Sudden infant death syndrome

Florian Tiefenbock studied human medicine at the LMU in Munich. In March 2014, he joined NetDoktor as a student and has since been supporting the editorial team with medical articles. After receiving his medical license and working in internal medicine at Augsburg University Hospital, he has been a permanent member of the NetDoktor team since December 2019 and, among other things, ensures the medical quality of the NetDoktor tools.

The term Sudden infant death syndrome means that a child dies without warning and without apparent cause. Medical professionals and scientists make the diagnosis of SIDS when they cannot identify any other cause of death, even after a thorough investigation. For the affected parents, sudden infant death syndrome is a catastrophe. Learn more about sudden infant death syndrome and what you can do to protect your child from SIDS.

Sudden infant death syndrome

Sudden Infant Death Syndrome: Description

Sudden infant death syndrome (mediz.Sudden Infant Death Syndrome (SIDS) means that a child dies suddenly and unexpectedly. In this tragic death of a seemingly healthy infant or toddler, doctors also speak of "Sudden Infant Death Syndrome", or SIDS for short. In this country, sudden infant death syndrome is also known as "crib death" or "sudden infant death syndrome". Causes cannot be determined with certainty.

Even a careful autopsy (internal necropsy), usually does not provide consistent causes for sudden infant death syndrome. Signs or warning signs can be found just as little as triggering circumstances. A fact that can be very disturbing for parents. Scientists have conducted numerous studies. To date, the results only provide possible risk factors of SIDS.

Sudden infant death syndrome: frequency and age

SIDS has become less frequent. According to the Federal Statistical Office, 131 children died of sudden infant death syndrome (SIDS) within the first year of life in Germany in 2012. In 2011, there were 147 SIDS deaths, at the turn of the millennium there were 482, and in 1990 there were even 1283 SIDS deaths. This decrease in infant deaths is explained by better preventive care.

Approximately two-thirds of cases occur in winter. This accumulation is explained by the fact that many SIDS children have previously suffered from a cold, which occurs more frequently in these months. Most infants die in their sleep in the early hours of the morning. The majority are found by their parents in a prone position. SIDS infants are often drenched in sweat and lie with their heads under the covers of their beds. When babies sleep on their stomachs, the risk of SIDS is significantly increased.

Sudden infant death syndrome increasingly affects boys: SIDS affects male infants in 60 percent of cases. Up to which age the risk for sudden infant death syndrome exists, cannot be said exactly. About 80 percent of the deaths occur before the sixth month of life. Only rarely are the children already over one year old.

Sudden infant death syndrome: causes and risk factors

Since no clear causes for sudden infant death syndrome have been found to date, experts assume that there is an interplay of several factors. These relate on the one hand to the course of pregnancy, as well as the physical condition and health of the child (endogenous risk factors). Secondly, environmental factors, i.e. external influences, play a decisive role in sudden infant death syndrome (exogenous risk factors).

Disturbances of the life-supporting functions

Every human being has natural control systems. For example, they keep the baby breathing. They also "measure" the gas content in the blood and react to it accordingly. One example: Every human being breathes in vital oxygen (O2) and exhales carbon dioxide (CO2). If a blanket lay on the face while sleeping, the emitted CO2 would accumulate there. The child would breathe in again and the CO2 level in the blood would rise. However, an area in the brain stem would immediately recognize the increased value, which is unfavorable for the body. Breathing would be cranked up or the person would wake up. In this way, the body can avoid undersupply and protect itself from suffocation.

Even an infant already has these life-sustaining reflexes, but they must first mature. In the case of sudden infant death syndrome, experts assume that there is a failure in the control function. A sleeping O2 or an elevated CO2 level can no longer be compensated, or a falling blood pressure is no longer caught.

Risk factor genes

Researchers have found that twins and siblings of SIDS children have a sixfold increased risk of also dying from SIDS. They therefore suspect that changes in the genetic material play a role. whose genes carry the information with which the body produces, for example, messenger substances (neurotransmitters) and their receiver structures (receptors). The body controls many of its functions in this way. Altered genes can cause a defect in this process. This can also affect the control of vital functions; a possible consequence is sudden infant death syndrome. SIDS comes without warning signs.

Risk factor problem birth

Various studies investigate the connection between birth process and sudden infant death syndrome. Premature babies have an increased risk of SIDS. This also applies to children from multiple births. Newborns who have breathing problems during or after birth are also at risk for SIDS. A congenital narrowing of the airways can cause SIDS. Another factor is weakness of the throat muscles. In the process, the upper airways are constricted and sudden infant death syndrome is promoted.

Risk factor age

Newborns are particularly sensitive in the maturation process of important bodily functions. Unfavorable external influences affect the biological systems and can lead to sudden infant death syndrome. However, it is precisely these external factors that can often be very well influenced by the parents.

Risk factors prone position and overheating

Parents are asked after a sudden infant death how they found their child. Evaluations of this data show how crucial the infant’s sleep situation is. The greatest risk factor for sudden infant death syndrome is considered to be the prone position. The risk of SIDS is even higher if the bedding is very soft or if there are additional pillows, stuffed animals, scarves and blankets in the bed. These conditions can lead to obstructed breathing. The child inhales too much carbon dioxide again, while at the same time the air he breathes contains less and less oxygen. The child cannot compensate for this by breathing more, nor can it free itself with specific movements. Sudden infant death syndrome looms.

At the same time the heat accumulates in the body of the infant. One suspects that this overheating additionally impairs the physical functions. If the cardiovascular system then fails, this too can lead to sudden infant death syndrome.

Risk factor infections

Cold infections put you at additional risk for sudden infant death syndrome. Their consequences are manifold. The still immature immune system does not have an adequate response to the pathogens. If breathing is difficult – for example in a prone position – bacteria can multiply even more easily. The infant’s body reacts to their toxins with fever, which in turn stresses the circulation and leads to increased fluid loss. All together can affect the central regulatory mechanisms of the child and thus even lead to sudden infant death syndrome.

Risk factor stress and social status

More and more people feel burdened by stress. Unconsciously, they also transfer some of this to their children. For infants and young children in particular, parental stress increases the risk of sudden infant death syndrome, studies say. Young maternal age (less than 20 years) and closely spaced pregnancies are also thought to increase the risk of SIDS. In addition, a poor financial and social status of the family is said to favor sudden infant death syndrome.

Risk factors smoking, drugs, alcohol

Studies show: if mothers smoke or take drugs during pregnancy, this leads not only in many cases to developmental disorders or malformations of the embryo, respectively the fetus. It also increases the risk of sudden infant death syndrome of the infant. The infant is particularly at risk if there is smoking in and around the home. Nicotine interferes with the control of vital functions in the child’s body.

Sudden infant death syndrome: investigations and diagnosis

If a small child has died of SIDS, the parents concerned are first interviewed. In this way, the medical examiner wants to learn as many details as possible about the previous history, i.e., from the beginning of the pregnancy to the sudden infant death syndrome. The situation in which the parents found their child is also particularly important. One speaks thereby of the evaluation of the so-called "death scene". This is the way to identify or rule out possible risk factors.

Subsequently, the infant who died of sudden infant death syndrome will be autopsied. This means that forensic experts or pathologists examine the child’s body. If the parents agree, a pathologist performs the autopsy. If not, the investigating prosecutor decides on further action. An autopsy ordered by him will then be taken over by a forensic pathologist. They should clarify whether internal causes or external fault could have brought about the suspected sudden infant death syndrome.

The diagnosis "Sudden Infant Death Syndrome" or "SIDS" is therefore a diagnosis of exclusion. Medical experts cannot clarify the causes of sudden infant death syndrome in this way.

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