Sudden Infant Death Syndrome (SIDS

). Defined as the sudden death of an infant younger than 1 year of age that remains unexplained after autopsy, investigation of the death scene, and review of the history, SIDS is the third leading cause of overall infant mortality among all races in the United States, accounting for approximately 10% of infant deaths.⁴ SIDS is the leading cause of infant death in the United States during the postneonatal period, between 1 and 12 months of age. Approximately 7000 infants die of SIDS each year. The specific cause of SIDS is not known. Factors associated with an increased prevalence of SIDS include prone sleeping position, African-American or Native-American race, prematurity, LBW, young maternal age, lack of prenatal care or inadequate prenatal care, smok­ing or substance use during pregnancy, and exposure to environmental cigarette smoke.

The prone sleeping position is a significant risk factor in SIDS. The frequency of SIDS is more than threefold greater when infants sleep on their stomachs compared with sleep­ing on their backs.⁴ Population-based education programs to decrease the practice of having infants sleep on their stom­achs have resulted in a substantial decrease in SIDS.

The exact cause of SIDS is unknown. Theories focus on brain stem abnormality, which prevents effective cardio-respiratory control. Features of SIDS include prolonged sleep apnea, increased frequency of brief inspiratory pauses, ex­cessive periodic breathing, and impaired response to in­creased carbon dioxide or decreased oxygen. A diagnosis of SIDS can be made only if an autopsy is performed to ex­clude other causes of death. Differentiation of child abuse from SIDS is an important consideration, and each case of SIDS must be subjected to careful examination.

Support of the family of an infant who dies of SIDS is crucial. Parents frequently feel guilty or inadequate as par­ents. The fact that there must be close scrutiny to differen­tiate a SIDS death from a death by child abuse adds to the guilt and disappointment felt by the family. After a diagno­sis of SIDS is made, it is important that the parents and other family members receive information about SIDS. Health care providers need to be fully aware of resources available to families with a SIDS death. The siblings of the child who died should not be overlooked. Children also need infor­mation and support to get through the grief process. Chil­dren may blame themselves for the death or fear that they, too, may die of SIDS. Too many times they are not given in­formation because the adults are trying to protect them.