October has been designated as a time to observe some solemn occasions that may affect families during pregnancy, birth and postpartum. This month, Science & Sensibility has previously covered Pregnancy and Infant Loss Awareness Month in two previous posts here and here. Today I would like to recognize that October is also SIDS Awareness Month.

As childbirth educators, part of our curriculum for expecting parents includes discussing SIDS, providing an explanation of what it is (and what it isn't) and how to reduce the risk of a SIDS death.

What is SIDS?

Sudden Infant Death Syndrome (SIDS) is defined as the sudden death of an infant less than 1 year of age that cannot be explained after a thorough investigation is conducted that includes a complete autopsy, examination of the death scene, and a review of the medical history. SIDS is the leading cause of death for infants aged 1 to 12 months in the United States. About 2000 infants die every year in the USA from SIDS. African American and American Indian/Alaskan Native babies are twice as likely to die of SIDS as white babies.

Most SIDS deaths occur in babies between 1 month and 4 months of age, and the majority (90%) of SIDS deaths occur before a baby reaches 6 months of age. However SIDS deaths can occur anytime during a baby's first year. Slightly more boys die of SIDS than girls.

Since the USA introduced the Safe to Sleep® campaign (formerly known as the Back to Sleep Campaign) in 1994, the number of infants dying of SIDS has dropped by 50%.

What SIDS is not

• SIDS is not suffocation nor is it caused by suffocation
• Vaccines and immunizations do not cause SIDS
• SIDS is not a result of choking or vomiting
• SIDS is not caused by neglect or child abuse
• SIDS is not contagious
• SIDS is not caused by strangulation

What causes SIDS?

While the cause of SIDS is not known, there is more and more evidence that infants who die from SIDS have brain abnormalities that interfere with how the brain communicates with the parts of the nervous system that control breathing, heart rate, blood pressure, waking from sleep, temperature and other things. More information on what researchers are finding as they work to identify the cause of SIDS can be found here.

What are the risk factors for SIDS?

There are several risk factors that put babies at higher risk of SIDS. Childbirth educators should be providing this information to families during class. These risk factors include:

• Being put to sleep on their stomachs
• Being put to sleep on couches, chairs, or other soft surfaces or under soft coverings
• Being too hot during sleep
• Being put to sleep on or under soft or loose bedding
• Being exposed to smoke in utero, or second hand cigarette smoke in the home or car, or the second hand smoke of care-givers or family.
• Sleeping in an adult bed with parents, other children or pets especially if:
  • Bed-sharing with an adult who smokes, recently had alcohol or is tired
  • Sleeping with more than one bed sharer
  • Covered by a blanket or a quilt
  • Younger than 14 weeks of age

NOTE: If families in your classes are going to be bed-sharing with their infants, (which sometimes is the reality for new parents getting accustomed to life with baby) it is important for you to provide information about what safe bed sharing looks like. I recommend 'Sharing Sleep with Your Baby' by Robin Elise Weiss for resources to share on this topic.

What reduces the risks of SIDS?

New parents can do many things to reduce the risk of their infant dying from SIDS. You can share this information with your classes. These risk reductions include:

• Always place a baby to sleep on his/her back
• Have the baby sleep on a firm sleep surface (Not a carseat, bouncy seat or swing as your baby's normal sleep spot.)
• No crib bumpers, toys, soft objects, or sleep positioning products (even if they claim to reduce the risk of SIDS) in the baby's sleep space
• Breastfeed the baby
• Room sharing with the baby
• Have regular prenatal care during pregnancy
• Mothers who refrain from smoking, drinking alcohol or using illicit drugs during pregnancy and after the baby is born
• Do not allow second hand smoke around the baby or have caregivers or family members who smoke around the baby
• Once breastfeeding and milk supply is firmly established and baby is gaining weight appropriately, offer a pacifier (not on a string) when baby goes down for their last sleep.
• Do not overdress the baby for bed or overheat the room
• Maintain all the healthy baby checkups and vaccines as recommended by the baby's health care provider
• Do not use home breathing monitors or heart monitors that claim to reduce the risk of SIDS.

Talking about difficult topics in a childbirth class can be hard for both the eductor and the families. No one wants to think that the unthinkable might happen to them. But sharing accurate facts about the risks and how to reduce those risks is an important part of any childbirth curriculum. How and when do you discuss this topic in your classes? Do you have a video or handout that you like to share? Please let us know in the comments section, how you effectively cover SIDS topics in your childbirth classes.

Resources for professionals

• http://www.nichd.nih.gov/sts/materials/Pages/default.aspx#providers
• http://www.nichd.nih.gov/sts/campaign/outreach/Pages/default.aspx
• http://www.nichd.nih.gov/health/topics/sids/researchinfo/Pages/default.aspx

Resources for parents and caregivers

• http://www.nichd.nih.gov/sts/materials/Pages/default.aspx#parents
• Safe to Sleep®
• SIDS Awareness Month

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