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sudden infant death syndrome

 
Medical Encyclopedia: Sudden Infant Death Syndrome
 
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Definition

Sudden infant death syndrome (SIDS) is the unexplained death without warning of an apparently healthy infant, usually during sleep.

Description

Also known as crib death, SIDS has baffled physicians and parents for years. In the 1990s, advances have been made in preventing the occurrence of SIDS, which killed more than 4, 800 babies in 1992 and 3, 279 infants in 1995. Education programs aimed at encouraging parents and caregivers to place babies on their backs and sides when putting them to bed have helped contribute to a lower mortality rate from SIDS.

In the United States, SIDS strikes one or two infants in every thousand, making it the leading cause of death in newborns. It accounts for about 10% of deaths occurring during the first year of life. SIDS most commonly affects babies between the ages of two months and six months; it almost never strikes infants younger than two weeks of age or older than eight months. Most SIDS deaths occur between midnight and 8 A.M.

— Teresa Norris, RN


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Dictionary: sudden infant death syndrome
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n. (Abbr. SIDS)

A fatal syndrome that affects sleeping infants under a year old, characterized by a sudden cessation of breathing and thought to be caused by a defect in the central nervous system. Also called crib death.


 
Sci-Tech Encyclopedia: Sudden infant death syndrome (SIDS)
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The sudden and unexpected death of an apparently normal infant that remains unexplained after an adequate autopsy. Of a group of apparently healthy infants dying suddenly and unexpectedly, 15% will usually manifest pathologic evidence of a disease process which is sufficient to explain the death. The remaining 85% are unexplained and are classified as SIDS. In spite of the probable heterogeneity of diseases in SIDS cases, the consistent and distinctive characteristics of these infant deaths support the notion that many, if not the majority, represent a single disease process.

The incidence of SIDS in the United States is about 2.0 cases per 1000 live births, which makes SIDS the leading cause of death between the ages of 1 month and 1 year. Most SIDS deaths occur at 2–4 months of age, and about 90% occur by 6 months. SIDS is more common in males, prematurely born infants, multiple births, and the economically disadvantaged. SIDS is also increased in infants of teen-age or smoking mothers and in infants who have a history of a severe apparent life-threatening event, usually accompanied by marked cyanosis or pallor and limpness, and absence of breathing. SIDS also occurs more frequently during winter months. The rate among Native Americans is greater than among Blacks, which is greater than among Caucasians; Asians have the lowest rate. While there is slight familial clustering of SIDS, there is probably not a genetic predisposition to SIDS.

The cause of SIDS is unknown; leading hypotheses include respiratory, cardiac, and metabolic mechanisms. Much attention has been focused on the “apnea hypothesis,” implicating a primary respiratory arrest due to chronic or transient insufficiency or irregularity of breathing. An imbalance between sympathetic and parasympathetic influences on cardiac activity, leading to potentially fatal cardiac arrhythmias, is a popular cardiac hypothesis.

While there is still no proof that SIDS can be prevented, electronic cardiorespiratory monitors have been prescribed for many infants in high-risk categories for SIDS. Home monitors are recommended only for infants at very high risk for SIDS. See also Congenital anomalies; Human genetics.

 
Dental Dictionary: sudden infant death syndrome
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n
SIDS

The unexpected and sudden death of an apparently normal and healthy infant that occurs during S sleep and with no physical or autopsic evidence of disease. It is the most common cause of death of children in the United States between 2 weeks and 1 year of age.

 
Children's Health Encyclopedia: Sudden Infant Death Syndrome
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Definition

Sudden infant death syndrome (SIDS) is the sudden, unexpected death of a seemingly normal, healthy infant under one year of age that remains unexplained after a thorough postmortem investigation, including an autopsy and a review of the case history.

Description

SIDS is a defined medical disorder that is listed in the International Classification of Diseases, 9th Revision (ICD-9). The first published research about sudden infant death appeared in the mid-nineteenth century. Since then, researchers and healthcare providers have struggled to define the syndrome and determine its causes. The key characteristics of SIDS include:

  • infant less than one year of age
  • infant seemingly healthy (no preceding symptoms)
  • complete investigation fails to find a cause of death
  • no associated child abuse or illness

Demographics

In the United States, SIDS was the third leading cause of postneonatal deaths (those occurring between the ages of 28 days and one year) in 2001. According to the National Center for Health Statistics, 2,234 infants in the United States died of SIDS in 2001, or 8.1 percent of total infant deaths. (In the late 1990s, many sources placed the annual total number of deaths as high as 6,000 due to possible under-reporting.) Ninety percent of SIDS deaths occur during the first six months of life, mostly between the ages of two and four months. SIDS also occurs about 1.5 times more frequently in boys than girls. The rate of SIDS in African-American infants is twice as high as that of Caucasians, a fact often attributed to the lower quality of prenatal care received by many African-American mothers.

Causes and Symptoms

Studies have identified many risk factors for SIDS, but the actual cause of the disorder remains a mystery. Although investigators are still not sure whether the immediate cause of SIDS deaths is due to respiratory failure or cardiac arrest, patterns of infant sleep, breathing, and arousal are a major focus of research in the early 2000s. It is known that young infants often stop breathing for short periods of time, then gasp and start again. Some researchers and physicians believe that SIDS involves a flaw in the mechanism that is responsible for resumption of breathing.

Aside from its occurrence during sleep, the other most striking feature of SIDS is its narrow age distribution, which has prompted researchers to examine the developmental changes that take place between the ages of two and four months, especially between the ages of two and four months, when most SIDS deaths occur. A growing number of experts believe that rather than a single cause, there are a number of different conditions that can cause or contribute to SIDS. This picture is complicated still further by the interaction of possible physical abnormalities with a number of environmental and developmental factors known to increase the risk of SIDS. Premature infants and low birth weight babies in general are known to be at increased risk of developing SIDS, as are infants born to teenage mothers, poor mothers, and mothers who for any reason have had inadequate prenatal care. Other risk factors include maternal smoking during pregnancy, exposure to smoking in the home after birth, formula feeding rather than breastfeeding, and prior death of a sibling from SIDS (although this is thought to be due to shared environmental risk factors rather than genetic predisposition). Many SIDS deaths occur in babies who have recently had colds (a possible reason that SIDS is most prevalent in winter, the time when upper respiratory infections are most frequent).

As of 2004, the most significant risk factor discovered for SIDS was placing babies to sleep in a prone position (on their stomachs). Studies have reported that anywhere from 28 percent to 52 percent of infants who die of SIDS are found lying face down. Another finding reinforcing the connection between SIDS and prone-sleeping is the fact that SIDS rates are higher in Western cultures, where women have traditionally placed children on their stomachs, than in Eastern ones, where infants usually sleep on their backs. The cause-effect relationship between prone-sleeping and SIDS is not fully understood. However, it is known that when infants sleep on their backs they are more prone to arousal, and SIDS is often thought to involve a failure to rouse from sleep. In addition, prone-sleeping raises a baby's temperature, which is another risk factor for the disorder.

When to Call the Doctor

Parents or caregivers should immediately call for emergency care if a child is found not breathing or without a pulse or is unable to be aroused from sleep.

Diagnosis

In most cases, three techniques are used in an attempt to determine the cause of an infant's death. These are:

  • Death scene investigation. A thorough examination of the scene of death, including recording baby's position, collecting items from the surrounding area, and interviewing family members and/or caregivers, can sometimes point to an external cause of death.
  • Autopsy. The autopsy, usually performed by a medical examiner or coroner, focuses on finding any identifiable cause of death. While parents may reject the idea of an autopsy because they feel it violates their infant's remains, it is often the only tool that can definitively rule out other potential causes of death.
  • Review of family history. Healthcare providers or police interview parents and/or caregivers in order to determine the child's medical and family history, in an attempt to rule out possible illness, child abuse, or other cause of death.

Treatment

Because SIDS affects seemingly healthy infants, and death is the first symptom of the disorder, it is not possible to treat an infant who is truly affected by SIDS. If life support is implemented and the child is resuscitated, emergency care will be provided in an attempt to stabilize the child. Healthcare personnel perform a complete medical exam and record the child's medical history to exclude other potential causes.

Prognosis

By definition the prognosis for babies affected by SIDS is invariably death. In some rare cases, emergency care providers are able to resuscitate an infant who is seemingly lifeless; the prognosis remains poor in these cases.

Prevention

In the 1990s a number of countries initiated campaigns aimed at getting parents to put their infants to sleep on their backs or sides. In the United States, the American Academy of Pediatrics (AAP) in 1992 issued an official recommendation that infants be put to bed on their backs (supine position) or on their sides (lateral position). In 1994 the Public Health Service launched its "Back to Sleep" campaign, targeting parents, other care givers, and healthcare personnel with brochures advocating supine or lateral infant sleeping and also including information about other risk factors for SIDS. By the mid-1990s it was apparent that this and similar campaigns worldwide had had a significant—in many cases dramatic—impact in reducing the number of deaths from SIDS. In a number of countries the incidence of SIDS dropped by 50 percent or more. SIDS deaths in Great Britain were reduced by 91 percent between 1989 and 1992; in Denmark they declined by 72 percent between 1991 and 1993; and they were reduced by 45 percent in New Zealand between 1989 and 1992.

In the United States, the AAP recommendations reduced the incidence of front-sleeping in infants from over 70 percent in 1992 to 24 percent in 1996. A decline in SIDS rates, already observed in the 1980s, tripled its previous pace between 1990 and 1994, with SIDS deaths falling 10 to 15 percent between 1992 and 1994. Links between SIDS and other aspects of an infant's sleep environment have also emerged. The best known is the finding that soft, padded sleep surfaces can endanger infants by obstructing breathing or creating air pockets that trap their expelled carbon dioxide, which they can then inhale.

Some research also suggests that co-sleeping (having an infant sleep with the mother in her bed) can help regulate an infant's sleep pattern in ways that reduce the risk of SIDS. (Like supine infant sleeping, co-sleeping is also prevalent among Asian populations, which have a low incidence of SIDS.) Infants who share their mothers' beds become accustomed to frequent minor arousals when the mother shifts position, and their own sleep tends to be lighter and more even than that of infants who sleep alone in their cribs and are more prone to the heavier, but sporadic, breathing that stops and then starts up again with a gasp. Experts speculate that this lighter sleep not only makes it less likely for an infant to stop breathing but also that such an infant, with the "practice" gained from more frequent arousals every night, can be aroused more easily when any respiratory distress does occur. In addition, infants who co-sleep with their mothers are naturally more likely to sleep on their backs or sides, which also reduces the risk of SIDS.

In December 1996 the AAP issued the following updated recommendations regarding infant sleep:

  • Infants should be put to sleep in a nonprone position. The supine position (on their backs) is safest, but sleeping on their sides can also significantly reduce the risk of SIDS. When infants sleep on their sides, the bottom arm should be extended to prevent them from rolling over on to their stomachs.
  • Soft sleeping surfaces should be avoided, and a sleeping infant should not be placed on soft objects such as pillows or quilts.
  • It may be better for parents, with the guidance of their pediatrician, to depart from these recommendations in the case of infants with certain health problems, such as gastroesophageal reflux (GER).
  • Infants should spend some time lying on their stomachs when they are awake and supervised by an adult.

Other precautions parents can take include obtaining adequate prenatal care; avoiding exposing infants to cigarette smoke, either pre- or postnatally; breastfeeding instead of formula feeding; and not allowing an infant to become overheated while sleeping. Another measure taken by some parents is the use of a portable battery-operated monitor that sounds an alarm in response to significant deviations in infants' respiration or heart rates while they are asleep. Monitoring is based on the belief that if parents can quickly reach an infant who has stopped breathing, they can either get him breathing again themselves or call for emergency assistance. There has been no substantiated link between monitoring and the decrease in SIDS, and infants have, in fact, died while being monitored. Nevertheless, monitors provide peace of mind for many parents, especially those who have already lost an infant to SIDS or whose baby has special risk factors for the disorder. Medical opinion is generally in favor of monitoring only for newborns who have had episodes of apnea (cessation of breathing) or for any infant who has had a precipitous, life-threatening interruption of breathing or cardiovascular function.

Parental Concerns

Losing a child—a traumatic experience for any parent—is especially difficult for those who lose a child to SIDS because the death is so sudden and its cause can often not be determined. Parents of a child who dies of SIDS do not gain a medical explanation of their infant's death. Although such an understanding does not lessen their loss, it can serve an important function in the healing process, one that SIDS parents do not have. In addition to the emotions that normally accompany grief, such as denial, anger, and guilt, SIDS parents may experience certain other reactions unique to their situation. They may become fearful that another unexpected disaster will strike them or members of their families. After the death of a child from SIDS, parents often become over-protective of the infant's older siblings and of any children born subsequently. Some fear having another child, due to misgivings that the tragedy they have experienced may repeat itself. Parents of children who die of SIDS often make major changes in their lives during the period following the death, such as relocating or changing jobs, as a way to avoid confronting painful memories or as a way to protect themselves against the SIDS death of another baby by changing the circumstances of their lives as much as possible.

SIDS deaths place a great strain on marriages. Parents' individual ways of coping with their grief may prevent them from giving each other the support they need, creating an emotional distance between them. Nevertheless, the divorce rate among SIDS parents appears to be no higher than that for the general population, and in one survey half the respondents reported that their marriages had ultimately been strengthened by the experience.

A SIDS death also has a significant effect on the infant's siblings. Young children often experience developmental regressions in toilet training or other areas. Some fear going to sleep, which they associate with the death of their baby brother or sister. As with any death in the family, children need to be reassured that they are not guilty in any way. Many pose difficult questions to their parents, wanting to know why the baby died or where he has gone, or even whether they are going to die, too. Children may also come to feel jealous of the attention paid to the infant who has died or resentful of the disruption the death has caused in their family's life. Most parents report that their way of caring for their remaining children changes after the family experiences a SIDS death. Having young children (or infants born later on) sleep with them at night makes some parents feel more confident of preventing a second tragedy from occurring. In addition to overprotecting their children and worrying about their health, SIDS parents may also spoil them and find it hard to say no to their requests. On the positive side, many parents simply value their remaining children more, spend more time with them, and become closer to them. In a minority of cases, however, the reverse happens, and parents feel emotionally distant from their surviving children. In addition, fear of being hurt sometimes makes it difficult for some parents to bond with babies born later.

Many parents of infants who die of SIDS are helped by participating in local support groups, where they can share their feelings and experiences with others who have undergone the same experience. Counseling can also be beneficial, especially with a mental health professional experienced in dealing with parental grief.

Resources

Books

Byard, Roger W., et al. Sudden Infant Death Syndrome:Problems, Progress, and Possibilities. Oxford, UK: Oxford University Press, 2001.

Mawhiney, Robert. S.I.D.S.: New Research into Sudden InfantDeath Syndrome—Cause and Effect. Philadelphia: Xlibris Corp., 2003.

Periodicals

Anderson, Robert, and Betty Smith. "Deaths: Leading Causes for 2001." National Vital Statistics Report 52, no. 9 (November 7, 2003): 1–86.

Organizations

American Academy of Pediatrics. 141 Northwest Point Blvd., Elk Grove Village, IL 60007–1098. Web site: www.aap.org.

National SIDS/Infant Death Resource Center. 2070 Chain Bridge Rd., Suite 450, Vienna, VA 22182. Web site: www.sidscenter.org.

SIDS Alliance. 1314 Bedord Ave., Suite 210, Baltimore, MD 21208. Web site: www.sidsalliance.org.

Web Sites

s

National SIDS/Infant Death Resource Center. Available online at www.sidscenter.org (accessed November 4, 2004).

Tabib, Shahram, Thomas Tsou, and Charles Drew. "Sudden Infant Death Syndrome." eMedicine Health, July 22, 2004. Available online at www.emedicinehealth.com/articles/10223-1.asp (accessed November 4, 2004).

[Article by: Stephanie Dionne Sherk]


 
Encyclopedia of Public Health: Sudden Infant Death Syndrome
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Sudden infant death syndrome (SIDS) was defined in the United States in 1989 by a conference of the National Institute of Health as the sudden death of an infant under one year of age that remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and a review of the clinical history. Most cases occur between three weeks and six months of age. The cause of SIDS is, by definition, unknown. One current theory is that ineffective respiration may cause the infant to stop breathing. Placing infants on their back when they sleep reduces the incidence of SIDS by approximately 30 to 40 percent. A number of factors increase the incidence of SIDS. These include (1) the use of waterbeds and soft bedding; (2) sleeping on the stomach; (3) infants born of mothers who smoke or use drugs; (4) young, unmarried mothers of low socioeconomic status; (5) male infants; and (6) prematurity and low birth weight. There is no genetic cause of SIDS, and immunizations do not cause SIDS. An autopsy must be performed to exclude abuse, injury, infection, or metabolic disease. These diagnoses remove the cases from the SIDS category.

(SEE ALSO: Child Mortality; Perinatology)

Bibliography

DiMaio, D. J., and DiMaio, V. J. (1993). Forensic Pathology. Boca Raton, FL: CRC Press.

Hauck, F. R., and Hunt, C. E. (2000). "Sudden Infant Death Syndrome in 2000." Current Problems in Pediatrics 30:237–268.

Spitz, W. U. (1993). Medicolegal Investigation of Death, 3rd edition. Springfield, MA: Charles C. Thomas.

— MARVIN S. PLATT


 
Britannica Concise Encyclopedia: sudden infant death syndrome
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Unexpected death of an apparently well infant. It occurs almost always during sleep at night and usually at 2 – 4 months of age. Sleeping facedown and exposure to cigarette smoke have been implicated. It is more common in cases of premature birth, low birth weight, and poor prenatal care. Many cases that would once have been labeled SIDS prove to be due to suffocation in bedding or overheating. Some babies who die of SIDS have been found to have brain stem abnormalities that interfere with their response to high levels of carbon dioxide in the blood.

For more information on sudden infant death syndrome, visit Britannica.com.

 
US History Encyclopedia: Sudden Infant Death Syndrome
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Sudden Infant Death Syndrome (SIDS), sometimes referred to as crib death, is a medical term for the decease of an apparently well infant. It describes a death that remains unexplained after all known and possible causes have been ruled out through autopsy, investigation of the scene, and review of the child's medical history. SIDS was first identified as a separate medical entity and named in 1969. SIDS causes the death of as many as 7,000 infants each year in the United States. It is the most common cause of death in children between their first month and first year of age. SIDS more frequently affects males than females and nonwhites than whites. It affects infants born into poverty more often than those in higher-income situations. Most at risk are infants born to women with inadequate prenatal care, infants born prematurely, and infants whose mothers smoked during pregnancy or after delivery. Deaths usually occur during sleep, are more likely during cold months, and occur more frequently in infants who sleep on their stomachs than in infants who sleep on their backs.

In 1994 a "Back to Sleep" campaign encouraging parents and caretakers to put babies to sleep on their backs was initiated as a cooperative effort of the U.S. Public Health Service, the American Academy of Pediatrics, the SIDS Alliance, and the Association of SIDS and Infant Mortality Programs. The cause of SIDS is unknown. Theories include an unidentified birth defect, stress in a normal baby caused by infection or other factors, and failure to develop. Because no definitive cause can be found and because parents are totally unprepared for such a loss, the death often causes intense feelings of guilt.

Bibliography

Guntheroth, Warren G. Crib Death: The Sudden Infant Death Syndrome. Armonk, N.Y.: Futura Publishing, 1995.

 
Columbia Encyclopedia: sudden infant death syndrome
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sudden infant death syndrome (SIDS) or crib death, sudden, unexpected, and unexplained death of an apparently healthy infant under one year of age (usually between two weeks and eight months old). SIDS accounts for 10% of infant deaths and is the second highest cause of death (after accidents) in infancy. The risk is higher in males, in low-birth-weight infants, in lower socioeconomic levels, during cold months, and for babies who sleep face down.

Causal theories suggest that the infant may have immature or hypersensitive lungs, may have a defect in brain-stem control of breathing, or may be rebreathing carbon dioxide. Recent studies have shown persistent high levels of an infant form of hemoglobin in babies with known risk factors for the condition.

SIDS victims are thought to have brief episodes of apnea (breathing stoppage) before the fatal one. An alarm system that detects breathing abnormalities is sometimes used with infants suspected of being prone to SIDS. The American Academy of Pediatrics has recommended that babies be laid to sleep on their backs or sides.

 
Health Dictionary: sudden infant death syndrome
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Also called crib death, the deaths of sleeping infants less than a year old for unexplained reasons.

 
Wikipedia: Sudden infant death syndrome
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Sudden infant death syndrome
Classification and external resources
ICD-10 R95.
ICD-9 798
OMIM 272120
DiseasesDB 12633
eMedicine emerg/407  ped/2171
MeSH D013398

Sudden infant death syndrome (SIDS) is a syndrome marked by the sudden death of an infant that is unexpected by history and remains unexplained after a thorough forensic autopsy and a detailed death scene investigation. The term cot death is often used in the United Kingdom, Ireland, Australia, India, and New Zealand.

Contents

Overview

Typically the infant is found dead after having been put to bed, and exhibits no signs of having suffered.[1]

SIDS is a diagnosis of exclusion. It should only be applied to an infant whose death is sudden and unexpected, and remains unexplained after the performance of an adequate postmortem investigation including

  1. an autopsy;
  2. investigation of the scene and circumstances of the death;
  3. exploration of the medical history of the infant and family.

SIDS was responsible for 0.543 deaths per 1,000 live births in the U.S. in 2005 (wonder.cdc.gov). It is responsible for far fewer deaths than congenital disorders and disorders related to short gestation, though it is the leading cause of death in healthy infants after one month of age.

SIDS deaths in the U.S. decreased from 4,895 in 1992 to 2,247 in 2004.[2] But, during a similar time period, 1989 to 2004, SIDS being listed as the cause of death for sudden infant death (SID) decreased from 80% to 55%.[2] According to Dr. John Kattwinkel, chairman of the Center for Disease Control (CDC) Special Task Force on SIDS "A lot of us are concerned that the rate (of SIDS) isn't decreasing significantly, but that a lot of it is just code shifting”.[2]

SIDS Back To Sleep Campaign: History and Theory

In 1985 Davies reported that in Hong Kong, where Chinese custom called for supine infant sleep position, SIDS was a rare problem.[3]In 1987 the Netherlands started a campaign advising parents to place their newborn infants to sleep on their backs (supine position) instead of their stomachs (prone position).[4] This was followed by infant supine sleep position campaigns in the United Kingdom, New Zealand, and Australia in 1991, the U.S. and Sweden in 1992, and Canada in 1993.[4][5]

This advice was based on the epidemiology of SIDS and physiological evidence which shows that infants who sleep on their back have lower arousal thresholds and less Slow-Wave Sleep (SWS) compared to infants who sleep on their stomachs.[6] In human infants sleep develops rapidly during early development. This development includes an increase in non-rapid eye movement sleep (NREM sleep) which is also called Quiet Sleep (QS) during the first 12 months of life in association with a decrease in rapid eye movement sleep (REM sleep) which is also known as Active Sleep (AS)[7].[8][9] In addition, slow wave sleep (SWS) which consists of Stage 3 and Stage 4 NREM sleep appears at 2 months of age.[10][11][12][13] and it is theorized that some infants have a brain-stem defect which increases their risk of being unable to arouse from SWS (also called Deep Sleep) and therefore have an increased risk of SIDS due to their increased inability to arouse from SWS.[6]

Studies have shown that preterm infants,[14][15] full-term infants,[16][17] and older infants [18] have greater time periods of quiet sleep and also decreased time awake when they are positioned to sleep on their stomachs. In both human infants and rats, arousal thresholds have been shown to be at higher levels in the Electroencephalography (EEG) during Slow-wave sleep[19].[20][21]

In 1992,[22] a SIDS risk reduction strategy based upon lowering arousal thresholds during SWS was implemented by the American Academy of Pediatrics (AAP) which began recommending that healthy infants be positioned to sleep on their back (supine position) or side (lateral position), instead of their stomach (prone position), when being placed down for sleep. In 1994,[23] a number of organizations in the United States combined to further communicate these non-prone sleep position recommendations and this became formally known as the “Back To Sleep” campaign. In 1996,[24] the AAP further refined its sleep position recommendation by stating that infants should only be placed to sleep in the supine position and not in the prone or lateral positions.

In 1992, the first National Infant Sleep Position (NISP) Household Survey[25] was conducted to determine the usual position in which U.S. mothers placed their babies to sleep: (1) Lateral (side); (2) Prone (stomach); (3) Supine (back); (4) Other; (5) No Usual Position. According to the 1992 NISP survey, 13.0% of U.S. infants were positioned in the supine position for sleep.[26] According to the 2006 NISP survey 75.7% of infants were positioned in the supine position to sleep.[27]

Since 1998 there have been several studies published which report that infants placed to sleep in the supine position lag in motor skills, social skills, and cognitive ability development when compared to infants who sleep in the prone position.[28][29] In the 1998 article entitled “Effects of Sleep Position on Infant Motor Development.” [14][29] by Davis, Moon, Sachs, and Ottolini, the authors state “We found that sleep position significantly impacts early motor development.” The prone (stomach) sleeping infants in this study slept an average of 225.2 hours (8.3%) more in their first 6 months of life than the supine (back) sleeping infants.

In the 1998 article entitled “Does the Supine Sleeping Position Have Any Adverse Effects on the Child? II. Development in the First 18 Months”[30] by Dewey, Fleming, Golding, and the ALSPAC Study Team the objective of the study was “To assess whether the recommendations that infants sleep supine could have adverse consequences on their motor and mental development.” They used the Denver Developmental Screening Test (DDST) and studied infants at 6 and 18 months. According to the study, at 6 months of age, the infants who were placed to sleep in the prone position had statistically significant higher social skills scores, gross motor scores, and total development scores than those infants who were put to sleep in the supine position. In addition, the total development scores of prone sleeping infants were still higher than supine sleeping infants at 18 months of age but were no longer statistically significant. In the 2005 article entitled “Influence of supine sleep positioning on early motor milestone acquisition”[28] by Majnemer and Barr they used the Alberta Infant Motor Scale Scores (AIMS Scores) to analyze the impact of infant sleep position. They reported that “Typically developing infants who were sleep-positioned in supine had delayed motor development by age 6 months, and this was significantly associated with limited exposure to awake prone positioning.” But, the authors also note that awake prone (stomach) positioning is associated with prone (stomach) sleeping. No studies have been conducted which compare supine sleeping infants who have regular awake prone positioning (tummy time) to prone sleeping infants who have regular awake prone positioning (tummy time).

Placing infants on their stomachs while they are awake (tummy time) has been recommended to offset the motor skills delays associated with the back sleep position[28] but positioning the infant on their stomach while awake will not impact the amount of slow wave sleep[14][15][16][17][18] since tummy time only occurs when an infant is awake.

Undiagnosed conditions

Some conditions that may be undiagnosed and thus result in a diagnosis of SIDS include

Risk factors

Very little is certain about the possible causes of SIDS, and there is no proven method for prevention. Although studies have identified risk factors for SIDS, such as putting infants to bed on their stomachs, there has been little understanding of the syndrome's biological cause or causes. The frequency of SIDS appears to be a strong function of the infant's sex, age and ethnicity, and the education and socio-economic-status of the infant's parents.

According to a study published in October 2007 in JAMA, babies who die of SIDS have abnormalities in the brain stem (the medulla oblongata), which helps control functions like breathing, blood pressure and arousal, and abnormalities in [[serotonin] signaling. According to the National Institutes of Health, which funded the study, this finding is the strongest evidence to date that structural differences in a specific part of the brain may contribute to the risk of SIDS.[37]

In a British study released May 29, 2008 researchers discovered that the common bacterial infections Staphylococcus aureus (staph) and Escherichia coli (E. coli) appear to be the cause of some cases of Sudden Infant Death Syndrome. Both bacteria were present at greater than usual concentrations in infants who died from SIDS.[38] SIDS cases peak between eight and ten weeks after birth, which is also the time frame in which the antibodies that were passed along from mother to child are starting to disappear and babies have not yet made their own antibodies.

Listed below are several factors associated with increased probability of the syndrome based on information available prior to this recent study.

Prenatal risks

Post-natal risks

  • mold (can cause Bleeding Lungs plus a variety of other uncommon conditions leading to a misdiagnoses and death). It is often misdiagnosed as a Virus, Flu, and/or Asthma like conditions. [49]
  • low birth weight (wonder.cdc.gov reports in the U.S. from 1995-1998 that the rate for 1000-1499 gms was 2.89/1000 and for 3500-3999gms it was 0.51/1000)[50]
  • exposure to tobacco smoke[51]
  • prone sleep position (lying on the stomach, see sleep positioning below)[52]
  • not breastfeeding[53]
  • elevated room temperature[54]
  • excess bedding, clothing, soft sleep surface and stuffed animals[55]
  • infant's age (incidence rises from zero at birth, is highest from two to four months, and declines towards zero at one year)[56]
  • premature birth (increases risk of SIDS death by about 4 times. See wonder.cdc.gov. In 1995-1998 the U.S.SIDS rate for 37–39 weeks of gestation was 0.73/1000; The SIDS rate for 28–31 weeks of gestation was 2.39/1000)

Risk reduction for SIDS

Though SIDS cannot be prevented, parents of infants are encouraged to take several precautions in order to reduce the likelihood of SIDS.

Environment

Sleep positioning

Sleeping on the back has been recommended by (among others) the American Academy of Pediatrics (starting in 1992) to avoid SIDS, with the catchphrases "Back To Bed" and "Back to Sleep." The incidence of SIDS has fallen sharply in a number of countries in which the back to bed recommendation has been widely adopted, such as the US and New Zealand.[57] However, the absolute incidence of SIDS prior to the Back to Sleep Campaign was already low in the US.[citation needed]

Among the theories supporting the Back to Sleep recommendation is the idea that small infants with little or no control of their heads may, while face down, inhale their exhaled breath (high in carbon dioxide) or smother themselves on their bedding—the brain-stem anomaly research (above) suggests that babies with that particular genetic makeup do not react "normally" by moving away from the pooled CO2, and thus smother. Another theory[citation needed] is that babies sleep more soundly when placed on their stomachs, and are unable to rouse themselves when they have an incidence of sleep apnea, which is thought to be common in infants.

Arguments against infant back-sleeping include concerns that an infant could choke on fluids it brings up.[58] Hospital staff commonly place newborns on their side, although they advise parents to place their infants on their backs after going home from the hospital.[citation needed]

Other concerns raised about the Back to Sleep Campaign have included the possible increased risk of positional facial and head deformities (see positional plagiocephaly),[58] possible interference with development of good sleep habits (which in turn may have other bad effects),[58] and possible interference with motor skills development (as infants delay attempts to lift their heads, crawl, etc.).[58]

Breastfeeding

A 2003 study published in Pediatrics, which investigated racial disparities in infant mortality in Chicago, found that previously or currently breastfeeding infants in the study had 1/5 the rate of SIDS compared with non-breastfed infants, but that "it became nonsignificant in the multivariate model that included the other environmental factors". These results are consistent with most published reports and suggest that other factors associated with breastfeeding, rather than breastfeeding itself, are protective."[59] However, a more recent study shows that breast feeding reduces the risk of SIDS by approximately 50% at all infant ages [60].

Co-sleeping

 The neutrality of this section is disputed. Please see the discussion on the talk page. Please do not remove this message until the dispute is resolved. (September 2008)

One approach to lowering SIDS rates is limiting co-sleeping. A 2005 policy statement by the American Academy of Pediatrics on sleep environment and the risk of SIDS found co-sleeping and bed sharing to be unsafe.[61] A recent article reports that co-sleeping infants have a greater risk of airway covering than when the same infant sleeps alone in a cot [62].

Some data[citation needed] has suggested that almost all SIDS deaths in adult beds would be occurring when other prevention methods, such as placing infants on their backs, are not used. Co-sleeping studied in the West has been present mostly in poorer families where other risk factors are present.[63] while co-sleeping in other cultures such as in China is more prevalent and is done in combination with practices such as sleeping children on their back, correlating with a significantly lower rate of SIDS than the West.[64] There are also evolutionary theories as to why co-sleeping would be healthier for infants than sleeping alone.[63] Further studies have suggested that factors associated with safe co-sleeping such as enhanced infant arousals are responsible for a positive contribution to SIDS prevention.[65]

Co-sleeping is made safer with the use of a bedside "co-sleeper", rather than having the infant sleep in your bed.[citation needed] Adult beds are unsafe for infants.[citation needed] Co-sleeping in couches is very hazardous.[66] Available evidence indicates that the safest place for infants to sleep is a crib in the parent's room.[67]

Secondhand smoke reduction

According to the U.S. Surgeon General’s Report, secondhand smoke is connected to SIDS.[68] Infants who die from SIDS tend to have higher concentrations of nicotine and cotinine (a biological marker for secondhand smoke exposure) in their lungs than those who die from other causes. Infants exposed to secondhand smoke after birth are also at a greater risk of SIDS. Parents who smoke can significantly reduce their children's risk of SIDS by either quitting or smoking only outside and leaving their house completely smoke-free.

The maternal pregnancy smoking rate decreased by 38% between 1990 and 2002.[69]

Sleeping area

Bedding

To prevent SIDS, many families use firm mattresses with tight-fitting sheets in cribs or bassinets. The families do not allow pillows, stuffed animals, or fluffy bedding in the cribs. In cold weather, the families dress the infants warmly in well-fitted clothing.[70]

Infants' blankets should also not be placed over their heads. It has been recommended that the infants are only covered up to their chest with their arms exposed. This will help eliminate the chances of the infant moving the blanket over their head.

Sleep sacks

In colder environments where bedding is required to maintain a baby's body temperature, the use of a "baby sleep bag" or "sleep sack" is becoming more popular. This is a soft bag with holes for the baby's arms and head. A zipper allows the bag to be closed around the baby. A study published in the European Journal of Pediatrics in August 1998[71] has shown the protective effects of a sleep sack as reducing the incidence of turning from back to front during sleep, reinforcing putting a baby to sleep on its back for placement into the sleep sack and preventing bedding from coming up over the face which leads to increased temperature and carbon dioxide rebreathing. They conclude in their study "The use of a sleeping-sack should be particularly promoted for infants with a low birth weight." The AAP also recommends them as a type of bedding that warms the baby without covering its head.[72]

Pacifiers

According to a 2005 meta-analysis, most studies favor pacifier use.[73] According to the American Academy of Pediatrics (AAP), pacifier use seems to reduce the risk of SIDS, although the mechanism by which this happens is unclear.[74] SIDS experts and policy makers haven't recommended the use of pacifiers to reduce the risk of SIDS because of several problems associated to pacifier use, like increased risk of otitis, gastrointestinal infections and oral colonization with Candida species.[74]. A recent study shows that pacifier use by breastfed infants does not reduce the rate of breastfeeding.[75]

A 2005 study indicated that use of a pacifier is associated with up to a 90% reduction in the risk of SIDS depending on the ambiental factors, and it reduced the effect of other risk factors.[76] It has been speculated that the raised surface of the pacifier holds the infant's face away from the mattress, reducing the risk of suffocation. If a postmortem investigation does not occur or is insufficient, a suffocated baby may be misdiagnosed with SIDS.

Air circulation with fan use

According to a study of nearly 500 babies published the October 2008 Archives of Pediatrics & Adolescent Medicine, using a fan to circulate air correlates with a lower risk of sudden infant death syndrome. Researchers took into account other risk factors and found that fan use was associated with a 72% lower risk of SIDS. Only 3% of the babies who died had a fan on in the room during their last sleep, the mothers reported. That compared to 12% of the babies who lived. Using a fan reduced risk most for babies in poor sleeping environments.[77] Author De-Kun li said that "the baby's sleeping environment really matters" and that "this seems to suggest that by improving room ventilation we can further reduce risk."[78]

Bumper pads

Bumper pads may be a contributing factor in SIDS deaths and should be removed. Health Canada, the Canadian government's health department, issued an advisory[79] recommending against the use of bumper pads, stating:

The presence of bumper pads in a crib may also be a contributing factor for Sudden Infant Death Syndrome (SIDS). These products may reduce the flow of oxygen rich air to the infant in the crib. Furthermore, proposed theories indicate that the rebreathing of carbon dioxide plays a role in the occurrence of SIDS.

Speculated associations

A number of theoretical causes have been proposed as a trigger for SIDS, but many of them are unproven or have not been thoroughly studied and peer-reviewed. As of June 2009 there were 113 such articles found in Medical Hypotheses as cited in PubMed.

Mattress bugs

A 2004 study hypothesized that bugs feeding on baby vomit and dust could be fatal for small children, creating 'supertoxins' which spur the baby's body into overreacting, leading to anaphylactic shock. [80]

Brain disorder

A recently published research article [81] showed evidence that cells in the brainstem fail to develop receptors for Serotonin in the womb. This abnormality continues until after birth, supposedly until the end of their first year. This would account for there being few to no SIDS deaths after the first year of infancy and the reason the risk is more for premature infants. The SIDS Alliance/First Candle has posted a message about this along with a link to the abstract on their website (www.firstcandle.com), which can be accessed from the front page

Vitamin C

According to a 1993 article in Journal of Orthomolecular Medicine, Australian medical doctor Archie Kalokerinos performed research showing that high doses of vitamin C eliminates SIDS.[82] As SIDS was shown to be caused solely by vitamin deficiency, the article stated that it was no longer a syndrome, and that the proper disease name is now SID. As of May 2009, the Journal of Orthomolecular Medicine was not included among journals selected by the U.S. National Library of Medicine for inclusion in their Medline database.[83][84] A later article does not support this hypothesis [85]

Toxic gases

In 1989, a controversial piece of research by UK Scientist Barry Richardson claimed that all cot deaths were the result of toxic nerve gases being produced through the action of fungus in mattresses on compounds of phosphorus, arsenic and antimony. These chemicals are frequently used to make mattresses fire-retardant.

A major plank in this explanation is the widely-observed phenomenon that the risk of cot death rises from one sibling to the next. Richardson claims that the cause is that parents are more likely to buy new bedding for their first child, and to re-use that bedding for later children. The more frequently used the bedding is, the more chance there will be that fungus has become resident in the material; thus, a higher chance of cot death. A paper by Peter Fleming and Peter Blair[86] references evidence from other studies that both supports and refutes the increasing occurrence of SIDS with mattress sharing and suggests that this is still inconclusive.

In 1994, the New Zealand government, under the advice of Dr. Jim Sprott, issued advice recommending new parents to either buy bedding free of the toxic compounds or to wrap the mattresses in a barrier film to prevent the escape of the gases. Dr. Sprott claims that no case of cot death has ever been traced back to a properly manufactured or wrapped mattress.[87]

However, a final report of The Expert Group to Investigate Cot Death Theories: Toxic Gas Hypothesis, published in May 1998, concluded that "there was no evidence to substantiate the toxic gas hypothesis that antimony- and phosphorus-containing compounds used as fire retardants in PVC and other cot mattress materials are a cause of SIDS. Neither was there any evidence to believe that these chemicals could pose any other health risk to infants."[88] The report also states that "in normal cot-like conditions it is not possible to generate toxic gas from antimony in mattresses" and "babies have also been found to die on wrapped mattresses." Dr. Sprott's website, however, claims[89][90] that the study does not actually refute his theory:

Contrary to media publicity, the 1998 UK Limerick Report did not disprove the toxic gas theory—as a highly qualified environmental scientist has stated in the New Zealand Medical Journal. In fact, the Limerick Committee's experiments proved the fungal generation of toxic gases (forms of stibine and arsine) from cot mattress materials.

According to Dr. Sprott, as of 2006, the New Zealand government has not reported any SIDS deaths when babies have slept on mattresses wrapped according to his method. While the Limerick report claims that babies have been found to die on wrapped mattresses, Dr. Sprott argues that a chemical analysis of the bedding should be performed. He additionally claims that this part of the report was flawed:

In February 2000 Dr Peter Fleming (a co-author of the Limerick Report and principal author of the UK CESDI Report) conceded that the claim that three babies in the United Kingdom had died of cot death on polythene-covered mattresses could not be substantiated.[91]

Central Respiratory Pattern Deficiency

There is ongoing research in the pediatric/neonatal community that has begun to associate apnea-like breathing cessations in animal models with unusual neural architecture or signal transduction in central pattern generator circuits including the pre-Bötzinger complex.[92] It is possible that irregularities in neurotransmitter release (such as GABA, adenosine, and NMDA) or deficiencies in their associated receptors (including both GABAA, GABAB subtypes and NMDA-glutamate receptors) are linked to incomplete prenatal development as is evident in pre-term infants.

Genetic factors are also being studied with several rat and mouse knockouts.

Upper cervical spinal cord injury as a result of birth trauma

During birth, if the infant's head is traumatically turned side to side, upper cervical spinal injury can result. Difficulty breathing is a classic sign of upper spinal cord and brain-stem injury.[93] When infants with undiagnosed upper cervical spinal cord injury are continually placed on their stomach for sleep, they are forced to turn their head to the side to breathe. This is hypothesised to aggravate and prolong the spinal cord injury sustained during birth, preventing proper healing and ultimately leading to fatal breathing difficulty.

Gender

There is a consistent 50% male excess in SIDS per 1000 live births of each sex. Given a 5% male excess birth rate (105 male to 100 female live births) there appear to be 3.15 male SIDS per 2 female SIDS for a male fraction of 0.61.[94][95] This value of 61% in the U.S. is an average of 57% Black male SIDS,62.2% White male SIDS and 59.4% for all other races combined. Note that when multiracial parentage is involved,infant "race" is arbitrarily assigned to one category or the other, most often it is chosen by the mother. The X-linkage hypotheses for SIDS and the male excess in infant mortality have shown that the 50% male excess could be related to a dominant X-linked allele that occurs with a frequency of ⅓ that is protective of transient cerebral anoxia. An unprotected XY male would occur with a frequency of ⅔ and an unprotected XX female would occur with a frequency of 4⁄9. The ratio of ⅔ to 4⁄9 is 1.5 to 1 which matches the observed male 50% excess rate of SIDS.

Although many authors have found autosomal and mitochondrial genetic risk factors for SIDS they cannot explain the male excess because such gene loci have the same frequencies for males and females. Supporting evidence for an X-linkage is found by examination of other causes of infant respiratory death, such as suffocation by inhalation of food and other foreign objects. Although food is prepared identically for male and female infants, there is a similar 50% male excess of death from such causes indicating that males are more susceptible to the cerebral anoxia created by such incidents in exactly the same proportion as found in SIDS. See the data found at http://wonder.cdc.gov for 9ICD 911-912 and 10ICD W79-W80 for death rates from inhalation of food and foreign objects by sex.

The study which indicated that there was a relationship between fewer serotonin binding sites and SIDS noted that the boys "had significantly fewer serotonin binding sites than girls." However,such neurological prematurity decreases with age, but the male fraction of approximately 0.61 persists each month throughout the first year of life [96]. Furthermore, this cannot explain the identical male fraction of 0.61 in other respiratory mortality causes such as respiratory distress syndrome or suffocation from inhalation of food or foreign objects cited above, that also exists for all ages 1 to 14 years in the U.S. from 1979 to 2005 as reported in wonder.cdc.gov.

Child abuse

Several instances of infanticide have been uncovered where the diagnosis was originally SIDS.[97][98] This has led some researchers to estimate that 5% to 20% of SIDS deaths are infanticides.[99][100][101][102] In 1997 The New York Times, covering a book called The Death of Innocents: A True Story of Murder, Medicine and High-Stakes Science, wrote:

The misdiagnosis of infanticide as SIDS "happens all over," Ms. Talan, a medical reporter at Newsday, said. "A lot of doctors and police don't know how to handle it. They don't take it as seriously as they should." As a result of the book's revelations, people are starting to scrutinize possible cases of this "perfect crime," which involves no physical evidence and no witnesses.[103]

British former pediatrician Roy Meadow believes that many cases diagnosed as SIDS are really the result of child abuse on the part of a parent displaying Munchausen Syndrome by Proxy (a condition which he was first to describe, in 1977). During the 1990s and early 2000s, a number of mothers of multiple apparent SIDS victims were convicted of murder, to varying degrees on the basis of Meadow's opinion. In 2003 a number of high-profile acquittals brought Meadow's theories into disrepute. Several hundred murder convictions were reviewed, leading to several high-profile cases being re-opened and convictions overturned.

The Royal Statistical Society issued a media release refuting the expert testimony in one UK case in which the conviction was subsequently overturned.[104]

Nitrogen dioxide

A 2005 study by researchers at the University of California, San Diego found that "SIDS may be related to high levels of acute outdoor NO2 exposure during the last day of life."[105] While nitrogen dioxide (NO2) exposure may be one of many possible risk factors, it is not considered causal, and the report cautioned that further studies were needed to replicate the result.

Inner ear damage

Records of hearing tests administered to certain infants show that those who later died of SIDS had a unique pattern of partial hearing loss, according to the journal Early Human Development.[106] One suggestion for the cause of SIDS is that the deaths are caused by disturbances in respiratory control (from other than suffocation). The vestibular apparatus of the inner ear has been shown to play an important role in respiratory control during sleep. It is speculated that this inner ear damage could be linked to SIDS. It is speculated that the damage occurs during delivery, particularly when prolonged contractions create greater blood pressure in the placenta. The right ear is directly in the "line of fire" for blood entering the fetus from the placenta, and thus could be most susceptible to damage. If the findings are relevant, it may be possible to take corrective measures. Researchers are beginning animal studies to explore the connection.[107]

Side effects of SIDS risk reduction recommendations

Dr. Rafael Pelayo from Stanford University and a number of other pediatric sleep researchers in the U.S. have stated that they believe that the American Academy of Pediatrics' recommendations regarding cosleeping and pacifier use may have unintended consequences. They have stated that the SIDS prevention strategy of the American Academy of Pediatrics which keeps infants at a low arousal threshold and reduces the time in quiet sleep may be unhealthy for children. They state that slow wave sleep is the most restorative form of sleep and limiting this sleep in the first 12 months of life may have unintended consequences to both the sleep and the infant.[108]

According to a 1998 study by British researchers that compared back sleeping infants to stomach sleeping infants there were developmental differences at 6 months of age between the two groups. At 6 months of age the stomach sleeping infants had higher gross motor scores, social skills scores, and total development skills scores than the back sleeping infants. The differences were apparent at the 5% statistical significant level. But, at 18 months the differences were no longer apparent. The researchers deemed the lower development scores of back sleeping infants at 6 months of age to be transient and stated that they do not believe the back sleeping recommendations should be changed.[30] Other scientists have stated that the conclusion that the negative effects of back sleep at 18 months of age is transient is based upon very little evidence and that no long-term randomized trials have been completed.[109]

Other side effects of the back sleeping position include increased rates of shoulder retraction, positional plagiocephaly, and positional torticollis.[110] Some scientists dispute that plagiocephaly is a negative side effect. Dr. Peter Fleming, who is co-author of the study that deemed delays at 6 months of age to be transient, has stated that he does not think plagiocephaly is a negative side effect of back sleep. In an interview with the Guardian Dr. Fleming stated "I do not think it is a medical problem—it is more of a cosmetic one. Mothers may feel it is a syndrome and a problem when it really is nonsense."[111] A research study on children with plagiocephaly found that 26% had mild to severe psychomotor delay. This study also showed that 10% of infants with plagiocephaly had mild to severe mental development delay.[112]

Because of the delays caused by back sleep some medical professionals have suggested that the "normal" ages at which children had previously attained developmental milestones should be pushed back. This would enable medical professionals to consider "normal" children who previously were considered developmentally delayed.[113]

Additional studies have found the following negative conditions that the back sleep position has been reported to be associated with are: Increase in Sleep Apnea, Decrease in Sleep Duration, Strabismus, Social Skills Delays, deformational plagiocephaly, and Temporomandibular Jaw Difficulties.[110] In addition, the following are symptoms that are associated with sleep apnea: growth abnormalities, failure to thrive syndrome in infants, neurocognitive abnormalities, daytime sleepiness, emotional problems, decrease in memory, decrease in learning, and a delay in nonverbal skills. The conditions associated with deformational plagiocephaly include visual impairments, cerebral dysfunction, delays in psychomotor development and decreases in mental functioning. The conditions associated with Gross Motor Milestone Delays include speech and language disorders. In addition, it has been hypothesized that delays in motor skills can have a negative impact on the development of social skills.[114][115] In addition, other studies have reported that the prone position prevents subluxation of the hips, increases psychomotor development, prevents scoliosis, lessens the risk of gastroesophageal reflux, decreases infant screaming periods, causes less fatigue in infants, and increases the relief of infant colic.[4] In addition, prior to the “Back to Sleep” campaign many babies self-treated their own torticollis by turning their heads from one side to the other while sleeping in the prone position.[116] Supine sleeping infants cannot self-treat their own torticollis.

Further reading

Notes

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Translations: Sids
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Dansk (Danish)
abbr. - Sudden Infant Death Syndrome; vuggedød

Nederlands (Dutch)
wiegendood

Français (French)
abbr. - (abrév = sudden infant death syndrome) syndrome de la mort subite du nouveau-né

Deutsch (German)
abbr. - plötzlicher Kindstod

Ελληνική (Greek)
abbr. - αιφνίδιος θάνατος ανεπιτήρητου βρέφους

Italiano (Italian)
Sindrome di morte improvvisa di infante (Sudden Infant Death Syndrome), morte in culla

Português (Portuguese)
abbr. - síndrome (f) de morte súbita de bebês

Русский (Russian)
внезапная смерть грудного ребенка (сокр.)

Español (Spanish)
abbr. - muerte súbita infantil

Svenska (Swedish)
abbr. - Sudden infant death syndrome, plötslig spädbarnsdöd

中文（简体）(Chinese (Simplified))
婴儿猝死综合症

中文（繁體）(Chinese (Traditional))
abbr. - sudden infant death syndrome 之縮寫, 嬰兒猝死綜合症

한국어 (Korean)
abbr. - sudden infant death syndrome (유아 돌연사)

日本語 (Japanese)
abbr. - 幼児突然死症候群

العربيه (Arabic)
‏(اختصار) مختصر : موت الأطفال السريري المفاجىء‏

עברית (Hebrew)
abbr. - ‮תסמונת מוות בעריסה‬

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