Law Enforcement and Fire Service Chaplaincy of Napa County
Sudden Infant Death Syndrome
Prepared by Chaplain Lee Shaw
Law Enforcement and Fire Service Chaplaincy of Napa County
Telephone: 707.479.5812
E-mail: lee@napachaps.com
PO Box 2022
Napa, California 94558
Sudden Infant Death Syndrome
Definition
Sudden Infant Death Syndrome (SIDS) is the "sudden death of an infant under one
year of age which remains unexplained after a thorough case investigation,
including performance of a complete autopsy, examination of the death scene, and
review of the clinical history" (Willinger, et al., 1991).
Sudden Infant Death Syndrome (SIDS), more commonly known as “crib death,” is
a medical mystery, which affects up to 7,000 infants each year in the United States.
Although there are several theories of cause, none have yet to withstand the careful
scrutiny of medical investigation. SIDS is defined as the sudden death of an infant,
which is unexpected by history and for which there is no satisfactory explanation
of a cause of death, following a thorough postmortem examination and autopsy. In
other words, the death is inexplicable – it can’t be predicted nor prevented.
Basic Facts about SIDS
A. SIDS is the number one cause of death in infants who are more than one
week old.
B. SIDS most commonly occurs in infants between ages three weeks to
seven months. Occasionally an older or younger baby may die of SIDS.
C. SIDS is not a rare disease. Approximately 6,000 to 7,000 babies die as a
result of SIDS every year in the U.S. – about two to three for every
1,000.
D. SIDS victims do not suffer; death occurs within seconds, usually during
sleep.
E. SIDS is at least as old as the Old Testament and seems to have been at
least as common in the 18th and 19th centuries as it is now. The term
Sudden Infant Death Syndrome (SIDS) came into general medical use
after 1969.
F. SIDS is not caused by suffocation, aspiration, aspiration or regurgitation,
although sometimes death certificates erroneously bear such terms. SIDS
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became an acceptable term for general use on death certificates after
1973. Periodically other terms may still be used.
G. A minor illness such as a common cold may precede the death, but many
victims display no observable symptoms. The majority have appeared
entirely healthy.
H. SIDS is not contagious.
I. SIDS is not considered hereditary.
J. SIDS occurs among families of all social and economic strata.
K. Researchers believe SIDS probably has more than one cause, although
the final process of death may be similar in most cases.
L. Due to the nature of SIDS, no single test has been discovered to identify
which infants will succumb to it. There is, therefore, no means of
prevention.
What Causes SIDS?
Countless theories exist about the possible causes of SIDS. Today, in
spite of extensive research, no single theory has yet been proven, but many
have been disproved. It seems likely that SIDS, like many other disorders,
will eventually have more than one final explanation.
Current studies include those involving the nervous system, the heart,
breathing and sleep patterns, body chemical balances, autopsy findings and
environmental factors. Researchers claim that no single area of study will
provide the final solution, but each area may ultimately contribute to its
understanding. Scientists generally agree that while SIDS victims may
appear normal, they most likely have subtle functional defects, which are not
discernable at this time. The National SIDS Foundation makes available
results of the most current research.
Articles and reports about SIDS often appear in the news media, often
claiming “the cause” has been discovered. It is important to re-state
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that SIDS continues to be an unsolved problem. Even with current scientific
knowledge, SIDS victims cannot be identified beforehand.
Commonly asked Questions about SIDS
A. Question: Can SIDS be prevented?
Answer: No.
Nearly all affected parents wonder if there might have been something they
Could have done to prevent their baby’s death. The answer is that there still is no
way to determine which baby will die of SIDS. Presently there is no certain way
anyone can prevent the death.
SIDS occurs in all social, economic, ethnic and racial groups in the United
States. There are, however, certain groups of babies who are at slightly increased
risk. For example, statistics indicate that there is a higher incidence of SIDS among
premature and low-birth weight infants as well as among twins and triplets. SIDS is
more frequent among babies born to teenagers, mothers who smoke heavily or abuse
drugs and those who have not received good prenatal care. Other groups at
increased risk are babies of American Indians, black, and poor families. Although
the previously mentioned groups have more of a chance of having a baby die of
SIDS, most victims of SIDS have few or none of the risk factors mentioned.
SIDS is not predictable or preventable at this time. However, there are actions
that parents may take to decrease the risk, not only for SIDS but also for other infant
problems. Health professionals should encourage mothers to take good care of
themselves during pregnancy and to obtain good prenatal care to decrease their risk.
B. Question: Did the baby suffer?
Answer: SIDS is considered to be an almost instantaneous event.
There may be some movement during the last few seconds of life, accounting for
the crumpled covers or unusual positions in which babies are found. Babies do not
cry out and often show no signs of having been disturbed in their sleep. Parents who
have witnessed their babies’ deaths have reported that they appeared to die very
peacefully in their sleep, that they appeared simply to stop breathing.
C. Question: Did the baby suffocate in its bedding?
Answer: SIDS is not caused by suffocation.
It is not uncommon for a victim to be found wedged into a corner of the crib or
with blankets over its head. Sometimes the face may be pressed down into the
pillow or mattress; it may be discolored. Under these circumstances it is natural to
assume that the baby smothered. However, SIDS has also occurred under conditions
in which there was no possibility of smothering. The baby can be found without any
bedding, clothing, toys, or pets around or near the face. The autopsy findings are the
same in suffocation and in SIDS. Investigators have found, however, that even when
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babies are completely covered by bedding, the amount of oxygen available to them is
not reduced enough to cause suffocation.
D. Question: Could the baby have vomited and choked after the last
feeding?
Answer: SIDS is not caused by vomiting or choking.
Sometimes milk or even blood-tinged froth is found around the mouth or nose or
on the bedding. This discharge has been shown to have occurred after death; at
autopsy, the fluid is found not to have blocked the internal air passage.
E. Question: Was it something infectious? Are others in the family in
danger?
Answer: SIDS is not a contagious disease that spreads from one
person to another.
SIDS is not likely to occur after the first year of life; so, older children are not at
risk. There is no need to be afraid of contamination from clothing, bedding or
furniture of the baby who died of SIDS.
F. Question: Is SIDS caused by a DPT shot?
Answer: Presently there is insufficient evidence for the conclusion
that DPT immunization is a cause of SIDS.
Research studies conducted by the National Institute of Child Health and Human
Development and other research groups have failed to show any increased frequency
of DPT vaccination among SIDS infants as compared with matched controls. The
results on multiple (two or more) DPT inoculations, furthermore, reveal a lower
proportion for SIDS cases than control infants, regardless of race. SIDS occurs with
virtually the same frequency in countries with different immunization schedules.
SIDS has also occurred in infants who have never received immunizations.
G. Question: Is SIDS caused by child abuse or neglect?
Answer: SIDS is not caused by child abuse or neglect.
Because a SIDS death may not be discovered for hours, postmortem changes may
occur which result in the body’s appearing to be injured. It is important that first
responders and emergency personnel recognize normal postmortem changes.
Parents may also have questions about their baby’s appearance and should discuss
them with their doctor or SIDS counselor.
H. Question: Would it have helped if the baby had breast fed?
Answer: Breast feeding does not prevent SIDS.
The problem of SIDS was mentioned in literature of past centuries when nearly all
babies were breast-fed. Recent research shows SIDS occurs to breast-fed as well
as bottle-fed babies. Breast feeding is recommended not because it is a way to
prevent SIDS, but because breast milk is usually well tolerated by the baby.
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I. Question: What about babies that parents might have in the future?
Answer: According to the best available data, SIDS is not
hereditary, and any future babies in the family will run
only a very slight risk.
More than 99 in 100 will not die of SIDS. More harm than good may be done to a
Subsequent child by excessive anxiety over SIDS.
J. Question: Is SIDS a newly discovered disease? Are there more
cases now?
Answer: SIDS deaths have probably been recorded for thousands
of years.
In earlier times most infants slept with their mothers and it was assumed that
when “crib death” occurred, the mother had accidentally smothered the baby by
rolling over on it. Now, such an event is considered extremely unlikely. SIDS is a
terrible tragedy for a family and the notion that parents have some how caused the
death is untrue and unnecessary.
In recent years there has been more publicity about SIDS, which makes it seem
that there are more cases of SIDS. However, the incidence has remained about the
same for many years.
K. Question: Do SIDS Deaths occur all over the world?
Answer: SIDS is widespread.
Studies of the syndrome in Europe, Australia, Canada, Japan, the Soviet Union,
Philippines and throughout the United States have all revealed similar rates of
occurrence. SIDS occurs as frequently in warmer climates as in cooler ones.
Suggestions for planning a child’s service
A.
Consider . . .
 Take your time; don’t be rushed.
 Plan a service that meets your needs; don’t be restricted by what others
may think.
 Take an active part as the parent in the planning of the service.
 Meet your needs without financially draining yourself.
 If you need financial help, the funeral director should be able to direct
you to the proper authorities in county offices.
B.
Also consider . . .
 requesting a lock of your baby’s hair
 requesting a hand print or foot print of your baby
 having someone take photos of floral arrangements
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 using a bonnet or hat on the infant if an autopsy has been performed
 finding out if there are visitation hours or limitations as to when you can
be with your child prior to the service.
 burying your child with family pictures, a favorite toy or in their favorite
clothing
 having photos taken of your child alone, or with family members
 putting stillborn or very small infants in doll clothes, which tend to fit
better
 letting each sibling select something of the child’s to place in the casket
 placing a friendship necklace on the child (the type where you wear the
other half)
 in lieu of flowers, establish a scholarship or donate to a SIDS or other
organization
 asking for changes if you are not pleased with the positioning or
appearance (hair/makeup) of your child
C.
In the days and months that follow, consider the following:
 seeking out a peer or professional support group
 using the memorial/service card to announce your child’s death to friends
who may not have heard of the death
 taking your time in dispersing your child’s toys and other belongings
 donating your child’s toys to a hospital or church nursery
 asking for a copy of the autopsy report
 collecting pictures, cards, etc., for a memory box
What Are the Most Common Characteristics of SIDS?
Most researchers now believe that babies who die of SIDS are born with one or
more conditions that make them especially vulnerable to stresses that occur in the
normal life of an infant, including both internal and external influences. SIDS
occurs in all types of families and is largely indifferent to race or socioeconomic
level. SIDS is unexpected, usually occurring in otherwise apparently healthy
infants from 1 month to 1 year of age. Most deaths from SIDS occur by the end of
the sixth month, with the greatest number taking place between 2 and 4 months of
age. A SIDS death occurs quickly and is often associated with sleep, with no signs
of suffering, . More deaths are reported in the fall and winter (in both the Northern
and Southern Hemispheres) and there is a 60- to 40-percent male-to-female ratio.
A death is diagnosed as SIDS only after all other alternatives have been
eliminated: SIDS is a diagnosis of exclusion.
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What Are Risk Factors for SIDS?
Risk factors are those environmental and behavioral influences that can provoke ill
health. Any risk factor may be a clue to finding the cause of a disease, but risk
factors in and of themselves are not causes.
Researchers now know that the mother's health and behavior during her pregnancy
and the baby's health before birth seem to influence the occurrence of SIDS, but
these variables are not reliable in predicting how, when, why, or if SIDS will
occur. Maternal risk factors include cigarette smoking during pregnancy; maternal
age less than 20 years; poor prenatal care; low weight gain; anemia; use of illegal
drugs; and history of sexually transmitted disease or urinary tract infection. These
factors, which often may be subtle and undetected, suggest that SIDS is somehow
associated with a harmful prenatal environment.
How Many Babies Die From SIDS?
From year to year, the number of SIDS deaths tends to remain constant despite
fluctuations in the overall number of infant deaths. The National Center for Health
Statistics (NCHS) reported that, in 1988 in the United States, 5,476 infants under 1
year of age died from SIDS; in 1989, the number of SIDS deaths was 5,634
(NCHS, 1990, 1992). However, other sources estimate that the number of SIDS
deaths in this country each year may actually be closer to 7,000 (Goyco and
Beckerman, 1990). The larger estimate represents additional cases that are
unreported or underreported (i.e., cases that should have been reported as SIDS but
were not).
When considering the overall number of live births each year, SIDS remains the
leading cause of death in the United States among infants between 1 month and 1
year of age and second only to congenital anomalies as the leading overall cause of
death for all infants less than 1 year of age.
How Do Professionals Diagnose SIDS?
Often the cause of an infant death can be determined only through a process of
collecting information, conducting sometimes complex forensic tests and
procedures, and talking with parents and physicians. When a death is sudden and
unexplained, investigators, including medical examiners and coroners, use the
special expertise of forensic medicine (application of medical knowledge to legal
issues). SIDS is no exception.
Health professionals make use of three avenues of investigation in determining a
SIDS death:
(1) the autopsy,
(2) death scene investigation, and,
(3) review of victim and family case history.
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The Autopsy
The autopsy provides anatomical evidence through microscopic examination of
tissue samples and vital organs. An autopsy is important because SIDS is a
diagnosis of exclusion. A definitive diagnosis cannot be made without a thorough
postmortem examination that fails to point to any other possible cause of death.
Also, if a cause of SIDS is ever to be uncovered, scientists will most likely detect
that cause through evidence gathered from a thorough pathological examination.
A Thorough Death Scene Investigation
A thorough death scene investigation involves interviewing the parents, other
caregivers, and family members; collecting items from the death scene; and
evaluating that information. Although painful for the family, a detailed scene
investigation may shed light on the cause, sometimes revealing a recognizable and
possibly preventable cause of death.
Review of the Victim and Family Case History
A comprehensive history of the infant and family is especially critical to determine
a SIDS death. Often, a careful review of documented and anecdotal information
about the victim's or family's history of previous illnesses, accidents, or behaviors
may further corroborate what is detected in the autopsy or death scene
investigation.
Investigators should be sensitive and understand that the family may view this
process as an intrusion, even a violation of their grief. It should be noted that,
although stressful, a careful investigation that reveals no preventable cause of
death may actually be a means of giving solace to a grieving family.
What SIDS Is and What SIDS Is Not
SIDS Is:
 the major cause of death in infants from 1 month to 1 year of age, with most
deaths occurring between 2 and 4 months
 sudden and silent--the infant was seemingly healthy
 currently, unpredictable and unpreventable
 a death that occurs quickly, often associated with sleep and with no signs of
suffering
 determined only after an autopsy, an examination of the death scene, and a
review of the clinical history
 designated as a diagnosis of exclusion
 a recognized medical disorder listed in the International Classification of
Diseases, 9th Revision (ICD-9)
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 an infant death that leaves unanswered questions, causing intense grief for
parents and families
SIDS Is Not:
 caused by vomiting and choking, or minor illnesses such as colds or
infections
 caused by the diphtheria, pertussis, tetanus (DPT) vaccines, or other
immunizations
 contagious
 child abuse
 the cause of every unexpected infant death
Any sudden, unexpected death threatens one's sense of safety and security. We are
forced to confront our own mortality (Corr, 1991). This is particularly true in a
sudden infant death. Quite simply, babies are not supposed to die. Because the
death of an infant is a disruption of the natural order, it is traumatic for parents,
family, and friends. The lack of a discernible cause, the suddenness of the tragedy,
and the involvement of the legal system make a SIDS death especially difficult,
leaving a great sense of loss and a need for understanding.
References:
Corr, C.A., Fuller, H., Barnickol, C.A., and Corr, D.M. (Eds). Sudden Infant Death Syndrome: Who Can Help and
How. New York: Springer Publishing Co., 1991.
Goyco, P.G., and Beckerman, R.C. "Sudden Infant Death Syndrome." Current Problems in Pediatrics 20(6):299346, June 1990.
National Center for Health Statistics. "Advanced Mortality Statistics for 1989." Monthly Vital Statistics Report, Vol.
40, No. 8, Supp. 2, January 7, 1992, p. 44.
National Center for Health Statistics. "Advance Report of Final Mortality Statistics, 1988." Monthly Vital Statistics
Report, Vol. 39, No. 7, Supp. 1990, p. 33.
Willinger, M., James, L.S., and Catz, C. "Defining the Sudden Infant Death Syndrome (SIDS): Deliberations of an
Expert Panel Convened by the National Institute of Child Health and Human Development." Pediatric Pathology
11:677-684, 1991.
Information Sheet #1 was originally published in 1993.
This publication was produced by the National Sudden Infant Death Syndrome Resource Center, 2070 Chain Bridge
Road, Suite 450, Vienna, VA 22182, (703) 821-8955, (operated by Circle Solutions, Inc.). The Resource Center is an
affiliate of the National Center for Education in Maternal and Child Health and is a service of the U.S. Department
of Health and Human Services, Public Health Service, Health Resources and Services Administration, Maternal and
Child Health Bureau. This publication is not copyrighted; it may be reproduced in whole or in part without
permission. However, in accordance with accepted publishing standards, it is requested that proper credit be given
to the source(s). The views in this publication do not necessarily reflect the views of the sponsoring agency.
Compiled, written and edited by International Chaplain’s Ministry
with acknowledgement and sincere expression
of appreciation to these sources:
Washington State Chapter, National SIDS Foundation, c/o Children’s Hospital
PO Box C5371, Seattle, WA 98105; (206) 526-2110
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National SIDS Foundation, 10500 Little Patuxent Parkway, Suite 420,
Columbia, Maryland 21044; (800) 221-SIDS
To protect copyrighted information, no part of this instructional manual may be reproduced.
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