The autopsies of babies who die of SIDS show no obvious cause of death. Even very experienced pathologists who perform autopsies on these babies may find no adequate explanation. Their respiratory tract may be mildly inflamed. A slight excess of fluid may appear in the air spaces of their lungs (although not enough to account for the death). It is also likely that pinpoint hemorrhages, called petechiae, will show up in the thymus gland and the membranes covering the lungs. But these did not cause the baby to die.
In perhaps 15% to 20% of all infants who have died suddenly, the cause of death may prove to be an unsuspected cardiac malformation or a severe, rapidly developing infection. A diagnosis of SIDS, however, is reserved for those deaths in which a cause cannot be found.
If a definite cause of death is found, then that becomes the baby’s official cause of death, and while it remains a sudden and unexpected infant death, it is no longer considered a case of SIDS.
It should be pointed out that in many cases of sudden unexpected infant deaths, there are no overt anatomical abnormalities, and hence the autopsy is reported as negative, since the defects involve submicroscopic, cellular and molecular mechanisms. These defects can only be detected by methods of modern cellular and molecular biology. Therefore, it is not surprising that such defects are missed by most forensic centres in Canada performing autopsies on infants who died suddenly and unexpectedly, since these tests are often not performed in these forensic centres.
A pattern of recurring features has emerged from the results of many SIDS research studies underway around the world. We know that these sudden deaths are most likely to happen between the ages of 2 and 4 months, although both older and younger babies also die of SIDS. Usually the babies seem healthy or perhaps just recovering from a cold. Research has found that there are risk factors that can increase the chances of SIDS occurring.
Investigations into the cause of death take time. Therefore, parents often receive a temporary diagnosis of SIDS and are referred to associations and support groups for help until the results of the investigation are available through the final autopsy report.
The pathologist performing the autopsy carefully examines all organs and regions of the body, searching for abnormalities that might explain the infant’s death. After receiving the reports of all the investigation, if the coroner or medical examiner still cannot determine the cause of death, a diagnosis of SIDS should be retained. When a cause of death is identified during the investigation, the final diagnosis will pertain to that cause (for example, infection, heart malformation, or genetic disease).
Since 2012, coroners in most Canadian provinces have made a unilateral administrative decision to stop using the term SIDS to qualify infant deaths for which a cause cannot be found. Instead, they are using the term “undetermined”. While the term SIDS implies a medical condition not yet understood, using the term “undetermined” means that no manner of death has been excluded.
In recent years, there has also been a tendency by Canadian coroners to categorize risk factors as causes of death, and to exclude a diagnosis of SIDS whenever a known risk factor is present, referring to those deaths as “unsafe sleep” related deaths. This approach implies that the infant could still be alive if risk factors had not been present and puts unjustified and unfair blame on the families.
We strongly believe that this is a regressive step and we do not support this new approach. Remember that risk factors are not causes of death, and that SIDS babies do not die of “unsafe sleep”. There is no evidence that the infant would not have died without the presence of the risk factors.
If your baby died suddenly and unexpectedly, and no definite cause of death can be established, then you are a SIDS parent, independently of what your infant’s autopsy report concludes. We advocate for equal and compassionate counseling and advice for all families who lost an infant suddenly and unexpectedly, regardless of the “official” categorization of the cause of death.
And remember that Baby’s Breath supports and offers services to all parents who have lost an infant suddenly and unexpectedly, no matter what your infant’s autopsy report says, and whether or not a cause of death is established.
No one is at fault. When a baby dies as the result of a car accident or a known disease, we can understand what has happened. But in the case of SIDS, when even doctors cannot explain the cause, the death seems mysterious. Many parents blame themselves, or even each other at first; they feel they must have done, or failed to do, something. While it is understandable that parents feel this way, such guilt is not necessary.
Families sometimes blame a caregiver or their doctor. Frequently the baby was examined shortly before death, and the doctor found no signs that would lead anyone to suspect that the baby might die. But SIDS cannot be predicted. Many doctors and nurses have lost their own babies to SIDS. It can happen to infants even in the hospital.
No. While much has been learned about SIDS, we are still baffled as to its cause or causes and how to prevent it. Researchers are now able to identify certain common elements about the babies who die, about their parents, and even about the death itself. These are referred to as “risk factors”. But this does not mean that the majority of SIDS cases have several or even one of these elements in common – only that they have been seen more frequently in infants dying of Sudden Infant Death Syndrome than in other infants.
It is important to remember that associations and risk factors are not causes. Clearly, the vast majority of SIDS babies were well nourished, well cared for, and in apparent good health prior to death.
Many researchers think that what we now call SIDS will one day be found to be a number of disease processes that, on the surface, appear to be similar. Because we cannot yet pin down a cause of SIDS, no definitive tests are available that would enable doctors to identify a baby at special risk. Since we know of no particular condition that exists prior to death, there are no known preventative measures that can be taken.
Most of the SIDS babies appear to die undisturbed in their sleep. Usually, at the time no one is even aware of the event. It is likely that such deaths are without pain or suffering; no outcry or struggles have been reported.
Sometimes stomach contents or blood-tinged froth may be found around the infant’s mouth and nose, or on the bedding. This is not the cause of death, rather it is the result of the act of dying. Note, too, that babies who sleep on their backs are not at greater risk of choking.
Breastfeeding, although recommended for many reasons, provides no guarantee against SIDS. SIDS occurs in both breastfed and bottle fed infants. Indeed, unexpected sudden deaths have occurred since ancient times, when all babies were breastfed.
Whatever the cause of SIDS, it is not transmitted from the infant who died to other babies or children. Parents and caregivers do not need to take special precautions when caring for other children or adults in the family.
SIDS is rare before one month of age, peaks at 2 to 4 months, and is also rare after one year of age. It takes the life of 1 of every 2,000 live-born babies in Canada. Babies of aboriginal background are at greater risk of SIDS.
It is estimated that three babies die of SIDS every week in Canada. It is difficult to get an accurate statistic on SIDS because of the definition of SIDS and the usage of different terms (ie. undetermined) that may include other causes of death. We do know that SIDS rates varies from place to place and from year to year. SIDS also occurs throughout the world.
These parties are obliged by law to investigate all unexpected deaths to ensure that they are due to natural causes. A thorough investigation that includes police involvement is therefore undertaken.
Many people have heard about the home apnea monitors that can be attached to the baby or mattress to track heart rate and breathing. A monitor is not a treatment; it can only alert the caregiver to a potential problem. Although some parents may be reassured to know that their baby’s breathing is being continuously assessed, some families find the full-time commitment to operating the device and the psychological stress that can result, a heavy burden. These should be balanced against any possible benefits. Babies die even while on a monitor. Unfortunately, the research of the last 30 years provides no evidence that the incidence of SIDS decreases with the use of monitors.
Whenever someone we love dies, we go through a period of grieving and mourning. It is a natural and normal process. People grieve in many different ways. After the first shock and numbness have worn off, most parents feel depressed and have difficulty concentrating; they are excessively anxious about the safety of their other children or worry about caring for them. Sometimes parents feel they may be losing their minds.
Anger, while often denied, is another common grief reaction. It may be directed at the other parent, the doctor, the babysitter, the other children, even the SIDS baby or society in general. Anger may be expressed or suppressed; each individual copes with it in a personal way. Sometimes parents begin to argue as a result of the anger, or to feel distant from each other.
These and other upsetting symptoms are normal reactions. With time, however, they become less intense and, eventually, they become less severe. It is good for parents to express their feelings, both to others and to each other. When they feel low and depressed, it often helps to talk to another parent who has had a baby die from SIDS. People who have had a similar experience can understand and provide support to the grieving parents. They can explain that things do eventually improve. Baby’s Breath is able to put bereaved parents in touch with each other.
Other people such as clergy, health professionals, and professional counselors may be able to help. Often too, the parents’ families and friends can be supportive; they can help by allowing the parents to talk about their baby, by listening without trying to “fix” the parents’ pain. If the parents’ grief seems excessive or prolonged, further professional help may be needed.
Children are also profoundly affected by a death in the family as well, however, they don’t always understand or talk about death in the same way as an adult. They may actually deny it or appear unconcerned. The youngest ones, who are less able to verbalize their fears or may not understand explanations, mostly need to be reassured of their parents’ continuing love and affection and of their own safety. Older children should be told that the baby died of SIDS. They must be allowed to express their emotions and discuss their fears.
Just as parents feel the loss and have doubts, guilt, and sorrow, so do children. Children need an honest explanation; they need to know they were not responsible for the baby’s death. They need reassurance that they will not die in the same way. Children may act out, have nightmares, revert to bedwetting, or become clingy. They may also have problems at school. Seeking professional support that specializes in childhood grief may be helpful.
Sometimes relatives, babysitters, or professional childcare providers were in charge of the baby when the death occurred. All caregivers should receive the same information about SIDS as do the parents. They should have an opportunity to express their feelings and speak to a counselor if they so wish. Parents may blame the caregiver or themselves for having left the baby with someone else. The caregivers may blame themselves.
Grandparents should be included in those who receive information about SIDS. They often have a special relationship with the baby as well as with the parents.
It is important that everyone understands the facts about SIDS. No blame should be laid on anyone. The distribution of accurate literature may help to explain the tragic situation.
This decision is one that only the parents can make. It is wise for parents to take their physical health and emotional state into consideration. Some people decide to have another baby soon after the loss of their child; others may decide to wait. The decision should be made when both partners feel ready. It is important to remember that the next baby cannot replace the one who has died. The next baby is a new and unique person.
It is very rare for SIDS to occur more than once in a family. Many parents have brought up healthy children both before and after their baby has died of SIDS. However, it is true that the risk of SIDS is slightly higher if another sibling has died of SIDS.
Many people are misinformed about SIDS. Well-meaning friends sometimes repeat misinformation to parents, causing them needless distress. Articles and items about SIDS frequently appear in the news media. They often imply that “the cause” has been discovered, or a “breakthrough” has occurred. Television programs may sensationalize SIDS in presenting a story. If you read anything in the newspapers or hear anything on television or radio that is misleading, notify Baby’s Breath. Its members will attempt to clarify the accuracy of the report.
Medical researchers are working to uncover the causes of SIDS so that it can be eliminated. They are also trying to identify which babies are at special risk, so that customized preventive approaches can be applied. Specific areas of study include the investigation of the many factors that control such basic functions as heart rate, breathing, temperature control, and other automatic functions. Other research examines how best to help grief-stricken families adjust to such a tragedy.
One key task of current research involves examining the normal development of healthy infants so that we can better understand how SIDS babies differ. Many SIDS researchers feel that these infants are born with some problem or defect that makes them more vulnerable to situations encountered in a baby’s daily life. SIDS, however, probably has more than one overriding, single explanation.
Today, we hold some pieces of the puzzle. But we must piece together the total picture if we are to understand, and eventually prevent SIDS.
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