eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Sudden Infant Death Syndrome: Follow-up

Author: Patrick L Carolan, MD, Adjunct Associate Professor, Departments of Pediatrics, Family Practice, and Community Health, University of Minnesota Medical School; Medical Director of Minnesota Sudden Infant Death Center; Attending Staff, Department of Emergency Services, Children's Hospitals and Clinics of Minnesota
Contributor Information and Disclosures

Updated: Oct 1, 2009

Follow-up

Deterrence/Prevention

  • Sudden infant death syndrome (SIDS) risk is lowest for infants placed in the supine position for sleep. The side-sleep position is recognized to be unstable and carries a higher risk for SIDS than the supine sleep position.
  • Recent studies from overseas centers have indicated that pacifier use may reduce the risk of SIDS.16 The pacifier may be offered to the infant when placed for sleep. Reinserting the pacifier if it falls out is not necessary once the infant is asleep. Do not force use of the pacifier if the infant refuses it. Clean and replace the pacifier regularly. Do not sweeten the pacifier to enhance its use. For breastfed infants, delay pacifier introduction until the infant is older than 1 month to ensure the establishment of breast-feeding.
  • Avoid overbundling and head covering, which may help reduce risk.
  • Avoid excessively soft or padded sleep surfaces, including pillows, comforters, and waterbeds. Keep soft objects and loose bedding out of the crib.
  • Avoid cigarette smoke exposure. Create a smoke-free zone around the infant.
  • Although somewhat more controversial, current evidence suggests that bed-sharing should be avoided. Bed-sharing may lead to compromise of the infants' airway, because the infant may be suffocated by soft or loose bedding or a sleeping adult. In addition, overheating may occur. Cosleeping on a couch or sofa is associated with an unusually high risk for SIDS and should be avoided. The American Academy of Pediatrics (2005) recommends room-sharing as an intervention to enhance breastfeeding but advises that once a feeding is complete, the infant should be placed for sleep in a separate bassinet or safety-approved crib.21
  • Media file 4 specifies current recommendations on sleep position and the infant sleep environment as interventions to lower the risk of SIDS.

    Several key recommendations related to infant sle...

    Several key recommendations related to infant sleep position and the sleep environment. Sources: American Academy of Pediatrics (AAP), National Institutes of Health and Human Development (NICHD), Consumer Product Safety Commission (CPSC), Association of SIDS and Infant Mortality Programs (ASIP). Adapted from "What is SIDS" monograph published by the National Sudden Infant Death Syndrome Resource Center.

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    Several key recommendations related to infant sle...

    Several key recommendations related to infant sleep position and the sleep environment. Sources: American Academy of Pediatrics (AAP), National Institutes of Health and Human Development (NICHD), Consumer Product Safety Commission (CPSC), Association of SIDS and Infant Mortality Programs (ASIP). Adapted from "What is SIDS" monograph published by the National Sudden Infant Death Syndrome Resource Center.

Patient Education

The following are resources for information on SIDS and related issues: 

  • NICHD may be contacted for information on SIDS and the "Back to Sleep" campaign. Specific informational materials can be accessed from this site.

NICHD Back to Sleep Campaign
31 Center Drive
Room 2A32
Bethesda, MD 20892-2425
Public Information Phone: (301) 496-5133
Fax: (301) 496-7101
Toll free: 1-800-505-CRIB

  • On the American Academy of Pediatrics Web site, use "SIDS" as a key word to search for information related to SIDS and infant mortality. Policy statements pertaining to SIDS, sleep practices, and death investigation may be accessed from this site.
  • The Association of SIDS and Infant Mortality Programs (ASIP) is a professional organization of SIDS and other infant death information and counseling programs located throughout the United States and Canada. They may be contacted with specific questions related to SIDS and infant mortality and to seek counseling referrals on behalf of families of infants who have died of SIDS.

  • The National SIDS/Infant Death Resource Center/Project IMPACT (NSIDRC) is a comprehensive, federally sponsored clearinghouse for scientific, clinical, and bereavement-related materials pertaining to SIDS and infant mortality.
    • NSIDRC is sponsored by the Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration (HRSA), and the United States Department of Health and Human Services.
    • The NSIDRC collaborates with the National SIDS & Infant Death Program Support Center, the National Center for Cultural Competence, and the National SIDS & Infant Death Project IMPACT.
    • The NSIDRC serves as a central source of information on sudden infant death (including SIDS, miscarriage, stillbirth, and other sudden infant deaths), on bereavement, and on promoting healthy outcomes for infants from the prenatal period through the first year of life and beyond. The NSIDRC Web site provides access to this information. Searchable databases and special issues of the MCHB alert with a focus on infant mortality are available.

National SIDS/Infant Death Resource Center
8280 Greensboro Drive, Suite 300
McLean, VA 22102
Toll Free: (866) 866-7437
Local: (202) 687-7466
email: info@sidscenter.org

Miscellaneous

Special Concerns

  • In addition to notifying the medical examiner or coroner, several other key individuals should be contacted immediately after the death.
    • The infant's primary health care providers should be notified of the death so that they may provide consolation and immediate guidance to the family. They can also provide the infant's relevant medical history.
    • If subspecialty health care providers cared for the infant, they should also be contacted for the same reasons.
    • Immediate and extended family members should be contacted to assist the family with grief support.
    • The family's religious institution and chaplain staff may also be contacted to offer consolation and guidance to the family.
    • In special cultural settings, family or tribal elders may need to be notified to assist the family following the death.
  • Experts in the field of grief support describe the following strategies for supporting the family under these difficult circumstances:
    • At the time of death: Express condolences to the family. Encourage the parents and family to see and hold the infant if they feel that they are able to do so. Explain the local procedure that is followed after the death, including autopsy and death investigation by local authorities. If sudden infant death syndrome (SIDS) is suggested, reassure the family that they could not have done anything to prevent the death. Reassure the family that intense feelings of grief are normal and that resources are available for support.
    • Early support following the death (first days after death): Refer the family to the local SIDS program (US SIDS program listings are available at Association of SIDS and Infant Mortality Programs). Attend the viewing or services and send a sympathy card. Listen supportively and allow expressions of grief. Discuss potential sibling reactions. Arrange an appointment to discuss autopsy findings.
    • Reviewing the autopsy findings: Meet with the family to discuss the results of the autopsy and answer their questions. Discuss grief response to the loss.
    • Long-term family support: Be available to families as needed. Explain that special times of grief include the anniversaries of the infant's birth and death.
 


More on Sudden Infant Death Syndrome

Overview: Sudden Infant Death Syndrome
Differential Diagnoses & Workup: Sudden Infant Death Syndrome
Follow-up: Sudden Infant Death Syndrome
Multimedia: Sudden Infant Death Syndrome
References
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Further Reading

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Keywords

sudden infant death syndrome, SIDS, crib death, cot death, sudden unexpected infant death, SUID, upper respiratory tract illness, livor mortis, rigor mortis, intrathoracic petechiae, neurotransmitter abnormalities, delayed development of the brain stem, positional asphyxia, mechanical asphyxia, accidental asphyxia, overlay, bed sharing, apnea, apparent life-threatening event, ALTE, near-miss SIDS, aborted crib death, respiratory syncytial virus infection, RSV, gastroesophageal reflux disease, respiratory syncytial virus bronchiolitis, pertussis, sepsis, meningitis, cyanotic breath-holding spell, cardiac dysrhythmia, long QT syndrome, anemia, structural CNS anomaly, airway anomaly, hypoglycemia, hyponatremia, hyperkalemia, hypocalcemia, severe dehydration, enterocolitis, systemic sepsis, inherited metabolic disorders, medium-chain acyl-CoA dehydrogenase deficiency, MCADD

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Contributor Information and Disclosures

Author

Patrick L Carolan, MD, Adjunct Associate Professor, Departments of Pediatrics, Family Practice, and Community Health, University of Minnesota Medical School; Medical Director of Minnesota Sudden Infant Death Center; Attending Staff, Department of Emergency Services, Children's Hospitals and Clinics of Minnesota
Patrick L Carolan, MD is a member of the following medical societies: American Academy of Pediatrics and International Society of SIDS Researchers
Disclosure: Nothing to disclose.

Medical Editor

Susanna A McColley, MD, Director of Cystic Fibrosis Center; Head, Division of Pulmonary Medicine; Associate Professor, Department of Pediatrics, Children's Memorial Medical Center of Chicago, Northwestern University
Susanna A McColley, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Sleep Disorders Association, and American Thoracic Society
Disclosure: Genentech Honoraria Speaking and teaching; Genentech Honoraria Consulting; Novartis Honoraria Consulting; Altus  Consulting fee Consulting; Axcan Scandi Consulting fee Consulting; Boston Scientific Consulting fee Consulting; Gilead  Speaking and teaching

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Charles Callahan, DO, Professor, Deputy Chief of Clinical Services, Walter Reed Army Medical Center
Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

CME Editor

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians
Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Michael R Bye, MD, Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center
Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Merck Honoraria Speaking and teaching

 
 
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