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 fetus, which can be a contributing factor in improper

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.

Works Cited

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Bosma, James F. Development of Upper Respirator Anatomy and Function.

Washington, D.C.: National Institutes of Health, 1974.

Cruan, Arno. “The Relationship of Sudden Infant Death Syndrome and Parental

Unconscious Conflicts.” Pre and Pari natal Psychology Journal. 2 (1987): 50-

56.

Defrain, John. “Learning About Grief From Normal Families: SIDS, Stillbirth,

and Miscarriage.” Journal of Marital and Family Therapy. 12 (1991): 215-232.

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