SIDS is one of the most common fears among new mothers all over the world. This fear is pushed into mothers heads the moment after they birth their babies by medical professional, by sharing videos on how to prevent SIDS, CPR, and a non-compliance form to sign if you refuse to watch the material, they present to you. Making parents feel that SIDS is more common than it actually is, and that infants that are perfectly healthy are at a very high risk of losing their life every night. This often causes an extreme amount of stress and anxiety for mothers, taking away from time that should be spent with their new baby. It's no wonder post-partum anxiety and depression are on the rise. The thought of finding an infant dead in their sleep space with little to no explanation is any parents worst nightmare. Parents are often fearful of milestones that should be celebrated such as rolling over or essential motor skills because they are fearful that these milestones may cause them to lose their baby. New devices ranging from $300-$5000 are advertised to parents to prevent SIDS despite medical professionals concluding that they are of no value, and that they may be harmful to the health of infants.
Sudden Infant Death Syndrome is the leading cause of death in infants between the ages of 1 month and 1 year, with the peak incidence being between 1-4 months. It is estimated that nearly 2500 infants die each year in the United States due to Sudden Infant Death Syndrome. While there is no specific cause of SIDS, unsafe sleep habits can contribute to this syndrome. Despite removing these factors, SIDS cases have not been fully eliminated. Many cases of SIDS
are often misclassified causing challenges in precise understanding of statistics. It is also difficult to come up with an accurate action to prevent and minimize these cases.
Today in the U.S., more than 2,000 babies die of SIDS every year, according to government figures, (Hsu). 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, (Hsu). True cases of SIDS have no specific cause which makes it difficult to differentiate between cases of infant death. Many cases of SIDS had a cause of death that would have been preventable, however these cases are marked as SIDS when the medical examiner believes the cases need to be investigated further. It's often called a "diagnosis of exclusion," meaning it's the diagnosis that's given when everything else has been ruled out. But, Tackitt says, often the term SIDS comes up prematurely, (Hsu). "Differentiating between these causes, especially SIDS and infant suffocation, can be challenging, because SUID case investigations are not always conducted in a standard manner, and universally accepted definitions or biological markers to distinguish SIDS from suffocation do not exist," (Shapiro-Mendoza et al.) There is usually no witness in cases of infant death, and deaths deemed as accidental suffocation need to have a witness or evidence present at the scene of the death. About 1 in 5 cases in the SUID registry (18 percent) were classified as being explained by suffocation (obstructed breathing). Another 13 percent were classified as unexplained but possibly caused by suffocation," (Fliesler). This can cause difficulties in diagnosing and defining SIDS cases correctly and can lead to severe repercussions in the conclusion of research.
SIDS is a difficult topic to research as it a severely sensitive topic. It is important that we show empathy to parents that have experienced the loss of their infant, and that we do not place blame on them for situations that may have been outside of their control. Some would argue that a SIDS diagnosis offers compassion to parents in a moment of distress, and a way to avoid blaming parents amid the tragedy., (Hsu). Carl Schmidt disagrees with the statement and believes that it is cruel to provide a false diagnosis as a way of comfort, and instead recommends that we tell parents way they may have made an error to prevent these kinds of instances in the future. Rachel Moon, a pediatrician at the Children's National Medical Center states that it has been several years since they have seen a true SIDS case, and that all babies who have unexpectedly passed away was due to their sleep environment. Misclassified cases of SIDS are also of high concern to some medical professionals in the pediatric field.
Misclassified SIDS cases can cause challenges in the accurate understanding of statistics. Studies show that when the cause of the death is not known, or when the possible contributing factors are not specified, the term SIDS is used. This can lead to confusion on how and when the term SIDS should be used. "In the past, SIDS has been applied to cases even when the investigation does not fulfil the required definitions, and an autopsy has not been performed," (Duncan). Not all deaths that have been classified as SIDS cases have the same features.
Some cases classified as SIDS are actually due to unsafe sleep habits. Many infants are lost every year due to pediatricians' recommendations not being followed, however these cases are often classified as SIDS when they should be classified as suffocation or overheating. "A Study by Kleemann et al. found that profuse sweating was present at the time of death in 36% of SIDS cases, suggesting that hyperthermia plays a role in some SIDS deaths", (Duncan). "The mechanism of death attributed to prone sleeping is often suffocation, and while suffocation is a valid possibility in some cases, it does not account for all deaths," (Duncan). Sharing a sleep surface, specifically beds and sofas increase the risk of the parent rolling over on the infant, suffocation, and overheating as well. Safe sleep is described as placing the infant on their back, in a sleep sack, on a firm flat surface with no bumpers, loose blankets or stuffed animals. It is recommended that the room is shared with the infant, but the infant should have their own safe sleep space such as a cot or crib. It is important that the baby is not dressed too warm and that the room temperature is cool and comfortable. Pacifiers with strings or stuffed animals attached should not be given to infants in their sleep space. Parents should not smoke in their home as this also increases the risk of SIDS.
Misclassified cases of SIDS cause difficulty when implementing action to reduce the overall number of SIDS cases. When cases are consistently misclassified and not fully studied, it's difficult for us to implement proper preventative measures. According to ICD-10 coding rules, an unexpected infant death may be coded as SIDS even when other conditions are listed on the death certificate, (Shapiro-Mendoza et al.) Many parents are told that safe sleep habits will protect their baby from SIDS, but how can we protect infants from true SIDS if we don't know what SIDS is? If SIDS cases are simply infants dying due to unsafe sleep habits they should be documented as such. However, some infants have died while being placed on their back in a safe place with a comfortable temperature which may point to a true SIDS case. These specific cases need to be studied further so we have a clearer understanding of genetics that may cause SIDS. If we understand what may be causing these deaths, we can explain why they happened and prevent these types of deaths in the future.
There was a study conducted on medical examiners, and it concluded that many examiners label similar deaths in a different manner. For example, one medical examiner may use the term, "accidental suffocation," while another may have the cause as unknown. (Fliesler). This creates confusion in the medical field and confusion to those reading and assessing the information. Infant cases of death need to be properly and consistently documented so we can
put more scientific research and resources in finding the cause of true SIDS cases. This will also assist forensic investigators in looking further into potential cases of homicide.
There are certain genetic factors that play a part in certain cases. These factors still do not help us determine if these cases of infant death are true SIDS cases, or if they were caused by unsafe sleep habits, or illness. Race may play a part in SIDS, as SIDS is more common among African American, Native American, and Native Alaskan infants. SIDS is also more common among male infants. There are certain factors in the pregnancy can also place infants at a higher risk:
·When mothers do not receive proper health care during the pregnancy infants are at a higher risk of SIDS.
·When mothers do not gain enough weight throughout their pregnancy infants are at a higher risk of SIDS.
·When Maternal Age is under 20 years old.
·Women with a history of sexually transmitted diseases and urinary tract infections are at increased risk.
·Women with a history of Drug use place infants at a higher risk of SIDS.
Misclassified SIDS cases may have severe repercussions in the conclusion of research. We are doing more damage to parents and their mental well-being by giving them false causes of their child's death. There is no way for us to research the cause of SIDS if we do not have a clear understanding of what SIDS is. We cannot advise parents of proper prevention measures if we are misadvised on what is causing SIDS. Doctors will not research further genetic factors in their infant patients if they believe SIDS is suffocation/strangulation. Many doctors believe that true SIDS cases are very minimal compared to the number that is reported, and that if more parents followed the recommendations, we would have little to no cases of SIDS. Additionally, there have been cases of infanticide, or the homicide of infants, that have been improperly documented as SIDS and only properly documented if the caregiver was caught and went to trial. However, if we do not properly investigate cases of SIDS and falsely identify them, how can we help the person responsible for the infant death accountable? How do we get babies justice? "One of the greatest issues faced by families, clinicians, medical examiners, and researchers is that SIDS itself is not a cause of death and remains a diagnosis of exclusion and, as there is no one standardized definition, the application of the term as a "cause of death" can be extremely subjective," (Duncan). SIDS should no longer be a blanket term for the death of infant. It is important that we are more specific in the conclusion of an autopsy so we can better document these cases for parents, and medical health professionals.
Looking further into SIDS cases would provide parents with relief to their anxiety regarding this very serious matter. Additionally, further research will allow us to better support parents that have experienced the loss of their infants due to SIDS in the past, and properly explain prevention methods to future parents. It is also important that we have qualified professionals researching these cases such as experienced medical examiners rather than coroners that have been voted in with minimal knowledge. The misclassification of Sudden Infant Death Syndrome cases creates a consequential issue in the field of infant health. When cases of SIDS are not accurately labeled or improperly understood, it interferes with medical health professionals' ability to collect exact data, understand the dangers, and implement proper measures of prevention.
