential dangers for the child and should be avoided.

Mattresses with alarm / Angelcare®

There are children who are at a particularly high risk of sudden infant death syndrome. For example children with a sibling who died of sudden infant death syndrome or children with breathing disorders. There are certain monitoring devices for so-called home monitoring for these infants. In particular, breathing is monitored here. However, a home monitor is only prescribed for children who have an increased risk of sudden infant death syndrome. Numerous parents of completely healthy and not more endangered children, however, also worry about the well-being of their babies night after night. Therefore monitoring systems have been developed that do not require medical prescription and can be purchased privately.
These are mattresses that measure the child's breathing movements. They are also known as sensor mats, baby monitors or motion detectors. The best-known manufacturers of these mattresses are Angelcare® and Babysense. Most of these monitoring systems are also combined with a baby monitor to ensure additional auditory or visual monitoring. The sensor mat is placed under the actual mattress of the bed. It registers the child's breathing movements. As soon as there is no movement for a certain period of time, i.e. the mattress takes a break, an alarm is triggered. The period from which an alarm is triggered is usually 20 seconds without breathing movement or less than 10 breathing cycles per minute. Angelcare® brand sensor mats, for example, can be purchased online from 85 euros.

Pacifiers as prophylaxis?

Some studies have found evidence that sleeping with a pacifier may lower the risk of sudden infant death syndrome. However, the data situation on this is partly inconsistent. So far it has been clear that breastfeeding should protect against sudden infant death syndrome. It is not yet clear why. It was investigated whether it has a protective effect for children who cannot (or cannot) be breastfed if they sleep with a pacifier. This hypothesis has been proven in several studies. However, this does not mean that a pacifier should be forced on the child. Overall, the following applies: especially with children who (cannot) be breastfed, a pacifier could have a protective effect. However, this only applies to the times when the child sleeps and not to the waking hours. This potentially protective effect does not mean that the child should always have the pacifier. If it doesn't want it or if it loses it in your sleep, then it shouldn't be offered any further. In the case of children who (can) be breastfed, the importance of the pacifier as protection against sudden infant death syndrome has not yet been sufficiently clarified.

Accompanying concerned parents

The death of one's own child represents a very great, stressful loss for the parents. In addition, there can be great self-reproach and blame if a sudden infant death occurs in the family. The police investigations into the ruling out child homicide contribute significantly to the feeling of guilt. For this reason, it is important to accompany and educate the parents. It has been shown that it helps parents a lot to talk to the autopsy doctor to find out the exact reasons for the infant death syndrome. In addition, the close relatives must be involved in the mourning process. Couples who have suffered a severe loss often pull back and isolate themselves. That is why family support is extremely important. Not least for the partnership. This can break through the death of the child, but there are also couples who grow closer together through such a fate. There are also self-help groups to provide support. In these communities people talk about what they have experienced in order to be able to process the loss.

Age at sudden infant death syndrome

More than two thirds of all sudden infant deaths occur within the first 6 months of life. The frequency peak is - depending on the study - between the 2nd and 4th or between the 3rd and 4th month of life. Sudden infant death syndrome occurs rather rarely in newborns and in older children from 1 year of age. Most cases occur during the winter months. However, the previously known winter peak is gradually disappearing.
The frequency of sudden infant death syndrome has fallen from 1-3% to less than 0.5% thanks to targeted preventive measures in European countries. Boys are usually affected slightly more often than girls.

Until when can sudden infant death syndrome occur

About 2-6% of unexplained deaths in children occur after the first year of life. However, by definition, Sudden Infant Death Syndrome (SIDS) is the death of an infant from an unexplained cause of death. A child up to the age of 1 is called an infant.

Is there also a sudden infant death syndrome in the womb?

No. Sudden infant death syndrome is an event that, by definition, occurs only after the child is born. It describes the death of an infant with an unexplained cause and usually occurs within the first year of life. Of course, it unfortunately also happens that unborn children die in the womb. However, this is not referred to as sudden infant death syndrome and can have various causes.

Causes of sudden infant death syndrome

So far, there is no established cause for sudden infant death syndrome. Therefore, the multifactorial hypothesis is currently considered the most likely. This states that children who are endogenous (inner) and exogenous (outer) Are exposed to risks, can decompensate during sleep under a lack of oxygen. 90% of children die in their sleep. The following risk factors could be observed more frequently in children who died from SIDS than in control children.

The individual risk factors can have different degrees of influence on sudden infant death syndrome. While the endogenous risk factors can hardly be influenced, the exogenous risk factors can in part be bypassed very well. It is important to know that the individual factors do not yet represent a risk, only several of the following points must occur. Even then, however, this does not mean that sudden infant death syndrome can certainly occur. Since the cause has not yet been precisely explained, this is a summary of all factors that have been linked to cot death.

Risk factors

Endogenous risk factors include Premature babies or those born with defects, especially if the lung present. In addition, infants who are suffering from a severe form of respiratory depression and Circulatory weakness suffered after giving birth. Siblings of SIDS deaths and infants who have already suffered an attack and received timely treatment are at increased risk. Furthermore, children of drug-addicted mothers or children with proven breathing pauses during sleep are considered at risk. In addition, the following autonomous regulatory weaknesses are fraught with risk:

Conduction changes in the heart, increased sweat production, Reflux disease, impaired suction-swallowing coordination, noticeable sedentary lifestyle and high-pitched screaming. Children who are difficult to wake up can also have an increased risk.

The exogenous factors are much more controllable and therefore important for parents. It is noticeable that the clear majority of the children were found in the prone position. In addition, overheating during sleep, a soft mattress and exposure to nicoin can be problematic during and after pregnancy. Frequent infections in children, both viral and bacterial, can lead to breathing pauses or heat stress. The sleeping situation is also very important. For example, screwing into the duvet, being trapped or being covered over can pose a risk. Sleeping the child in close physical contact with alcoholic parents can also be dangerous. Psychosocial factors such as increased stress of the child, little attention, neglected care and a poor socio-economic status can all have an impact on sudden infant death syndrome. Whether a missing Breastfeeding Influence is so far unclear.

In addition to these rather vague causes, there are also some pathological causes of sudden infant death syndrome. These include cerebral disorders such as bleeding, Tumors and malformations. Also respiratory diseases such as pneumonia or malformations, as well as cardiac diseases or sepsis can lead to sudden death. Congenital metabolic disorders and gastrointestinal diseases can also be explainable causes. Furthermore, of course, accidents during sleep, e.g. Strangulation and suffocation or willful infanticide through suffocation or poisoning are possible. In order to trace the mass of possible causes back to an individual diagnosis, an autopsy is necessary.

Prone position as a risk factor

In addition to smoking, the child's prone position is one of the main risk factors for sudden infant death syndrome. Sleeping in the prone position is said to increase the risk by 9 to 13 times. But lying on your side, in contrast to lying on your back, also means a 2 to 3-fold increased risk. Probably most likely because the children can roll onto their stomachs relatively quickly from their rather unstable side position during sleep.In the past, sleeping on your back was seen as a risk of developing skull deformities. However, this has now been refuted. Parents can also lay their children on their stomachs when they are awake to avoid lying on their backs all the time. Because the prone position is only dangerous during sleep phases. The use of baby pillows, the so-called sleep positioners, to avoid the prone position is not recommended, they are more likely to be dangerous.

Smoking as a risk factor

Sudden infant death syndrome is still the subject of research and study. It is still not clear what causes seemingly healthy children to suddenly die. However, there are certain risk factors that can increase the likelihood of sudden infant death syndrome. This includes the mother's cigarette consumption during pregnancy.
According to recent studies, the risk of sudden infant death syndrome increases significantly from a consumption of 10 cigarettes per day. From 10 cigarettes a day, the risk of sudden infant death syndrome is said to increase by 8 to 10 times. Ten years ago almost one in five pregnant women smoked. This shows what a significant influence this risk factor has. A 2007 study found that smoking was one of the most important risk factors of all. According to this study, 60% of sudden infant deaths could be prevented without nicotine consumption. Passive inhalation of cigarette smoke, also known as passive smoking, increases the risk of sudden infant death syndrome. About 2 to 3 times as much.

Fireplace as a risk factor?

The current data on factors that can promote the occurrence of sudden infant death syndrome includes cigarette smoke, but not fireplace smoke. According to current studies, there is agreement that cigarettes (both in passive form in the infant and in active form through smoking by the pregnant mother) are one of the main risk factors for sudden infant death syndrome and should therefore be avoided at all costs. So far there is no data on the influence of chimney smoke. In the case of a fireplace that - as is common practice everywhere - has been checked and approved by a chimney sweep, the smoke that arises when the fire is lit should be drawn upwards through the draft and therefore not pose a risk.

Vaccination as a risk factor?

Many opponents of vaccinations discuss vaccinations as a possible trigger or risk factor for sudden infant death syndrome. In particular, the six-fold vaccination, which can be administered from the second month of life and should be repeated twice, is the focus here. However, there are no studies to suggest that vaccinations could increase the risk of sudden infant death syndrome.
On the contrary: studies show that control children (who have not died) are vaccinated significantly more often than children who died from sudden infant death syndrome. According to experts, the idea that vaccinations could increase the risk of sudden infant death syndrome only came about because the peak of the disease coincides with the time when most children receive their first vaccinations.

Statistics in Germany on sudden infant death syndrome

In 2002, 334 children in Germany died of sudden infant death syndrome. The diagnosis was the cause of almost 22% of deaths in children between the 8th day of life and the first year of life. In 2008 there were 215 cases. In 2014, 119 children died of sudden infant death syndrome.
About 80% of these unexplained deaths occur before the age of 6 months. Sudden infant death syndrome most frequently occurs between the 2nd and 4th month of life. About one and a half times as many young boys as girls are affected. Sudden infant death syndrome is still the most common cause of death during the first year of life.

Summary

Sudden infant death syndrome is a rare but even more devastating event when it occurs. The parents can avoid many potential dangers for the child through preventive measures such as the right sleeping situation and thus significantly reduce the risk for their own child. It is particularly important to avoid the prone position when children are sleeping. If sudden infant death syndrome occurs, resuscitation measures must be started immediately if the child cannot be awakened. Successful resuscitation can be very unlikely, depending on the length of time between the respiratory arrest and the first attempts at resuscitation. If death has occurred, a police investigation is always followed in such cases, as willful infanticide must be ruled out. This also means an autopsy in which other causes of death are sought. If these cannot be found, but there are indications that suggest an oxygen deficiency, the diagnosis of sudden infant death syndrome is made.

After such a great loss, the parents should focus on coping with the grief with medical and psychological support.