Sudden Infant Death Syndrom Essay, Research Paper
Sudden Infant Death Syndrom
Sudden infant death syndrome, better known as S.I.D.S., is one of the
leading causes for the inflated infant mortality rate in this country today. It
is often misunderstood or unrecognizable. For the most part, the causes of SIDS
are unknown to the general public. This is changing, however, as public
awareness is ever increasing. Thus, the purpose of this paper will be to
explain sudden infant death syndrome and its known or suggested causes. Also,
the history of SIDS, the problems and emotional suffering that results from the
loss of a child, the toll it takes on the surviving sibling, and possible
counseling or other help that is available for parents who may have lost a child
to SIDS are such areas that will be explored. Overall I hope to achieve a
better understanding of all these suggested topics within the body of the paper.
SIDS is also commonly referred to as crib death. It is said to claim
approximately in the range of 6,000 to 7,000 babies a year within the
continental United States alone, with a slight increase each year (Bergman xi).
This would seem to be an astounding figure, but when the figure of the total
amount of babies that are born in the United States is compared to that of the
number of deaths due to SIDS, it accounts for only a small percentage. It is a
small percentage that hopefully can be reduced. And to any parents, the loss of
just one child is definitely one too many, despite of the statistics that are
currently available. During the first week of life is where most deaths that
are associated with prematurity dominate, SIDS is the leading cause of death
among infants under one year of age, according to Bergman. It ranks second only
to injuries as the cause of death in children less than fifteen years of age.
An unknown fact is that SIDS takes more lives than other more common diseases
such as leukemia, heart disease or cystic fibrosis (Bergman 24). Ironically it
was not until the middle of the 1970?s until SIDS was no longer ignored as being
a cause of death. For the most part, no research was being conducted, leaving
families and victims left to wonder why their babies died (Mandell 129). For
the family and friends of the family, who also are victims, this was definitely
a tragedy. Not knowing the cause of death had to have caused physical and
emotional distress in their lives. Self blame was something that had to exist,
even though there was nothing that most of these parents could have possibly
done.
Today where more research in this area is needed, researchers are making
strides in combating this disease. But understanding the crucial aspects of
SIDS and how to prevent it, are still limited. The leaders in this field are
hoping to improve understanding of this disease by providing direction and
opportunities for more quality intensified research. According to L. Stanley
James, MD, chair of neonatology at Columbian Presbyterian Medical Center in New
York City, “The government is now having a rejuvenation of SIDS research, and
over the next five years, they are going to be putting in thirty to forty
million dollars.” The direction will be supplied through a five year research
plan proposed by a panel of experts from The National Institute of Child and
Human Development in Bethesda, Maryland (Zylke 1565). In response to a Senate
request, there will be representatives from the fields of epidemology,
neonatology, cardiorespiratory and sleep research, neuroscience, behavioral
medicine, pathology, infectious disease, immunology and metabolism to meet an
release a report on current knowledge and research recommendations (Zylke 1565).
It was important to this group that people would have a definition of SIDS that
would be acceptable to all. The current definition of SIDS, developed in 1969,
states SIDS as being “the sudden death of any infant or young child which is
unexpected by history and in which a thorough postmortem examination fails to
demonstrate and adequate cause of death.” (Bosa 5).
Much has been learned through research in the recent years. Such
examples have now been considered to be facts, one being that the peak incidence
occurs at about ten weeks of age and that it is uncommon at less than three
weeks and greater than nine months (Zylke 1566). What also is commonly known is
that death usually occurs during sleep and that most victims do not exhibit any
illnesses in any one degree at that time. It must also be important to realize
what complications might arise from a broad generalization such as the previous.
It may be used by some doctors in the medical profession to cover up what might
otherwise be considered to be malpractice. With the good comes the bad as well.
Therefore, the National Institutes of Health assembled a group of
experts to come up with a new definition of SIDS. “The sudden death of an
infant under one year of age which remains unexplained after a complete
postmortem examination, including an investigation of the death scene and a
review of the case history. Cases failing to meet the standards of this
definition, including those with postmortem examinations, should no be
diagnosed as having SIDS. Cases that are autopsied and carefully investigated
but which remain unresolved may be designated as undetermined, unexplained, or
the like” (Zylke 1566). A few conclusions can be determined from this quote.
One is that it gives a more precise, operant definition of the SIDS is in
terms of age. Another, is that it provides room for cases that do not have all
the symptoms of what is to be considered SIDS to be classified as unexplained or
ruled out as being due to SIDS itself. It also takes abuse and neglect into
account by examining the scene of death. Obvious conclusions can be raised if a
child?s environment was of poor living conditions where it was not well cared
for, which most likely could have resulted in death. Is must be remembered that
this definition only meant to serve as a benchmark for other research and can
not be applied to all conditions where a death attributed to SIDS is considered.
There are also other socioeconomic and demographic factors that can be
associated with an increased risk of SIDS, but few exact causes have been
identified. There have been studied however, that may show a correlation
between cigarette smoking and SIDS. It “has not been determined whether or not
a history of maternal smoking during pregnancy is biological in nature or a
proxy for maternal behavior is not clear” (Malloy 1380). Research done by
Haglund and Cnattingius have shown that infants born to women who smoke during
pregnancy die earlier because of SIDS than do those infants whose mothers did
not smoke during pregnancy (Malloy 1381). Their report supports the
plausibility of a biological mechanism. What they did find, was that it was
not possible to conclude that there was a relationship between the age of death
and a history of maternal smoking during pregnancy, but there was a relationship
between quantity of cigarettes smoked with an increased risk of SIDS (Malloy
1381). These affects that maternal smoking has on the SIDS baby have not gone
without others taking notice. According to other researchers, respiratory
disorders during sleep have been thought to be one of the major causes of SIDS.
With a distinct link to breathing abnormalities in many SIDS cases, suffocation
has also been linked to mothers who smoke during pregnancy.
Another study has shown that Chronic Fetal Hypoxia may predispose
infants to SIDS as well (Raub 2731). This is due to low hematrocrit during
pregnancy (Raub 2731). This study has been supported by the National Institute
of Child Health and Human Development. Researchers analyzed 130 SIDS cases and
1,930 members in their control group that survived the first year of life.
They found that infants whose mothers smoked ten or more cigarettes a day had
increased their infants chance of SIDS by almost 70% (Raub). So it can be seen
from this that the more cigarettes a mother smoked per day while pregnant would
do nothing but increase their infants chance of SIDS, according to this research.
These researchers also see that maternal smoking may predispose infants to SIDS
by impairing their normal development of the fetal central nervous system (Raub).
The central nervous system is in control of such bodily functions such as
breathing, which goes back to the theory of suffocation during sleep in SIDS
babies (Martin 194). In breathing disorders have been theorized to cause SIDS,
and maternal smoking has been shown to impair development of the fetal central
nervous system, there is an obvious link that exists between the two. Mothers
should become increasingly aware of smoking as a cause of SIDS, along with
other drugs and carcinogens as well. Sometimes the best solution to this
problem boils down to the obvious which is prevention. In this case, it is
prevention of smoking during pregnancy.
Another possible cause of SIDS may be due part to a defect in the
autonomic nervous system. Increases in cardiac sympathetic activity may induce
malignant arrhythmia?s even in the absence of heart disease ( Stramba 1514).
There has been a consensus that SIDS might be multifactoral and that in most
SIDS cases, death may be attributed to either cardiac or respiratory problems
(Stramba 1515). There are still not any preventive measures for SIDS as of this
time.
It is know that the development or maturation of cardiac and respiratory
functions continue after birth, and that the chance of the infant having
malignant arrhythmia?s during this time are different from that of an adult (
Stramba 1514). To understand the mechanisms that cause SIDS, a fuller
understanding of what goes on in this postnatal period is crucial. There is
also the possibility that SIDS victims may have a cardiac instability during the
first months of life (Stramba 1521). This idea supports the notion of heart
rate problems in such infants. According to recent data, the risk for SIDS
increases by almost 30% for babies with heart rates that deviate from the mean (
Stramba 1541). All of these ideas open up a new area in the understanding of
SIDS. Maybe there is a way to predict or to test for SIDS by checking such
measures as heart and breathing rates. But there is still the problem that
physicians can not be totally confident in the use of such tests as they have
not proved to be reliable in accurately predicting SIDS. This is why further
research and testing must be done in not only this but in all areas.
There has been recent research in the risk of SIDS associated with
vaginal breech delivery. A study done by Germain M. Buck, PhD., clinical
assistant professor in the Dept. of Social and preventative medicine in Buffalo,
NY, has also shown that there is more than twice the risk of SIDS when mothers
were in labor for approximately sixteen hours or longer (Bergman 214).
According to Buck, “The majority of breech SIDS infants were single footling
deliveries (a rarer type of breech presentation with the baby emerging with on
foot first). The more common form of delivery called ?frank? presentation, with
the baby exiting buttocks first was not associated with an increase in SIDS.”
(Bergman 215). What can be concluded from this is that a breech birth may be
an indicator of an earlier problem in the development of the fetus, and problems
in the development of proper heart rate and breathing. Oxygen and blood flow
may be restricted to the fe
fetal development (Bosma 107). It is important to realize that a breech
delivery is not the direct cause of this syndrome, which may be a false
conclusion that can be drawn from this.
Although today SIDS is what can be considered essentially a diagnosis of
exclusion, there is currently no apparent consensus about the extent of the
investigation that must be undertaken in order to eliminate other possible
causes of death ( Thatch 126). There is supposed to be a thorough examination
of the death scene by a medical examiner as stated previously, but this is at
their own discretion and does not happen very often (Gregory 2731). Simply put,
most coroners either do not have the time nor are they willing at times to go
out and investigate the death scene for other possible reasons of death. By
examining the death scene, they also bring themselves into conflict with the
parents of the child as well as outside support groups (Thatch 127). It is the
purpose of those who are to counsel those coping with the loss of a child due to
SIDS to diminish the pain and guilt that is associated with the death ( Cruan
53). Any outside investigation by the police or medical examiner does nothing
but to induce guilt, which is extremely hard on the parents especially if they
are not truly at fault.
The consideration of such an investigation may yield some unwanted
results. It will from time to time reveal potentially preventable causes of
death that may have otherwise been diagnosed as SIDS. Such causes that are
mistaken for “true SIDS” are namely overeating, overlying and most often,
accidental suffocation ( Thatch 126). The harsh reality is that nobody is a
perfect parent, and no matter how much care is given, accidents do happen.
Another implication is that accidental suffocation by overlying during sleep can
rarely, if ever, be conclusively proved by an examination (Bergaman 152). Once
the parent awakens the baby from the sleeping position, the evidence is
destroyed. The problems that arise from this are clear, making it obvious that
death by suffocation may be unprovable. Which brings up the question of whether
or not SIDS does actually exist. It is equally as hard to conclude the
suffocation was not the cause of death, however.
There has been a presumed association between that of SIDS and apnea,
which has led to the use of home apnea monitors for “diagnostic and preventive”
purposes (Ahmann 719). They are located in homes where it is thought there is
a risk of SIDS for the infant. According to the Congressional Office of
Technology Assessment, as many as 45,000 infants are on home apnea monitors,
which translates into 11.5 infants on monitors per every 1000 birth (Ahmann).
The problem that is associated with the home apnea monitor is that most likely
will cause distress within the family unit. It has been suggested to cause
parental fatigue, anxiety, social isolation, and depression ( Defrain 215).
This also leads to conflicts with others outside of the family such as friends,
relatives, and those in the workplace that indirectly result from this problem
in the home.
A Study was done by Elizabeth Ahmann to look for how home apnea monitors
disrupted family life. Data from telephone interviews and mailed questionnaires
were used to examine twelve aspects of family life such as parental depression,
health, and attachment to the infant in ninety-three families that had infants
who were considered to be at a high risk for SIDS, and who were on home apnea
monitors. There was also a matched comparison of eighty-six families with
infants that did not require monitoring. The results showed that the mothers
of monitored infants were of poorer health than of those in the control group.
Poor health, fatigue and somatic complaints were reported from mothers of
monitored infants (Ahmann 722). Prior mental health was not considered in this
study which may or may not account for those mothers of monitored infants that
complained or showed poorer health. This could have possibly swayed the
results, but the evidence still shows that those infants who were monitored had
parents that clearly exhibited more stress. When the point of view of the
mother of the monitored infant is taken, the results may be easier to see. It
must be difficult having a child that needs to be monitored because of a
possible chance of death within the home. This most likely would make it hard
for the parents to have any rest while their infant is sleeping for they may
feel that if they do not keep a constant eye on the child, it will be their
fault for the child?s death, if it should so happen.
When a baby dies, each person in the family is going to experience it in
a unique way. When a child dies from SIDS, this can be an even more tragic
event because for the most part the death goes unexplained. It has been said
that the death of a baby due to SIDS is extremely hard on the parents, for they
feel a great amount of self blame. It takes approximately three years or more
for the parents to recover from the death of a baby due to SIDS ( Defrain 229).
What is clear is that people are really never the same not only after a death
due to SIDS, but also a stillbirth or miscarriage as well. The parents must
learn that they can heal emotionally and that they can and must go on for their
future and their own good (Defrain 229). They need to learn that life will get
better even though the memory that they will always have of the child will exist
in their hearts and minds. Seeking professional help to cope with such an event
is a good idea. Deep emotional feelings that are bottled up need to be
expressed and brought out into the open. This is very beneficial not only for
the parents but for the entire family as well.
The death of an infant due to SIDS may also cause parental unconscious
conflicts. Parents have been shown to have the preoccupation with death in
their dreams and there spouses ( Arno 53). Parents also may exhibit a mode of
rejecting their child?s aliveness, independence or uniqueness ( Arno 54). These
can be attributed to the obvious stress load that SIDS puts on the family. It
shows that the pain and loss of a child reaches deep into the emotions of
parents. During this time husband and wife may become closer to one another and
show more feelings and compassion for one anther. These are defense mechanisms
that are used to ease the pain of the passing of the infant. Denial may bring
the parents closer to one another as they concentrate on other matters in order
to lessen the loss of the child. These can be considered to be normal
psychologically as long as they do not get out of hand to the point where it may
go on to such drastic measures such as suicide. This is a harsh reality, that
sometimes is best dealt with by seeking professional help.
The surviving child in the SIDS family is an important factor. The
mental health of a child that is part of such a loss is very important.
Children grieve, often deeply, and the unexpected loss of a sibling due to SIDS
elicits feeling from other family members that changes the family structure
(Mandell 217). It is of utter importance to bring out the child?s feelings into
the open and to see how they feel about it. Negative feelings that are kept
inside by the child may hurt the child?s development and how he grows up. It is
important to remember that the child is being discussed. An older child or
teenager still has a great amount of sorrow but is more understanding and
realistic to what has transpired.
It is now obvious that the impact that sudden infant death syndrome has
on the family and friends can be considered to be tragic and shocking to say the
least. Other health professionals also are at times struck by how SIDS can so
suddenly take a infants life away. The role of the family?s doctor and health
care professionals are important in coping with this loss of life (Limerick 147).
Providing early explanations and reassurance to the family along with the
support of counselors and parents? organizations are helpful especially when
there are legal investigations, and when there are no clear causes of death.
It is up to such health professionals to provide families with the support and
the advice that they need in order to cope with their loss. Losing an infant to
SIDS can be one of the most devastating event in the lives of many parents,
especially when they might feel that the death was their fault, when a lot of
times it was due to outside circumstances that are beyond their control. There
are some things that parents can have no control over, and SIDS is one of these
tragic events that can happen to a family unit.
Overall, I felt that I have explained SIDS, both causal and
psychologically to a full extent. SIDS is a real problem in our society today,
and it is one that can and must be dealt with, especially in USA. We have a
very high infant mortality rate for a country of our stature. Our health care
is top notch, but our babies are still not surviving. This can be prevented.
The emotional strain that SIDS puts on parents is unbelievable, and can not be
understood to its fullest extent unless one was to experience it first hand, in
my opinion. There is a lot of research that is being done in this area to try
to combat the causes of SIDS, which many times is incorrectly used as a cause of
death among infants. This is a shame, because it may lead researchers who study
these cases in the wrong direction. However, new research with good counseling
offers new hope.
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