Normal Limits

"Chance is the very guide of life"

"In practical medicine the facts are far too few for them to enter into the calculus of probabilities... in applied medicine we are always concerned with the individual" -- S. D. Poisson

November 15, 2005

AAP - The Changing Concept of SIDS

American Academy of Pediatrics's new policy statement on SIDS: "The Changing Concept of SIDS: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk"

SIDS is defined as
The sudden death of an infant under 1 year of age, which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history.

The incidence of SIDS has been going down...

But note the concomittent rise in the incidence of sudden unexpected infant death (SUID), especially after year 2000. SUID is a unexpected death with attributable cause, such as accidental suffocation in bed, accidental poisoning, assault and homicide, etc. But as we can appreciate from the graph this increase in SUID does not account for the fall in the rate of SIDS.

The rate of SIDS has indeed been going down, even if some of this progress may be attributable to changes in coding. Based on this encouraging trend and new research findings, the AAP recommends (among others):

  • A separate but proximate sleeping environment is recommended such as a separate crib in the parent�s bedroom. Bed sharing during sleep is not recommended.

  • Consider offering a pacifier at nap time and bedtime: The pacifier should be used when placing infant down for sleep and not be reinserted once the infant falls asleep.

  • Avoid commercial devices marketed to reduce the risk of SIDS: Although various devices have been developed to maintain sleep position or reduce the risk of rebreathing, none have been tested sufficiently to show efficacy or safety.

  • Do not use home monitors as a strategy to reduce the risk of SIDS: There is no evidence that use of such home monitors decreases the risk of SIDS.

  • Avoid development of positional plagiocephaly (flat back of head): Encourage �tummy time.� * Avoid having the infant spend excessive time in car-seat carriers and �bouncers.� Place the infant to sleep with the head to one side for a week and then changing to the other.

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