Dr. Dale Ackley

Understanding SIDS

By definition, SIDS is “the sudden death of any infant that is unexpected by history and in which a thorough postmortem exam fails to demonstrate an adequate cause of death.” Therefore, SIDS can only be declared a cause of death after an autopsy. What the pathologist is really saying is that he does not know why the child died. SIDS is the number one cause of death for all infants between the ages of 1 month and 1 year. The rate is about 2/1000 in the United States and kills about 6000 babies a year. The peak ages for death are from 2 to 4 months, with a sharp decline after 6 months of age. More deaths occur in the winter months. We do not know why there is an age or seasonal variation.

The parent needs to know that SIDS cannot be predicted. The parents are blameless. The first real indication of increased risk for SIDS comes when the parents find the baby already dead. The fear of SIDS exists for all families. We need to be extremely cautious about adding to that fear by exaggerating the incidence of SIDS. We also need to be cautious about leading families to believe that we know what SIDS is and how to prevent it. We clearly do not.

There is no classic case. Both rich and poor, white, black, and yellow are the victims. SIDS is not preventable and not predictable. The infant is usually put to bed after a feeding without any suspicion that something is out of the ordinary. Sometime later, a few minutes, several hours or the following morning, whenever the parents next check on the baby, the infant is found lifeless. There is no outcry, no struggle.

The infant may be lying face up or face down in the crib. The face and remainder of the body may bear bluish-purple discoloration, which may appear to be bruises. These are normal postmortem changes and should not be mistaken for injuries. Parents are usually plagued with self-doubt, second-guessing, and guilt. “What did I do wrong?” “Was it my fault?” “Why didn’t I detect that there was something wrong with my child?” These are the kinds of questions you will usually hear.

Lola Redford, wife of actor Robert Redford, tells how guilty they both felt after their first-born died in his crib. “I had this notion that when you come from strong Mormon stock, you just don’t have children who die.” She also spoke of not being willing to hire a baby-sitter for her two subsequent children, of spending all her energy “guarding” them. For almost nine years, I gave those children my undivided 100% neurotic attention. I was so afraid they would die.”

Some parents believe that they accidentally killed their child by allowing the infant to suffocate in the bedclothes or choke on regurgitated milk. There is no basis to believe this is true.

Grandparents are often unaware of the mysterious, sudden, unexpected death called SIDS. They may believe that the tragedy could have been averted by some action of their children such as a more proper diet or closer observation during a virus. Worst of all, they may believe the baby died because of some omission or neglect.

Grandparents need continual reassurance that the cause of the disease remains unknown and that the parents did not cause nor could they have prevented this crashing, bitter disappointment.

The Basics About the Nature of SIDS

1. It occurs in apparently healthy, normal, thriving babies who have received the most skillful and loving care.
2. The death does not reflect in any way on the ability of the parents to care for their children.
3. SIDS is not suffocation or pneumonia.
4. SIDS cannot be predicted or prevented.
5. They did nothing to cause death.
6. The infant was not in pain. In most cases, death is sudden, almost instantaneous. There are examples when the child “just stopped breathing” in the arms of the parent.