Sudden Infant Death Syndrome. What can be confused with sudden infant death syndrome? What to do if the newborn becomes ill

Most of the syndrome sudden death infants are susceptible, whose age varies from 2 to 4 months. By six months, this phenomenon is extremely rarely recorded, and among 9-month-old infants and older children, only isolated cases of SIDS have been noted.

The conducted research helped scientists to find out the most dangerous period infant mortality, but so far the exact cause of the sudden death of infants has not been found out. There are several major predisposing factors for SIDS. Pathological anatomical studies have proven some connection between the underdevelopment of certain parts of the brain and the frequency of infant mortality.

Understanding Sudden Infant Death Syndrome

It was not until the late 1960s that the medical community faced the acute question of mortality in infancy. It was during this period that the term SIDS was introduced. Of course, children have died before, but only at the end of the last century, pediatricians around the world began to "sound the alarm", holding all sorts of campaigns to try to prevent the development of this syndrome.

Although infants are able to quickly adapt to new conditions, their mortality due to external or internal causes is still high. Normally healthy-looking children die as a result of various pathologies development, due to past infections and often as a result of previous injuries. Unsuspecting parents put their baby to bed and then find him dead there.

A sleeping baby may experience respiratory problems. As a rule, its short-term delay for children is considered the norm. As soon as the level of oxygen in the blood drops, signals from the brain cause the child to wake up and restore breathing.

Only in rare cases, sleep apnea is fatal. If parents began to notice that their baby holds their breath for 10-15 seconds in a dream, and several stops occur within an hour, then this serious occasion to show the child to the doctor.

As a rule, the cause of death is determined at autopsy by the pathologist, and only when this fails, the diagnosis of SIDS is made. According to statistics:

• African American children are much less likely to die from SIDS;
• about three children out of a thousand who died at the autopsy fail to identify the cause of death;
• more than half of the dead are boys;
• in 90% of cases, 2-4-month-old children die;
• SIDS risks are highest when a child reaches 13 weeks of age;
• the death of a child in more than half of the cases is associated with the wrong behavior of the parents;
• in 40% of children infancy on the eve of death, symptoms of a cold were noted;
• most often, the development of the syndrome of sudden death of a child contributes to the period of cold weather.

Parents whose children are at risk need to make every effort to create the most favorable living conditions for their child. They need to be more attentive to the whims of the baby and devote most of their free time to him.

Factors that can provoke this phenomenon

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So far, such a phenomenon as SIDS has not been studied in full. Medical workers remain at a loss when caring parents suddenly die healthy child. No one can answer with 100% certainty what caused Sudden Infant Death Syndrome. The most likely provoking factors are:

• stop breathing during sleep;
• disturbed heart rate;
• pathology of the coronary vessels supplying oxygen to the brain;
• worsening general condition child's health against the background of psycho-emotional stress;
• infection;
• compression of the vertebral arteries.

It is also worth highlighting some factors that can adversely affect the health of the child and lead to sudden sudden death at night:

• nicotine and drug addiction of the mother during the period of gestation;
• delay prenatal development baby;
• the birth of a child prematurely;
• incorrect position of the baby in the crib during sleep (on the stomach);
• improperly selected bedding (large pillow, soft blanket, etc.);
• foreign objects in the crib (bottle, nipple, toys, etc.);
• excessive air temperature in the children's room;
• parents smoking.

Many dead babies could have been saved - most often children die through the fault of their parents. If at the autopsy the doctor finds traces of violent death, then SIDS qualifies as murder. It is not uncommon for her own mother to cover the baby with a pillow so that she no longer hears his crying.

Sometimes parents can inadvertently harm their helpless child. Due to the fact that the neck muscles of the baby are weak, any careless movement or shaking of the baby leads to concussions or bruises of the brain (we recommend reading:).

Often the baby calms down after a shake, he can lose consciousness and fall into a coma. Very often children die in their sleep when their own mother, under the influence sleeping pills or alcohol, with his body leans on a nearby sleeping helpless baby.

How high is the risk of developing SIDS?

For newborns and infants up to 2 months syndrome sudden death not typical. The peak of deaths occurs at the age of 13 weeks. If the child has moved to the next age category, he is over 6 months old, in this case risks of SIDS are reduced to 10%.

One-year-old children die in their sleep extremely rarely, only isolated cases are recorded. Adolescents and adults who were completely healthy can also die suddenly with increased physical activity, and being at rest.

SIDS most commonly occurs in children from birth to 1 year of age. As soon as the baby learns to roll over, sit down and stand up, then the risks of sudden death syndrome approach zero. From this moment on, the child can change the position of the body in a dream, taking the most comfortable position for himself.

Is the syndrome possible in an adult?

Unfortunately, sudden nocturnal death syndrome is also found among the adult population, so no one can say exactly until what age this phenomenon should be feared. Year by year, cases of death are recorded in the world when healthy people from 18 to 30 years old die for no clear reason.

Although many studies have brought scientists closer to unraveling the causes of SIDS, the phenomenon of sudden adult death requires serious study. The scientific community insists on the need to introduce a new term SIDS (Sudden Adult Death Syndrome). In young people, cardiac activity stops or breathing stops during sleep. At autopsy, there are no pathological changes that can cause death. On the contrary, in most cases the deceased was distinguished by good health.

Based on the available and very conflicting statistics, it can be assumed that on average in the world every week without visible reasons 4 people die. More than 200 cases of SHS are recorded per year.

If you look at other data obtained by scientists in the UK, the mortality rate from SHS is simply amazing. In this country, 3,500 people die every year for no reason.

First aid for a child with sudden respiratory arrest

Health workers in the maternity hospital and district pediatricians should conduct conversations with newly-made parents so that they, in turn, can immediately provide emergency care to their child. Knowing the terrible symptoms of sudden infant death syndrome, you can avoid the tragedy.

After stopping breathing, the child can be saved if measures are taken in time. Symptoms of SIDS can last from 1 to 30 minutes. Usually in infants, breathing becomes weak. The child does not show activity, turn blue skin, muscle tone is reduced.

As soon as parents suspect that the baby's heart rhythm is disturbed or there are breathing problems, you should immediately call an ambulance team. You can not waste a minute, you need to try to restore cardiac and respiratory activity, without panicking and keeping your composure. To do this, do the following:

• with fingers several times intensively hold along the spine;
• shake the baby lightly, trying to wake him up;
• massage feet, hands and earlobes.

Thanks to such actions, the child can be brought to life. He wakes up, his breathing and heart rate is restored. However, if all the manipulations performed did not give positive result, you don’t need to stop, you need to massage again and again until an ambulance arrives.

It is also necessary to give the baby a heart massage and chest. All actions must be performed with extreme caution, since the bones of the baby are still too fragile, you can injure him.

Is it possible to prevent the development of the syndrome?

Thanks to many years of research, doctors have been able to prove the effectiveness of preventive measures in the fight against SIDS. You can reduce your risk of sudden nocturnal infant death by:

• Stop smoking, as tobacco smoke is highly toxic. Its constant impact on the fragile body of the child is unacceptable.
• The bed should not be foreign objects. Children under 1 year old do not need a pillow, their mattress should be hard.
• You can not cover the baby with a warm blanket during sleep. The baby is not able to control his movements, he can easily pull the blanket over himself, thereby limiting access to fresh air.
• Many experts are of the opinion that it is better for a child to sleep with his mother. So she can control the baby's sleep. It must be understood that the use of alcohol or sleeping pills in this case is unacceptable.
• When placing the baby in the crib for sleep, it is necessary to lay him on his back, and take his head to the side, or on the side, fixing the body on both sides with a positioner.

If during pregnancy a woman will monitor her health, regularly visit women's consultation and follow the recommendations of doctors, then she has every chance to give birth and raise a healthy child. It has also been observed that breastfed babies have good health and better adapted to environment than formula-fed babies.

Based on the foregoing, a simple conclusion can be drawn: parents need to lead a healthy lifestyle, pay more attention to their child and follow the basic rules of children's sleep hygiene.

If the baby is at risk for SIDS, parents should take care in advance to purchase equipment specially designed for such cases. So during the sleep of the child, you can track his heart rate, in case of violation of which the alarm will go off. A respiratory monitor is placed next to the crib, and electrodes are attached to the child's body.

SIDS statistics in Russia

Sudden Infant Death Syndrome (SIDS) is not a disease. This is a diagnosis that is made only in cases where it is impossible to establish the true cause of death of an infant. At autopsy, there are no pathologies, no traces of violence, a lethal outcome is diagnosed as a result of SIDS.

In the Russian Federation, statistics of sudden deaths among child population. According to the statistics obtained, in Russia, the rate of sudden death per 1,000 children born is 0.43.

Educational activities of the Foundation for the Study of Infant Mortality began in 1991. Since then, the number of infant deaths in sleep has dropped significantly. Parents began to listen to the recommendations of specialists, tragic cases decreased by 75%, but SIDS continues to take the lives of babies.

Sudden Infant Death Syndrome (SIDS)- a concept applied to the unexpected death of a child of the first year, which occurred in a dream without established causes. SIDS is said to be when the study medical card and places of death, as well as post-mortem examination do not give a clear answer about the causes of death of the infant. To assess the risk of sudden infant death, test algorithms (Magdeburg scoring table) are proposed, ECG and polysomnography are performed. Prevention of SIDS includes optimizing the child's sleep conditions, identifying children at risk, and providing home cardiorespiratory monitoring.

The algorithm proposed by I.A. Kelmanson, contains 6 clinical and 12 morphological features that allow postmortem differential diagnosis sudden infant death syndrome and life-threatening diseases and is of interest mainly to pathologists.

Prevention

If an obvious life-threatening episode occurs, it is necessary to take the child in your arms, shake it up, vigorously massage the hands, feet, earlobes, back along the spine. Usually these actions are enough for the child to breathe again. If breathing has not been restored, it is urgent to call " ambulance» and begin carrying out artificial respiration and closed heart massage.

Prevention of SIDS includes primary and secondary measures. The principles of primary prevention are based on antenatal measures (refusal bad habits before pregnancy, rational nutrition of the mother, sufficient physical activity, prevention premature birth, early production for registration and management of pregnancy under the supervision of an obstetrician-gynecologist, etc.). Primary prevention measures also include optimizing sleep conditions. baby: sleeping on the back, application sleeping bag, excluding the child’s independent roll over on the tummy, sleeping on a dense mattress, avoiding overheating, sufficient access fresh air, maintenance of temperature and humidity conditions, lack of strong odors and tobacco smoke.

Secondary prevention of SIDS involves the identification of groups high risk and conducting targeted activities (restorative treatment, massage), home cardiorespiratory monitoring, etc.

One of the most tragic for a young family where a baby has recently been born can be a special “death in the crib” syndrome, or SIDS (sudden infant death syndrome) of a baby. A similar term in pediatrics refers to the death from unknown causes of relatively healthy children under the age of one year. Death occurs due to the stoppage of the heart or the center of respiration, while the obvious reason for the autopsy cannot be found by specialists. In fact, this is the unreasonable death of a child in a dream.

The study of this problem has been going on for more than one year, and although the exact cause of this phenomenon is not clear, today the main leading causes have been put forward, and certain influences that can act as provocateurs of this pathology have been identified. As a result, parents should be vigilant in early age crumbs, constantly monitoring his condition.

What is Sudden Infant Death Syndrome

This syndrome is not classified as a disease, it is a post-mortem conclusion given by pathologists after an autopsy, when neither the results of the study themselves, nor any data on the crumbs' medical record give obvious reasons for death.

This condition is not exhibited if during the autopsy malformations were found that had not previously manifested themselves (and affected the heart and breathing), or if death occurred due to accidents.

SIDS is not a new condition, the sudden death of babies has been recorded since antiquity, but even today no explanation has been found for this sad phenomenon, and leading experts around the world are actively studying this fact, trying to explain the ongoing lethal changes. SIDS, according to statistics, is not typical for children of Asian origin, and among Europeans, children die twice as often as among Indian and African families.

Characteristics of SIDS Infants

According to doctors, SIDS most often occurs during the baby's sleep, and on the eve of death there were no anxiety symptoms or diseases, similar cases noted with a frequency of up to 6 children per 1000 births.

According to post-mortem changes and retrospective analyzes, certain patterns of tragic events were identified. So, children under six months of age are most often subject to SIDS, the critical period falls on the age from the second to fourth month life. Moreover, episodes of death during the cold season predominate, with a peak in January-February, but according to data to date, such a pattern is not so clear.

Up to 60% of children who die as a result of SIDS are male gender, but it is impossible to predict such a thing in advance, as well as to prevent it through any treatment. And SIDS itself has nothing to do with the child's vaccinations and other medical manipulations. One of the leading risk factors for such a tragedy, doctors consider the state of prematurity and immaturity.

How is such a diagnosis made?

Exactly medical term SIDS was introduced into the practice of pediatrics in the 60s of the last century, but there have been descriptions of similar episodes before. By the mid-90s, doctors, first in Europe and America, and then throughout the world, began an active preventive campaign against. But today, such a diagnosis is made by the method of exclusion in a pathoanatomical study, when any painful causes have not been completely confirmed.

Although children are adapted to life in a new environment for themselves, and have high opportunities for adaptation at an early age, nevertheless, they can sometimes die from the action of critical external changes or internal processes(malformations of organs and systems, injuries - intentional and unintentional, infections, tumor growth).

Often, there are no external reasons for death, but the analysis of the medical record and the autopsy reveal previously unrecorded problems and pathologies. But if there are no changes in the body, while the death happened in a dream, and the day before the children were quite healthy, SIDS is put.

Critical age for the development of sudden infant death syndrome

Having retrospectively studied and analyzed hundreds of stories of SIDS, experts have come to certain conclusions regarding the age most dangerous for death "in the cradle ". Thus, these facts are noted:

• The development of SIDS is not typical for the first month of life,
• Most often, death occurs within 2 to 4 months after birth,
• The most critical is the 13th week of life,
• Up to 90% of deaths in the cradle occur in the first half of life,
• After a year, episodes of SIDS are extremely rare, although they cannot be completely ruled out.

note

There are descriptions in the literature of sudden death in preschool and school age, as well as in adolescence especially in the context of sports and physical activity, as well as in complete rest and even in a dream.

Possible mechanisms for the development of the syndrome

Although the whole mechanism similar condition has not been studied, but scientists suggest certain stages in the formation of SIDS. So, for death in the cradle, a combination of simultaneously certain genetic characteristics (heredity) is important, against the background critical age and influence of external unfavorable factors.

Children who are laid to sleep on soft beds, with oxygen deficiency (acute hypoxia), instantly wake up to change positions or give signals to parents by crying or groaning. If for some reason these mechanisms do not work, and defense reflexes are not turned on, then the baby can bury his face in the tissue, which leads to a decrease in the level of oxygen in the blood and a sharp increase in the level of CO2. This leads to a state of initially oppression, and then suppression of consciousness, up to a complete cessation of breathing and cardiac activity.

The baby will breathe until the level of CO2 reaches critical limits, when consciousness goes out. If at this moment it is not stirred up, death ensues. Accordingly, all factors that lead to hypoxia, both of the ambient air and those that affect the mechanism of respiration and reflex activity, are dangerous in terms of the development of SIDS.

Sudden Infant Death Syndrome: Causes and Theories of Development

Although the age of children has been clarified, during which the development of SIDS is most dangerous, the exact cause of this fact has not yet been identified. However, in the course of research, doctors noted some features in children who died from the syndrome. So, according to the autopsy, among all the babies, underdevelopment of the brain areas in the region of the arcuate nucleus and the reticular formation, as well as the stem regions, where the centers are located - respiratory and vasomotor, was revealed. But to date, the syndrome has not been precisely studied, there are mechanisms of explanation and theories of origin that most closely describe events that lead to death. Let's discuss the most common theories.

Respiratory dysfunction

During the sleep period of infants, they are characterized by periods of apnea (temporary stops in breathing), associated with the immaturity of the brain structures of the regulatory center of the brain stem. As a result of such delays, there is an accumulation of CO2 in the blood, with a sharp decrease in the level of O2, which in normal conditions excites the center of inhalation, leading to quickening and deepening of the baby's breathing. If such an exciting impulse does not come from the brain, the child may die.

Due to the immaturity of the respiratory center, holding the breath up to 10-15 seconds is not so rare, sometimes they are noted by the parents themselves, but if this occurs more than once an hour, and the periods exceed the 15 second interval, this is a reason to consult a doctor .

Disorders of the heart

The second most common theory is considered to be the cardiac hypothesis of SIDS, associated with disturbances in the rhythm of contractions, which threatens asystole (cardiac arrest in the phase of its relaxation). So, this is possible if you have baby heart rhythm disturbances with extrasystoles (excessive contraction) or with the development of blockades (violation of impulse conduction along the branches of the nerve). In addition, a decrease in the heart rate of less than 70 beats per minute, as well as an unstable, floating frequency of contractions, are dangerous. This theory can be confirmed by the discovery in children who died of SIDS, specific genetic mutations that lead to a change in the structure of specific channels in the heart muscle. It is due to them that deaths occur.

Rhythm changes are typical for healthy children, but they do not have critical stops and interruptions, the heart works stably.

Changes in the field of brain structures

In the medulla oblongata (stem area), the respiratory and cardiac centers are located, and as a result of research, scientists have identified enzymatic defects that lead to disruption in the formation of special mediators (substances that transmit impulses from cell to cell in nervous system). These mediators are poorly secreted in the brainstem region, and they are especially affected in the presence of passive smoking (if the mother or father is a smoker). The birth of a child from a smoking mother dramatically increases the risk of SIDS, which has long been proven.

Also, in some children who died from SIDS, lesions of the brain structures and cell changes in the brain stem were noted, which were the result of intrauterine hypoxia. In addition, changes were also noted in the data of ultrasound of the brain with the detection of pathologies of the cerebral arteries that feed the brain stem. This also speaks in favor of the hypoxic theory of damage to the centers of respiration and the heart.

It is believed that a certain position of the head of the crumbs in a dream led to arterial clamping, and underdevelopment neck muscles did not allow him to change his posture and turn his head. Similar skills are formed after 4 months, in connection with which this theory is also confirmed.

The deterioration of blood flow to the brain occurs when children are laid on their side, which reduces the flow of blood through the cerebral arteries to the trunk, this slows down the pulse and breathing.

stress theory

Some scientists are inclined to think that SIDS is formed as a result of exposure to stress on the body of infants, and leads to post-mortem changes in the body, which are found in all dead children. They provide proof of their opinion:

• Small hemorrhages (hemorrhages) in the thymus and lungs,
• Damage to the outer lining of the heart
• Stress ulceration and erosion of the digestive tract,
• Shrinkage of lymphoid elements,
• Decrease in blood viscosity.

Similar phenomena are formed against the background of a massive release of stress hormones - cortisol, adrenaline and noradrenaline - into the blood by the adrenal glands.

According to the researchers, external manifestations A similar stress syndrome in children could be the manifestation of lacrimation, changes in the size of the liver and spleen, hypertrophy of the tonsils, weight loss or a mild rash. Such changes are typical for children 2-3 weeks before the onset of SIDS, but often they are not detected, being taken as transient physiological phenomena.

Theories of infectious influence and immune shifts

For the vast majority of children who died suddenly, doctors noted a week or even earlier, the manifestation of any infections, and children under the supervision of a doctor could receive. According to scientists who support these ideas, microbes secrete toxins or certain factors that lead to the blocking of protective mechanisms and innate reflexes (awakening from sleep during hypoxia), which makes SIDS more likely. Toxins are most often blamed for the development of death, which intensified or provoked inflammatory changes in the body, and children, due to age and immaturity of immunity, are not able to protect their reflex reactions from overwhelming influences.

Another group of scientists compared the presence of antibodies to pathogens in children who died from SIDS and other infants. A significant number of the dead showed antibodies to enterobacteria and clostridia, and these antibodies did not provide full-fledged immune protection, as they belonged to class A. Against the background of provocateurs, such as the action of overheating, tobacco smoke, toxins, the defense mechanisms for these microbes were blocked, which threatened with suppression of respiration and cardiac activity.

A number of authors find a connection between infection of the stomach of children with ulcer-producing bacteria () with SIDS. These conclusions were made on the basis that in babies who died from the syndrome, the stomach tissues were massively infected with this microbe, in comparison with children who had other factors of death in infancy. These bacteria are capable of producing nitro compounds (ammonium), which block the respiratory center. When spitting up, children could inhale a certain amount of microbes with the contents of the stomach, which led to the absorption of ammonium into the blood and suppression of the respiratory center by it.

Gene mutation theory

More recently, the results of DNA studies of healthy children and those who died as a result of SIDS have been released. According to these data, a sharp increase in the risk of death was shown in those babies who had special mutations in the genes responsible for the formation immune system and certain parts of it. But by itself, this mechanism cannot be realized, it is necessary to influence provoking factors in the form of external influences and metabolic disorders within the body.

Theory of thermoregulation problems

According to scientists, the basic vital centers of the medulla oblongata are immature at birth, and their maturation occurs by a period of three months. If the area responsible for thermoregulation in the brainstem is imperfect, then the temperature of children may be below normal, and sharp fluctuations in values ​​are also typical. Body temperature reaches stability just in time for the 4th month of life (the critical age of SIDS). In the period of the second-fourth month, while the changes come to a stable operation, the fluctuations can be significant, which gives inadequate temperature responses. Against the backdrop of problems with the climate of the room and with too much wrapping, children overheat corny, which inhibits the activity of the centers of respiration and heart in the medulla oblongata, this leads to SIDS.

What could be worse than the death of a child in the cradle? This is what people call Sudden Infant Death Syndrome (SIDS). Another name for it is Sudden Infant Death Syndrome (SIDS). The English abbreviation is SIDS, sudden infant death syndrome. SIDS is his sudden death from respiratory arrest (apnea). Most often this happens at night or early in the morning when the baby is alone in the crib.

An autopsy failed to determine the cause of death. Scientists around the world have been struggling with the mystery of infant mortality for many years - the term SIDS was introduced back in 1969. Today we will talk about what they managed to find out.

Facts about sudden infant death

The collection of statistics on SIDS is quite difficult. However, the available evidence suggests that various countries SIDS accounts for 3 to 10 infant deaths per 1,000 children. In Russia, according to official statistics, 11 children out of 1,000 do not live to be one year old. However, the exact number of deaths due to SIDS is not known.

Sudden death of an infant is said to occur if it occurs for no apparent reason between the ages of one week and one year. Death in the first week of a child's life occurs from perinatal causes.

Most often, children aged 2-4 months die from sudden infant death. Presumably, this may be due to the fact that at this age the child can already turn on his stomach on his own, but cannot roll back or turn his head to the side if he begins to choke. Babies younger than 2 months are not able to roll over on their own, children older than 4 months have a more pronounced instinct for self-preservation.

Boys are more susceptible to sudden death of a child than girls - about 1.5 times. The reasons for this are not exactly known - perhaps such statistics are associated with lower immunity in newborn boys.

Children with reduced immunity are more likely than others to die suddenly. This is just understandable: immunity directly affects the heart activity and breathing of the child. That is why premature babies, children from multiple pregnancy and, of course, children of mothers with bad habits.

Sudden Infant Death Syndrome is directly related to the sleeping position: about 70% of deaths occur while sleeping on the stomach. Overheating and hypothermia are also big risk factors for babies, with overheating being much more dangerous.

What's New in Sudden Child Death Research

There are two lines of research that may shed light on the causes of SIDS. The first is the study of insufficient production of serotonin, known as the hormone of happiness. In the body of the dead babies, the level of serotonin was critically low. Meanwhile, this hormone is involved in many physiological processes, including cardio-respiratory activity. The theory speaks of a lack of serotonin as a factor that destabilizes breathing and heart rhythms.

In September 2012, the results of another study of sudden infant death syndrome were published: the absence of the Atoh1 gene does not allow the body to automatically regulate breathing and respond to an increase in carbon dioxide levels in the blood. The experiment was carried out on a population of mice.

What should parents do if the child is not breathing?

Since many parents have heard about death in the cradle, it is not surprising that this topic is actively discussed among young mothers. It is much more important to discuss rumors to know the algorithm of actions to be taken if you find that the child is not breathing. This could save his life! The sudden death of a child is diagnosed by doctors, but often the failure in breathing can be restored.

So, what should parents do while immediately calling an ambulance:

• Check the child's breathing (mouth and nose), movements of his chest;
• Quickly assess the color of the skin and mucous membranes - when breathing stops, they turn pale or turn blue;
• Try to stir up the baby by massaging his hands, heels, earlobes. Very often this is enough to restore breathing;
• If the measures taken do not help, you need to make sure that there are no foreign objects in the baby’s throat and immediately begin to give him artificial respiration - until the doctors arrive.

Prevention of SIDS

Unfortunately, there is no way to identify a child's tendency to sudden death. Therefore, the most important prevention of respiratory arrest. First of all, this applies to sleeping on the stomach, which many pediatricians oppose. The line is thin - after all, in many other respects, sleeping on the stomach, on the contrary, is useful. You can choose a compromise solution - for example, lay the baby on its side, placing a latch that prevents it from rolling over on its tummy in sleep.

In no case should it be hot in the room where the child sleeps - on the contrary, the room should be ventilated before going to bed. If the air is too dry, it is worth using a humidifier to achieve optimal humidity.

Some researchers of sudden infant death point to a direct connection of the syndrome with co-sleeping child and parents. However, there is no clear relationship here - in a number of countries where co-sleeping is considered the norm, the SIDS statistics are just lower, while in other countries it is the other way around. Most likely more an important factor there will be parental caution. 4.9 out of 5 (27 votes)

Sudden Infant Death Syndrome (SIDS, "death in the cradle") is the death of a child under the age of 1 year with no signs of illness and no features at autopsy. This phenomenon is one of the most mysterious and tragic in medicine; there are many myths and legends around it.

To avoid unnecessary fears for the child, as well as to prevent SIDS, you need to know scientific point view on this issue.

What is Sudden Infant Death Syndrome?

The term SIDS was introduced in the late 60s of the last century, although cases of sudden death of infants have been described earlier, such facts are found in the literature everywhere. Only in the 1980s and 1990s, after studying risk factors, pediatricians began to conduct active campaigns to prevent this syndrome.

SIDS is a diagnosis of exclusion. Despite high adaptive capabilities, infants often die from external and internal causes. Most often, these are malformations, infectious diseases, injuries (including intentional ones) and tumors. Usually, the cause of death can be determined from the medical history and autopsy results. But sometimes no research provides answers to questions. healthy, ok developing child falls asleep, and after a while, his parents find him dead in his crib. It is this sudden and uncaused death that is called SIDS.

Why does SIDS occur?

The risk of sudden death in crib is highest in children aged 2-4 months, gradually decreases by 6 months and tends to zero after 9 months. Scientists have found out up to what age the syndrome of sudden infant death is dangerous, but could not establish the cause. A number of features characteristic of all victims of SIDS have been identified. So, at autopsy, children were found to have underdeveloped parts of the brain (the arcuate nucleus, for example), which are responsible for the synchronism of cardiovascular and respiratory activity.

Long QT hypothesis

The time from the beginning of the contraction of the ventricles of the heart to their relaxation is indicated on the cardiogram Q-T interval. By different estimates the lengthening of this moment to 440-450 ms is called an extended QT. The connection of this feature with sudden coronary death in adults has been proven long ago. Now it turned out that in 30-35% of children who died from SIDS, such increased intervals were registered at which electrical instability of the heart muscle occurs. And often this feature is absolutely physiological, reaches a peak by 2 months and disappears by six months, which coincides with age-related risks of sudden death.

Apnea hypothesis

In many healthy children, there is a phenomenon of periodic breathing, when deep breaths interspersed with intervals from 3 to 20 seconds. But in some cases, the pauses between respiratory movements increase significantly. Most often this happens with. Such apnea (cessation of breathing) lasting more than 20 disappears after the premature babies reach the age corresponding to 37 weeks of pregnancy.

Although in rare cases, long pauses persist in full-term children. Scientists have identified some relationship between such apnea and SIDS, so premature babies with large breath holdings are recommended to install special breath recorders.

Serotonin receptor deficiency

A lack of serotonin-catching cells located in certain parts of the brain is a common autopsy finding in victims of SIDS. This deficiency is concentrated in the area of ​​the brain responsible for cardio-respiratory synchrony, that is, for the connection between breathing and heart rate. There is a hypothesis according to which it is defects in serotonin receptors that cause respiratory arrest during sleep in children.

Hypothesis of incomplete thermoregulation

It is believed that the vital centers in the medulla oblongata mature in children until they are three months old. With immature brain cells responsible for thermoregulation, the average body temperature in babies is below normal. By about 3 months of age, temperature constancy occurs (when measured in the rectum). Shortly before the maturation of these cells, fluctuations in the numbers on the thermometer and an inadequate temperature response may be noted. That is, when the microclimate of the bedroom changes, the baby can simply overheat, which will affect the respiratory and cardiac activity and lead to sudden death.

There are many other hypotheses (genetic, infectious, vertebral artery clamping hypothesis), but none of them explains absolutely all cases of SIDS.

Mechanism of sudden death

SIDS requires a combination of genetic factors, critical age, and adverse environmental conditions. Usually, children laid on their stomachs in a soft bed wake up instantly with a lack of oxygen and change their position. But for some babies, this defense mechanism does not work. They can bury themselves in the feather bed, the oxygen content in the blood will drop and the level of carbon dioxide will increase, but reflex awakening will not occur. The child will inhale the waste air again and again until the oxygen level becomes critical and leads to death. Such additional factor, like parental smoking, also causes disruption of this protective reflex.

Risk Factors for SIDS

Despite unsuccessful searches for the exact cause of sudden infant death, scientists have identified several risk factors. The exclusion of these factors can reduce the number of sudden deaths at times, although many predisposing features cannot be eliminated.

Factors associated with pregnancy and childbirth

• maternal drug abuse and smoking during pregnancy
• intrauterine hypoxia and developmental delay
• prematurity

Features of the child

• male, age 2-4 months
• resuscitation in the past (the more episodes in the child's life that require emergency care, the higher the risk)
• the child's brother or sister died of SIDS (this applies to deaths from any non-communicable disease, not just SIDS)
• frequent and prolonged episodes of apnea, high awakening threshold

baby sleep conditions

• sleep in the position on the stomach and on the side
• parental smoking after childbirth
• soft bed, feather bed, pillow
• overheating, cold weather
• living at high altitudes above sea level

The main factors in the occurrence of sudden uncaused death of a baby are sleeping on the stomach, conditions in the crib and smoking of the parents.

Sleeping in the prone position

Years of research have proven that a baby sleeping on their stomach is at greater risk of sudden death. It is especially dangerous to put children on their stomach in a dream after a long break or for the first time, that is, to create the so-called "unaccustomed position on the stomach." Most often it occurs during daytime sleep outside the home.

Previously, it was believed that the position on the side does not pose a threat. But now it is known that the risk of such a position is no less, since children often turn from it on their stomach. Therefore, the only safe position can be considered the position on the back. The exceptions are conditions in which sleeping on the back is contraindicated (underdevelopment of the lower jaw, pronounced gastroesophageal reflux). These children often spit up and may inhale the vomit. The vast majority of babies sleep comfortably on their backs without the risk of choking.

Sleep conditions

An important element of the safety of the baby is the situation in his bedroom and specifically in the crib. Potentially leading to sudden death can be:

• Warm quilts
• Volumetric soft pillows
• Soft duvets and mattresses
• Elevated room temperature
• Co-sleeping with parents

Smoking parents

Nicotine addiction of mom and dad harms not only their own health, but also adversely affects the child. There are several versions of why passive inhalation of tobacco smoke leads to sudden death in a dream. The most common is a decrease in the amount of catecholamines responsible for sensitivity to oxygen starvation under the influence of nicotine.

Since smoking mothers most often smoked during pregnancy, their children are characterized by delayed development of all parts of the brain, including the centers of cardiac and respiratory regulation. The combination of these factors leads to such a tragic consequence as SIDS.

What can be hidden under the mask of SAF?

Most infant deaths have causes. Sometimes, in order to find these causative factors, a thorough investigation and autopsy by experts is carried out. And only occasionally does death remain a mystery, receiving the name SIDS.

Consequences of abuse

The death of a child may be the result of a parent's outburst of anger, or it may be due to chronic beatings and bullying. Unfortunately, this happens more often than we would like. And if the doctors who arrived at the scene of the tragedy immediately find serious injuries and fractures, then it is not possible to immediately see some of the consequences of violence.

These include intentional strangulation and shaken baby syndrome. The latter is damage to the thin vessels of the brain as a result of shaking the baby. The weak neck and relatively large head of a child of the first year of life predispose to severe brain damage up to loss of consciousness, coma and death.

A repeated case of SIDS in the family suggests the possibility of child abuse. If a third child dies just as suddenly, then forensic doctors have no doubt abuse parents.

Unintentional suffocation

Sleepless nights, hormonal changes, and on-demand breastfeeding exhaust every mom. Therefore, her night's sleep can be very strong, despite the increased sensitivity to the cries of the baby. If the baby sleeps in the same bed as the mother, then there is some risk of unintentional suffocation. This risk increases several times when the mother takes alcohol or drugs for insomnia.

One of the most famous literary and historical facts of SIDS was the parable of Solomon's judgment from the Old Testament. Two mothers came to Solomon, one of whom found her child dead in bed (“sleeped” him) and put the little body in the bed of the second mother.

She called the living baby her son. Solomon wisely judged the women's dispute, giving the child to a real mother, who did not agree to cut it into two parts. Since then, the habit of putting the baby in the parents' bed has appeared and disappeared in different nations.

In the 18th and 19th centuries, there were even strict prohibitions on co-sleeping, and “sprinkling” a child was equated with deliberate murder. Currently, most mothers try to put their babies in a separate bed, although cases of their sudden death still occur.

Viral and bacterial infections

In infants, many infectious diseases occur atypically. In severe organ damage, sometimes there are no clear symptoms. This is especially true for small premature babies. Therefore, before making a diagnosis of SIDS, the pathologist will definitely exclude pneumonia, meningitis and other severe complications of infections.

Prevention of SIDS

Sudden infant death cannot be predicted and prevented with 100% certainty. But you can provide the baby safe environment and eliminate many risk factors.

Home breathing monitoring

IN last years many home appliances have appeared that allow you to monitor the child’s breathing, pulse, and even oxygen saturation of his blood. Such devices operate on the principle of a baby monitor, giving parents a sound signal during long pauses in the baby's breathing and heart rhythm disturbances. But, unfortunately, studies have not proven at least some preventive benefit of such devices. Home monitoring does little to reduce the incidence of SIDS. The use of sensors is permissible only in children of high risk groups:

• Babies who have had episodes of fainting, blueing, requiring emergency care (cardiopulmonary resuscitation)
• Premature small birth babies with frequent episodes of apnea
• Children with proven respiratory disease leading to respiratory arrest

Useless commercial novelties include wedges, as well as all kinds of sleep positioners. These devices fix the child, preventing him from turning on his stomach. From a statistical point of view, the risks of sudden death in such children do not decrease at all.

SIDS and vaccination

Anti-vaccination campaigners take pleasure in using the SIDS phenomenon to scare parents with the "vaccination horrors". Indeed, a baby's first vaccinations often coincide with the peak rate of sudden death. But numerous large-scale studies have shown that the coincidence of vaccination episodes and sudden death is completely random. Moreover, vaccinated children die in the cradle much less often than unvaccinated ones. Lack of vaccination will not only not protect against SIDS, but will also increase the risk of dying from respiratory arrest with whooping cough, for example.

When should you pay special attention to your child?

In some circumstances, it is necessary to show a little more attention to the health of the baby in order to avoid a tragic outcome.

• High fever in a child, especially during sleep
• Refusal to eat, reduced physical activity
• All respiratory diseases (pharyngitis, bronchitis, even the common cold)
• Baby's sleep after a long tantrum and crying
• Sleep in unusual conditions (at a party, not in your bed)

Help for parents who have experienced the sudden death of a child

The bitterness of such an unexpected and heavy loss is incomparable to anything. But it must be remembered that SIDS is impossible to foresee and prevent, and there is no fault of the parents in the death of the child. Therefore, it is necessary to seek help from a psychologist, start classes in support groups and continue to live on. Most families manage to maintain unity, have children and avoid a repeat of the tragedy.

Key Findings About SIDS

• The sudden death of a healthy child is a tragic but extremely rare occurrence.
• It is impossible to predict the development of SIDS
• A post-mortem diagnosis of SIDS is made only if there are no signs of illness or violence.
• Key measures to prevent sudden infant death: sleeping on your back, bed with hard mattress, no pillow and light blanket/sleeping bag, and parents not smoking
• Home devices for monitoring breathing and heart rate are necessary only for children at risk
• The presence in medicine of such a phenomenon as SIDS is not a reason for the development of anxiety in mom and dad. Create a child safe conditions and enjoy parenting!