e, 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 ...