Sudden infant death syndrome (SIDS) is the unexplained death, usually during sleep, of a

seemingly healthy baby less than a year old. SIDS is sometimes known as crib death because the infants
often die in their cribs.

Although the cause is unknown, it appears that SIDS might be associated with defects in the portion of
an infant's brain that controls breathing and arousal from sleep.

Causes

A combination of physical and sleep environmental factors can make an infant more vulnerable to SIDS.
These factors vary from child to child.

Physical factors

Physical factors associated with SIDS include:

 Brain defects.

 Low birth weight.

 Respiratory infection.

Sleep environmental factors

The items in a baby's crib and his or her sleeping position can combine with a baby's physical problems
to increase the risk of SIDS. Examples include:

 Sleeping on the stomach or side. Babies placed in these positions to sleep might have more
difficulty breathing than those placed on their backs.

 Sleeping on a soft surface. Lying face down on a fluffy comforter, a soft mattress or a waterbed
can block an infant's airway.

 Sharing a bed. While the risk of SIDS is lowered if an infant sleeps in the same room as his or her
parents, the risk increases if the baby sleeps in the same bed with parents, siblings or pets.

 Overheating. Being too warm while sleeping can increase a baby's risk of SIDS.

Risk factors

Although sudden infant death syndrome can strike any infant, researchers have identified several
factors that might increase a baby's risk. They include:

 Sex. Boys are slightly more likely to die of SIDS.

 Age. Infants are most vulnerable between the second and fourth months of life.

 Race. For reasons that aren't well-understood, nonwhite infants are more likely to develop SIDS.

 Family history. Babies who've had siblings or cousins die of SIDS are at higher risk of SIDS.
  Secondhand smoke. Babies who live with smokers have a higher risk of SIDS.

 Being premature. Both being born early and having a low birth weight increase your baby's
chances of SIDS.

Maternal risk factors

During pregnancy, the mother also affects her baby's risk of SIDS, especially if she:

 Is younger than 20

 Smokes cigarettes

 Uses drugs or alcohol

 Has inadequate prenatal care

Prevention

There's no guaranteed way to prevent SIDS, but you can help your baby sleep more safely by following
these tips:

 Back to sleep. Place your baby to sleep on his or her back, rather than on the stomach or side,
every time you — or anyone else — put the baby to sleep for the first year of life. This isn't
necessary when your baby's awake or able to roll over both ways without help.

Don't assume that others will place your baby to sleep in the correct position — insist on it. Advise
sitters and child care providers not to use the stomach position to calm an upset baby.

 Keep the crib as bare as possible. Use a firm mattress and avoid placing your baby on thick, fluffy
padding, such as lambskin or a thick quilt. Don't leave pillows, fluffy toys or stuffed animals in the
crib. These can interfere with breathing if your baby's face presses against them.

 Don't overheat your baby. To keep your baby warm, try a sleep sack or other sleep clothing that
doesn't require additional covers. Don't cover your baby's head.

 Have your baby sleep in in your room. Ideally, your baby should sleep in your room with you, but
alone in a crib, bassinet or other structure designed for infant sleep, for at least six months, and, if
possible, up to a year.

Adult beds aren't safe for infants. A baby can become trapped and suffocate between the
headboard slats, the space between the mattress and the bed frame, or the space between the
mattress and the wall. A baby can also suffocate if a sleeping parent accidentally rolls over and
covers the baby's nose and mouth.
  Breast-feed your baby, if possible. Breast-feeding for at least six months lowers the risk of SIDS.

 Don't use baby monitors and other commercial devices that claim to reduce the risk of SIDS. The
American Academy of Pediatrics discourages the use of monitors and other devices because of
ineffectiveness and safety issues.

 Offer a pacifier. Sucking on a pacifier without a strap or string at naptime and bedtime might
reduce the risk of SIDS. One caveat — if you're breast-feeding, wait to offer a pacifier until your
baby is 3 to 4 weeks old and you've settled into a nursing routine.

If your baby's not interested in the pacifier, don't force it. Try again another day. If the pacifier falls
out of your baby's mouth while he or she is sleeping, don't pop it back in.

 Immunize your baby. There's no evidence that routine immunizations increase SIDS risk. Some

evidence indicates immunizations can help prevent SIDS.

Epidemiology
the SUID rate among preterm infants was 2.25 deaths per 1,000 live births in 1995-97 and
1.72 deaths per 1,000 live births in 2011-13, a 23% decrease. The SUID rate among term infants was
0.89 deaths per 1,000 live births in 1995-97 and 0.76 deaths per 1,000 live births in 2011-13, a 15%
decrease.

In 2019, the SUID rate was 90.1 deaths per 100,000 live births. In recent years, SUID is being classified
less often as SIDS, and more often as ASSB (Accidental Suffocation and Strangulation in Bed) or
unknown cause. SIDS rates declined considerably from 130.3 deaths per 100,000 live births in 1990 to
33.3 deaths per 100,000 live births in 2019.

DIAGNOSTIC
Currently, there is no diagnostic test available for SIDS. A diagnosis of SIDS is reached only when the
cause of death remains unexplained after a death scene investigation, an autopsy and a review of the
clinical history. Similarly, there is currently no way to predict babies that are at risk of SIDS.

Assessment and Diagnostic Findings through autopsy

A diagnosis of sudden infant death syndrome (SIDS) is established by excluding recognizable causes of
sudden unexplained infant death (SUID).

 Laboratory studies. 

 Radiography and computed tomography scans. 

  Histology

PATHOPHYSIOLOGY
The most recent research indicates that SIDS is a polygenic, multifactorial condition in which
genetic, environmental, and behavioral/sociocultural factors play roles (Fig. 3). Arousal may play an
important role in SIDS. The re-breathing theory suggests that infants who lie prone are more likely
to trap exhaled carbon dioxide around the face, particularly when they are lying face down or on
soft bedding. For infants, re-breathing exhaled carbon dioxide can lead to hypercapnia and hypoxia
and subsequent death if arousal responses are not appropriate.

Therapeutics

There's no treatment for sudden infant death syndrome, or SIDS . But there are ways to help
your baby sleep safely. For the first year, always place your baby on his or her back to sleep.

Nursing Diagnoses
Based on the assessment data, the major nursing diagnoses for a child with SIDS are:

 Death anxiety related to anticipating: pain and impact of death to others.

 Grieving related to anticipatory loss or death of a significant others.

 Interrupted family process related to grieving

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Death After 8  Determine how  To After 8 hours,
“ Akala ko anxiety hours, the client sees self in determine the patient
mahimbing related to patient will usual lifestyle what is the was able to
ang tulog niya anticipating: able to role functioning current formulate a
kasi 4 hours pain and formulate a and perception situation of plan dealing
na natutulog impact of plan dealing and meaning of the client with the
yun pala hindi death to with the anticipated lost individual
na others. individual to him or her  To identify concerns and
humihinga” as concerns and SO (s). misconcep eventualities
verbalized the and tion, lack of of dying as
patient. eventualities  A certain current information appropriate.
of dying as knowledge of , other
appropriate. situation. – pertinent
issues
 Determine
clients role in the  To identify
family the areas of
constellation. concern of
Observe patterns need or
of concern,
communication also reveals
in family and strands
response of useful in
family/S0 to addressing
clients situations the
and concerns. concerns

 Assess impact of  To monitor

client reports of what is the
subjective affect of
experiences and the death
past experience to the
with death client

 Note physical  As it affects

and mental clients/SO‘s
condition and ability to
complexity of process
therapeutic information
regimen and
participate
 Determine in activities
ability to
manage own  Which may
self-care,end of be
life and other behavioral
affairs, indicators
awareness/use of use of
of other or withdrawal
available to deal
resources with
 problems
 Observe
behavior  help It may
indicated of level indicate
of anxiety presence of
present depression
and need
 Note use of for
alcohol or other interventio
drugs of abuse, n
report of
insomnia,  To be able
excessive to have a
sleeping, good and
avoidance of flexible
interaction with communica
others tion with
the client
 Listen to or to create
client/SO a
reports/expressi comfortabl
on of anger and e
concern, relationship
alienation from to the
God, belief that client
impending death
is a punishment  To enhance
for wrongdoing trust and
therapeutic
 Determine sense relationship
of futility; feeling
of hopelessness,  To reduce
helplessness; says
lack of feelings of
motivation to guilt/conflic
Listen for t, allowing
expressions of client to
inability to find move
meaning in life forward
or suicidal toward
ideation resolution
to reduce
 Provide open says
and trusting feelings of
relationship guilt/conflic
t, allowing
 Use therapeutic client to
move
 communication forward
skills or active toward
listening, silence, resolution
acknowledgment
to the client.
Respect clients
desire or request
not to talk.
Provide hope
within
parameters of
the individual
situation.

 Encourage
expression of
feelings (anger,
fear, sadness,
and others).
Acknowledge
anxiety/fear. Do
not deny or
reassured client
that everything
will be all right.
Be honest when
answering
questions/provid
ing information.

 Review life
experiences of
loss and previous
use of coping
skills, noting
clients strenghts
and successes

 Provide call,
peaceful setting
and privacy as a
appropriate

 Assist client
engage in a
spiritual group
activities,
 experience
prayer/meditatio
n and
forgiveness to
heal past hurts.
Provide
information that
in God is a
normal part of
grieving process.

 Support clients
efforts to
develop realistic
steps to put
plans into action

 Support clients
efforts to
develop realistic
steps to put
plans into action

 Treat expressed
decisions and
desires with
respect and
convey to others
as appropriate

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Grieving After 8  Determine  Grief can After 8 hours,
“ Akala ko related to hours, the circumstances be the patient
mahimbing anticipatory patient will Of current anticipator was able to
ang tulog niya loss or death able to situation y identify and
kasi 4 hours na of a identify and (mourning express
natutulog yun significant express  Evaluate the loss of feelings (e.g,
pala hindi na others. feelings client’s love one’s sadness, guilt,
humihinga” as (e.g, perception of former self fear) freely
verbalized the sadness, anticipated or before and effectively.
patient. guilt, fear) actual loss and actual
freely and meaning to death), or
effectively. him or her. actual.
What are your Both types
concerns? of grief can
What are your provoke a
fears? Your wide range
 greatest fear? of intense
How do you and often
see this conflicting
affecting you feelings.
or your Grief also
lifestyle? follows
loses other
 Ascertain than
response of death.
family/SO’s to
client  This can
situation and give
concerns understan
ding to the
 Note patient of
emotional what are
responses, the current
such as situation
withdrawal,
angry  This can
behavior, promotes
crying. a free
discussion
 Provide open of feelings
environment and
interesting concerns
relationship.
 This can
 Be honest enhance
when the sense
answering of trust
questions, and nurse-
providing client
information’s. relationshi
p
 Review past
life  This can be
experiences a
and previous recognitio
loss (es), rule n from
changes, and these
coping skills, factors
noting that can
strengths and help client
successes. focus
energy for
maximal
benefit
 Discuss and
control issues, outcome
such as what
is the power  This can
of the encourage
individuals to family to
change and support
what is and assist
beyond client to
control. deal with
the
 Incorporate situation
family/SO’s in while
problem- meeting
solving. Give needs of
information family
that feelings members
are OK and
are to be  To meet
expressed on going
appropriately. needs and
facilitate
 Expression of grief work
feelings can
facilitate the
grieving
process, but
destructive
behavior can
be damaging.

 Encourage
continuation
of usual
activities or
schedule and
involvement
in appropriate
exercise
program

 Identify and
promote
family and
social support
systems.
  Referred for
the additional
resources,
such as
pastoral care,
counseling,
psychotherapy
, community
or organize
support
groups, as
indicated, for
both client
and family.

ASSESSMEN DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATIO

T N
Subjective: Interrupte After 8  Determine  To determine After 8
“ Akala ko d family hours, the pathophysiolo what is the hours, the
mahimbing process patient will gy, present patient was
ang tulog related to able to illness/trauma, situation of able to
niya kasi 4 grieving demonstrat developmental the client demonstrate
hours na e individual crisis present. individual
natutulog involvement  This can involvement
yun pala in problem-  Identify family provide a in problem-
hindi na solving developmental baseline for solving
humihinga” process stage- Observe establishing process
as verbalized directed to patterns of plan of care directed to
the patient. appropriate communicatio appropriate
solutions for n in the family.  It can solutions for
the situation Are feelings identifies the the situation
or crisis. express? weakness or or crisis.
Freely?Who area of
talks to whom? concern to be
Who makes addressed as
decisions? For well as
home? Who strenght that
visits? When? can be used
What is the for resolution
interaction of problem.
between the
family  Do you know
 members? degree of
distress and
 No energy inability to
direction. Our handle what is
efforts at happening.
resolution/pro
blem solving or  This can
purposeful or indicated that
scattered? you love your
Listen for family or do
expressions of you have the
the dispair or trust to your
helplessness family

 Deal with  Reinforces

family that some
members in degree of
warm, caring, conflict is to
respect full be expected
way and can be
used to
 Acknowledge promote
difficulties and growth in
realities of the acknowledgin
situation g the
difficulties and
 Stressed reality of the
importance of situation
continues,
open dialogue  To reduce the
between feeling and
family give and
members -to relaxation
Facilitate Assist family
ongoing to identify a
problem- situation that
solving may lead to
fear or anxiety
 Encourage us
of stress  This can
management promotes
techniques commitment
to
 Involve family goals/continu
in planning for ation of plans.
the future and
mutual goal
 setting.

Nursing Interventions
Grief is coupled with guilt, even though SIDS cannot be predicted; disbelief, hostility, and anger are
common reactions.

Allow expression of feelings. The immediate reaction of the staff should be to allow the family to
express their grief, encouraging them to say goodbye to their infant, and providing a quiet, private place
for them to do so.

Appropriate referrals. Referrals should be made to the local chapter of the National SIDS Foundation
immediately; Sudden Infant Death Alliance is another resource for help.

Encourage use of community resources. In some states, specially trained community health nurses who
are knowledgeable about SIDS are available; these nurses are prepared to help families and can provide
written materials, as well as information, guidance, and support in the family’s home.

Monitoring subsequent infants. Caregivers are particularly concerned about subsequent infants; recent
studies have indicated that the risk for these infants for the first few months of life to help reduce the
family’s stress; monitoring is usually maintained until the new infant is past the age of the SIDS infant’s
death.