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Sudden death syndrome: causes. Sudden infant death - up to what age? All About Sudden Infant Death Syndrome

New parents do their best to keep their children healthy. But sometimes a child who appears to be perfectly healthy dies for no apparent reason.

When a baby dies before 1 year old, it is sudden infant death syndrome (SIDS). Since this condition often occurs during sleep, the term "cradle death" can also be heard.

SIDS is defined as the sudden death of an infant under 1 year of age that remains unexplained after careful investigation of the cases, including performing a full autopsy, examining the site of death, and reviewing the clinical history. Cases that do not meet this definition, including those without a posthumous investigation, should not be classified as sudden infant death; episodes involving an autopsy and a thorough investigation, but remain unresolved, may be designated as vague or unexplained.

Pathogenesis

Although numerous hypotheses have been proposed as the pathophysiological mechanisms responsible for SIDS, none have been proven. The triple risk model proposed by American experts suggests that sudden death syndrome is an intersection factors, including the following:

  • a defect in the nervous control of respiratory or cardiac function;
  • a critical period in the development of homeostatic control mechanisms (the form of the body's response to the conditions of existence);
  • exogenous external stimuli.

SIDS is rare in infants who have no risk factors or those with only one factor. In one study, 96.3% of children who died had 1 to 7 risk factors, and 78.3% had 2 to 7. In another report, 57% of infants had one intrinsic risk factor and 2 external ones.

Death occurs when a baby is exposed to stress factors, which has insufficiently formed structural and functional protective mechanisms. "

Epidemiological evidence suggests that genetic factors play a role, and many studies have attempted to identify genes associated with SIDS.

Several anatomical and physiological data support a role for apnea (respiratory arrest) in SIDS.

One study analyzed data from 6 home-monitored infants. Of the 6 deaths, 3 were attributed to SIDS. All patients with SIDS had bradycardia (decreased cardiac contractile activity), preceding or occurring simultaneously with central apnea; 1 had tachycardia (increased heart rate) before bradycardia. One patient showed a slow decrease in heart rate for about 2 hours before death.

In general, apnea can be classified according to the following three main types:

  • central or diaphragmatic (i.e., there is no effort in breathing);
  • obstructive (usually due to obstruction of the upper airway);
  • mixed.

While short central apnea (<15 секунд) может быть нормальным во всех возрастах, то длительная остановка дыхания, которая нарушает физиологическую функцию, никогда не бывает физиологической. Некоторые патологические доказательства и обширные теоретические данные подтверждают центральное апноэ как причину СВДС, а обструктивная остановка дыхания играет ассоциированную, если не ключевую, роль у некоторых младенцев.

Expiratory apnea (respiratory arrest on expiration) has been proposed as an etiology for SIDS; however, evidence of its presence is found in only a small number of cases.

Other findings also indicate the role of hypoxia (low oxygen content in the body), acute and chronic, in SIDS. Hypoxanthine, a marker of tissue hypoxia, is elevated in the vitreous (a gel-like structure located behind the lens of the eyeball) of patients who die from SIDS compared with control subjects who die suddenly.

Asphyxia (suffocation) in newborns occurs through the following clearly defined steps.

  1. Stage 1 - tachypnea (rapid shallow breathing) for 60 to 90 seconds, followed by apparent loss of consciousness, urination and lack of breathing effort.
  2. Stage II - deep, panting respiratory efforts separated by 10 second periods of respiratory silence.
  3. Stage III - petechiae (red dotted spots) form on the pleura (the membrane covering the lungs), the child stops suffocating.
  4. Stage IV - death if resuscitation has not started.

Although autopsy of children who have died from SIDS often do not detect abnormalities, most infants have an extremely high number of petechiae. Their presence suggests that repeated episodes of asphyxia were observed for several hours to several days before death, causing periodic attacks of shortness of breath with associated petechiae formations.

Thus, repeated attacks of asphyxiation, which were previously self-limited by arousal and restoration of consciousness without medical intervention, can ultimately prove fatal.

Etiology

There are several conditions that can lead to SIDS. They usually vary from one child to the next.

Brain abnormalities

Some newborns are born with brain disorders. They are more likely to experience SIDS than others. Certain parts of the brain control breathing and the ability to wake up from deep sleep. When the brain does not send a signal to perform the appropriate functions, the child dies.

Respiratory infection

When a child suffers from a prolonged cold, it is imperative to see a doctor immediately.

Many babies die when they suffer from persistent colds, further contributing to breathing problems.

Low birth weight

Premature birth or low birth weight of the infant is associated with a higher likelihood of SIDS. When a child is not mature enough, his body has less control over breathing or heart rate.

Hyperthermia (overheating)

Excessive wrapping of the child increases the temperature of his body. This leads to an increase in the metabolic rate and the infant may lose control of breathing.

Smoking

If the mother smokes, the chances of her child dying from SIDS are increased.

Having extra items in the crib or sleeping in a poor position increases the risk of SIDS.

Some sleep patterns that increase the likelihood of SIDS are as follows.

  1. Sleeping on the stomach - in this position, the baby has difficulty breathing.
  2. Sleep on a soft surface. Sleeping on soft mattresses or with fluffy comforts pressed against your face can block your baby's airways.
  3. Covering an infant with heavy blankets and completely covering your face is also dangerous.
  4. Sleep with parents. It is better when the baby sleeps in the room with them, but on a separate bed. When a child shares a bed with his parents, the space becomes overcrowded and he has difficulty breathing.

At-risk groups

Although sudden death syndrome can affect a normal, healthy baby, researchers have found several factors that increase its risk:

  • boys are more likely to suffer from SIDS than girls;
  • infants who have reached the age of 2 - 4 months;
  • babies whose siblings or cousins ​​have died of SIDS;
  • babies born to a smoking mother.

Babies are more likely to have SIDS if their mother experiences some of the the following factors:

  • inadequate antenatal care was provided;
  • poor weight gain during pregnancy;
  • placental abnormalities;
  • have a medical history of urinary tract infections or STDs;
  • smoking or drug addiction during or after pregnancy;
  • anemia;
  • pregnancy under the age of 20.

Diagnostics

Typically, an infant who died from SIDS was put to bed after breastfeeding or bottle feeding. The baby's checks at variable intervals are unremarkable, but the baby is found dead, usually in the position in which he was laid before bed.

While most babies appear healthy, many parents state that their babies “were not themselves” in the hours before death. Diarrhea, vomiting, and lethargy were noted two weeks before death.

Also observed following:

  • cyanosis (50 - 60%);
  • breathing problems (50%);
  • abnormal limb movements (35%).

It is important to determine the exact time sequence of events. It is necessary to answer on the following questions.

  1. Did the baby have a foreign body, trauma in the respiratory tract?
  2. Does the infant have a history of sleep apnea?
  3. How active was the infant before sleep apnea? Interruption of breathing after a paroxysmal (paroxysmal) cough in a child with an upper respiratory infection suggests whooping cough.
  4. Time and amount of the last meal. Parents may misinterpret regurgitation after feeding as a life-threatening event.

What was the child's position?

What was noted first? Chest wall movement and increased breathing in the absence of airflow indicate obstructive apnea. Lack of chest wall movement, respiratory effort, and airflow indicates central apnea.

What is the apnea period (in seconds)? Most healthy children stop breathing for a moment when they sleep.

Has the baby's skin color changed? It is necessary to check the location of cyanosis; some healthy babies develop cyanosis around the mouth when they cry, and acrocyanosis (blue discoloration of the hands, feet, ears) or discoloration during bowel movements can be misinterpreted as life-threatening.

What was the child's muscle tone (for example, lethargic, stiff, or trembling)? Numb or convulsive movements accompanied by apnea suggest an affective-respiratory seizure (an attack of holding the breath).

What was done (for example, cardiopulmonary resuscitation) and how was it done? The physician should carefully question the parents or other witnesses about their efforts to resuscitate the child; no need for resuscitation efforts suggests a benign cause, while the need for cardiopulmonary resuscitation suggests a more serious cause.

Circumstances related to death

The findings, consistent with SIDS, are in the following:

  • we see a healthy baby who is fed, put to bed and found dead;
  • silent death of children;
  • resuscitation measures were not crowned with success;
  • the age of the deceased child is younger than 7 months (90% of cases, with a peak prevalence of 2 to 4 months).

The course of pregnancy, childbirth and infancy.

Received data, associated with SHSM:

  • prenatal care from minimal to maximal;
  • reported smoking during pregnancy and preterm labor or low birth weight;
  • subtle defects in nutrition and neurological status (eg, hypotension, lethargy, and irritability) may be present.

Other factors include:

  • decrease in height and body weight after birth;
  • multiple pregnancy;
  • in an infant, candidal stomatitis, pneumonia, regurgitation, GER, tachypnea, tachycardia and cyanosis;
  • unwanted pregnancy;
  • inadequate or no antenatal care;
  • late arrival at a medical facility for childbirth or childbirth outside the hospital;
  • the child is not monitored by a pediatrician, there is no immunization;
  • use of alcohol or other drugs during and after pregnancy;
  • deviant feeding methods;
  • previous unexplained medical disorder (eg, seizures);
  • previous episodes of apnea.

Autopsy results

On autopsy, the infant usually shows signs of normal hydration and nutrition, indicating proper care. There should be no obvious or latent trauma symptoms. Extensive organ examination usually does not reveal signs of a congenital anomaly or an acquired pathological process.

Intrathoracic petechiae are usually present on the surface of the thymus (thymus), pleura, and epicardium (outer lining of the heart). Their frequency and severity does not depend on whether the babies were found in bed face down, up, or to the side.

Microscopic examination can reveal minor inflammatory changes in the tracheobronchial tree.

Laboratory research

Lab tests are done to rule out other causes of death (for example, electrolytes are checked to rule out dehydration and electrolyte imbalances, culture is done to rule out infection). In SIDS, these data are usually not detected.

While there are no guaranteed ways to prevent SIDS, parents should take several protective measures to reduce the risk of an unexpected incident.

1. Put your child to sleep on their back:

  • a child is more at risk for SIDS when he sleeps on his side or on his stomach. During this position, the baby's face strongly rests on the mattress, and he cannot breathe freely;
  • make sure the baby's head is open and it is best to lay the sleeping baby on its back. This helps him breathe more comfortably.

2. Keep your crib clean and tidy:

  • Do not leave soft toys or pillows in the baby's crib, as this interferes with breathing when the baby's face is pressed against these objects.

3. Avoid overheating your baby:

  • it is advisable to use a sleeping bag or light blankets to keep the child warm;
  • do not use any additional coverings and do not cover the child's face when he sleeps;
  • when covering the baby with fluffy blankets, as the baby makes many unconscious movements, and the blanket can strangle him;
  • choose small blankets and place them at the base of the mattress so that it covers the shoulders of the child;
  • Swaddling or wrapping a baby in fluffy and thick covers makes him feel uncomfortable and makes breathing difficult;
  • an overheated child is anxious and cannot tolerate high body temperature for a long period of time.

4. Breastfeeding is very beneficial:

  • breastfeeding increases the baby's immunity and protects him from respiratory tract infections;
  • it is advisable to breastfeed the baby for at least six months, which effectively reduces the risk of SIDS.

5. Nipple suggestion:

  • nipple sucking while sleeping effectively eliminates the risk of SIDS;
  • but if the baby is not interested in the nipple, you should not force him;
  • put the pacifier in your baby's mouth before bed. But don't put it in your mouth after he falls asleep;
  • keep the teat clean to prevent harmful germs from entering the infant's body.

6. Do not smoke around the baby:

  • parents who smoke should give up their addiction before and after the birth of their child;
  • secondhand smoke often leads to suffocation of the infant;
  • babies born to mothers who smoke are at greater risk of SIDS.

7. Ensure that the child sleeps on a hard surface:

  • always put your child to sleep on a hard surface;
  • do not put the child on the sofa, between the pillows;
  • When the baby falls asleep in the carrier, try placing it on a firm mattress as soon as possible.

8. Antenatal care:

  • early and regular prenatal care effectively helps reduce the risk of SIDS;
  • follow a balanced diet;
  • the mother needs to undergo frequent medical examinations throughout the pregnancy. This will provide early diagnosis of any abnormalities in the growing fetus. Brain abnormalities often lead to SIDS;
  • regular check-ups also reduce the risk of premature birth or low birth weight.

9. Regular examination of the pediatrician and immunization:

  • when the child looks sick or suffers from breathing problems, see a doctor immediately;
  • it is necessary to vaccinate the child according to the schedule. Immunization protects him from life-threatening diseases;
  • studies show that vaccinating a child within a specified time frame reduces the risk of SIDS;
  • If your child develops sleep apnea, take them to a doctor immediately. The doctor examines the health problems and takes the necessary treatment procedures.

Conclusion

Reducing the risk of SIDS requires attention to detail. Although Sudden Death Syndrome is rare in children, parents should do everything in their power to prevent this from happening.

Sudden Infant Death Syndrome (SIDS)- a concept used in relation to the unexpected death of a child of the first year, which occurred in a dream without established reasons. They talk about SDVS if the study of the medical record and the place of death, as well as the pathological examination, do not give a clear answer about the reasons for the death of the infant. To assess the risk of sudden infant death, test algorithms (Magdeburg score table) have been proposed, ECG and polysomnography are performed. Prevention of SDS 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 signs that allow postmortem differential diagnosis of sudden infant death syndrome and life-threatening diseases and is of interest mainly for pathologists.

Prevention

If an obvious life-threatening episode occurs, it is necessary to pick up the child, shake it, vigorously massage the hands, feet, earlobes, back along the spine. Usually, these actions are enough to get the child to breathe again. If breathing has not recovered, it is necessary to urgently call an ambulance and start artificial respiration and closed heart massage.

Prevention of SDAE includes measures of a primary and secondary nature. The principles of primary prevention are based on antenatal measures (rejection of bad habits before pregnancy, rational nutrition of the mother, adequate physical activity, prevention of premature birth, early registration and management of pregnancy under the supervision of an obstetrician-gynecologist, etc.). Primary prevention measures also include the optimization of the infant's sleep conditions: sleeping on the back, using a sleeping bag that prevents the baby from turning over on its tummy, sleeping on a tight mattress, avoiding overheating, sufficient access to fresh air, maintaining the temperature and humidity regime, the absence of sharp odors, and tobacco smoke.

Secondary prevention of SDA involves identifying high-risk groups and carrying out targeted measures (restorative treatment, massage), home cardiorespiratory monitoring, etc.

The death of a small child is always a tragedy for his parents. But illness, accident, catastrophe is at least understandable. However, from time to time, children simply die in their sleep for no apparent reason.

Of course, in the event of a child's death, doctors will do their best to look for the cause. The baby's card, the circumstances of death is studied in detail, all possible studies and analyzes are carried out. Sometimes it is possible to reveal hidden pathologies, sometimes - the negligence of the parents. But in some cases, the reason is really impossible to identify.

And then doctors talk about sudden infant death syndrome. This syndrome is called differently. There are such options as Sudden Infant Death Syndrome, Sudden Infant Death Syndrome, often called death in the cradle, since children usually die in their sleep. But the essence of the phenomenon does not change at all from the name change.

From time to time, on the Internet or in magazines, SIDS is referred to as "the leading cause of infant death." The horror of young parents reading such articles is hard to imagine. In fact, this happens extremely rarely, 5-6 cases per thousand children.

Causes of SHSM

Since we are talking about a sudden, that is, unexplained death, it would not be entirely correct to talk about the reasons. This phenomenon has been studied by physicians and scientists for more than 60 years, and so far it has not been possible to obtain reliable data.

There are several theories about what could be considered the cause of sudden infant death. But none of them has yet been confirmed.

So, some scientists argue that SHSM can be caused by brain disorders ... These violations directly relate to the respiratory center. Their essence is the lack of a specific protein, which ensures the reaction of the child's body to a change in the rhythm of breathing due to an excess of carbon dioxide.

According to other studies, the reason lies in disorders of the immune system ... It has been found that the blood of children with SIDS often contains large amounts of white blood cells. It is believed that the proteins in these cells can interact with brain cells, causing the child to fall into too deep sleep.

Metabolic disorders are also named among the possible causes of this phenomenon. Due to the absence of certain enzymes in the child's body, it may be difficult to form fatty acids. Changes in the structure of these acids, in turn, cause irreversible breathing disorders.

Risk factors

Unfortunately, all these are only hypotheses that have no confirmation, which means that it is difficult to talk about preventing sudden infant death syndrome. But the researchers still managed to identify some risk factors. Some of them do not depend on us in any way, while others are completely controllable. On their basis, preventive measures are formed that can significantly reduce the risk of developing the syndrome. However, we will talk about prevention later, now it is worth talking in detail about the risk factors.

It is reliably known that smoking parents are more likely than others to face sudden death of a child.... If a woman smoked herself during pregnancy or was regularly near smoking people, if someone from the family smokes in the presence of a child or in the same room where the baby lives, if mom or dad regularly breathes nicotine vapors on the baby, there is a risk of sudden death during sleep rises. The same goes for taking drugs and alcohol while carrying a baby.

Surprisingly, even regular visits to the doctor during pregnancy and after childbirth, it can affect the risk of developing SIDS. It has been noticed that women who register for pregnancy on time, do not miss examinations and regularly take their child to the pediatrician, significantly reduce the risk of death of their baby.

Too much the young age of the mother can also be a risk factor. However, experts do not agree on the issue of a specific age threshold. Someone says that a mother under 20 is already at risk, others lower this bar to 17 years.

Social and living conditions affect the risk of SIDS. It has been noticed that in dysfunctional families children die more often. Moreover, these deaths usually occur on weekends and holidays, when parents tend to want to relax. It can be assumed that the neglect of parents towards the child is partly a risk factor.

Not the least important baby's sleeping place and posture ... The safest is a baby cot. As for the posture, it is undesirable for the baby to sleep on his tummy.

The seasonality factor should not be overlooked either. Most often, SHSM falls on winter period ... In addition, the gender of the baby also matters. On average, boys die from SIDS more often than girls.

There is and age , in which SIDS occurs most often - 13 weeks. Children from 2 to 4 months are at risk, then the frequency of deaths decreases, after six months this risk is even less, and after a year, such deaths practically do not occur. As well as up to 2 months.

What if the child stops breathing?

Is there anything you can do if you woke up at night and realized that the child was not breathing? As in any extreme situation, the main thing here is not to panic. Whether the baby survives depends on the speed of your actions. First, touch it, shake it. Perhaps it just seemed to you, and the child still breathes, just quietly and slowly, in a dream. If the child does not react to your actions, and his forehead and chest turn blue, you must act immediately.

If you know how to do CPR - cardiopulmonary resuscitation for children, do it right away, let someone else call the ambulance. If there is someone alone with the child, then first you need to do CPR for 2 minutes, and only then call an ambulance. Then CPR resumes.

Since it is very difficult to ascertain death on your own, it is necessary to continue until the arrival of doctors or until the child begins to breathe on his own. Even if it seems to you that everything is hopeless, in no case should you stop.

Prevention of SHSM

Unfortunately, it is impossible to completely prevent the development of sudden infant death syndrome. But you can significantly reduce the risk. To do this, it is quite enough to carry out simple preventive measures.

At the same time, as you probably already guessed, you will have to start even before birth, and ideally before conceiving a child. To begin with, both parents, or at least the mother, need to refuse from bad habits if she has them. Smoking, drinking and using drugs during pregnancy is not allowed.

Do not allow smoking near you. Secondhand smoke will also negatively affect the child.

When the baby is born, you must not smoke in his presence. If one of the relatives is susceptible to this bad habit, then send him to smoke outside and keep him away from the child after smoking.

As soon as possible register for pregnancy. Visit your doctor regularly and follow all his recommendations. This behavior must be observed after the birth of the child. It also needs to be regularly shown to the local pediatrician. This is especially important if your child is at risk for SIDS.

As long as possible support breastfeeding ... This will not only help reduce the risk of sudden death, but also improve the health of the baby. And the emotional connection between mom and child will be stronger.

Many parents practice sleeping together. Of course, each of these issues decides for himself. However, experts believe that up to six months, the safest place for a child is his crib.

Moreover, this crib must be properly equipped.

  1. No soft mattresses, voluminous blankets, large soft toys.
  2. Get a hard mattress that fits your crib.
  3. Cover her with matching cotton sheets.
  4. Choose a blanket that is warm, but not too bulky.
  5. Cover the child with it only up to the shoulder line.
  6. Try to lay the child so that his legs are in contact with the headboard, this prevents slipping, as a result of which the baby's head may be covered with a blanket.
  7. If you use a sleeping bag for sleeping, make sure it is the right size for your child. Too large a bag can provoke head wrapping.

It is noticed that overheating also increases the risk of SIDS. Therefore, remember, a child should not sleep near a radiator, heater, in open sunlight, near a stove and fireplace. Maintain a comfortable room temperature. 18-19 degrees is considered optimal. You should not wrap up the baby in warm sweaters, put him to sleep under several blankets.

It was found that not the last place in the prevention of SIDS is choosing the right sleeping position ... Most often, sudden death finds children in a prone position. Various researchers offer different interpretations of this fact. The truth is, the exact cause has yet to be established.

In America, there was a massive Backtosleep campaign in which parents were encouraged to put their children to sleep on their backs instead of on their stomachs. After 4 years, the action gave its first results. More than 50% of parents started putting their children to sleep on their backs, and the number of cases of SIDS decreased threefold.

Of course, after six months, children often turn over on their own. Move them to the back if possible. True, there is no point in constantly monitoring the child and his posture either. There is no need to wake up for this in the middle of the night.

Follow these simple tips and remember that SIDS is extremely rare. Take basic preventive measures, and the risk of facing this problem will be reduced to almost zero.

Recommended for viewing: How to conduct cardiopulmonary resuscitation of a newborn

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What is Sudden Infant Death Syndrome (SIDS)?

Sudden Infant Death Syndrome (SIDS) is not a disease. Rather, it is a diagnosis made when a healthy child dies unexpectedly for no reason. If, after an autopsy, a detailed study of the place of the incident and the medical history of the child, doctors cannot identify the cause of death, they diagnose SIDS.

Such deaths can be reported as SIDS (Sudden Infant Death Syndrome), Sudden Infant Death Syndrome (SIDS), death of unknown cause, or simply death in a crib. SIDS is not listed as a cause of death if another cause has been identified, such as an accident, infection, or a previously undetected congenital disorder (genetic abnormality).

According to statistics in Russia, the SIDS rate per 1000 children born is 0.43. In 1991, the Child Mortality Research Foundation launched a campaign to reduce the risk of SIDS, and the number of deaths in the cradle was reduced by 75%. But it is still a common cause of death for children.

What is the cause of Sudden Infant Death Syndrome (SIDS)?

No one knows why some children die like this. Research is ongoing, and doctors believe a combination of factors is at play. There is an assumption that some children have problems in the part of the brain that is responsible for breathing and waking up, so they may inadequately respond to a situation when, for example, during sleep, their nose and mouth are covered with a blanket.

When does death occur in the cradle?

Most often, but not always, death in the cradle occurs during sleep. At night in a crib, or during the daytime in a stroller, or even in the arms of one of the parents. Crib deaths are more likely to occur in winter, although the reasons for this are not fully understood.

Which children are most at risk for SIDS?

Death in a cradle is not common among children under one month old. It most often occurs in the second month of life and about 90% of cases occur in children under six months of age. The older the child, the less the risk - after a year, such cases are extremely rare.

For unknown reasons, this syndrome is not common in Asian families.

Most often, death in a crib occurs in families in which at the time of the birth of the child, the mother was not yet 20 years old.

There are factors that put your child at risk for SIDS that you cannot do anything about. These factors include:

male - death in the crib is more common among boys: about 60% of cases occur with male children

premature birth (before 37 weeks of gestation)

being born with a low body weight (less than 2.5 kg)

How can my child's risk of SIDS be reduced?

Sadly, there is no way to prevent death in a crib. There are some steps you can take to try to reduce your risk of SIDS. The Ministry of Health recommends the following measures:

Put your baby to sleep on his back in his crib in your room.

At five to six months of age, babies begin to roll over, and at this age the risk of developing SIDS is reduced, so you can let your baby find a comfortable sleeping position on his own. But still put him to sleep on his back and if you suddenly notice that the baby has turned over in a dream on his stomach, turn him back onto his back, although, of course, you should not specially wake up at night and check how the baby sleeps.

Do not smoke during pregnancy and do not allow anyone to smoke in the presence of your baby. If you smoke during pregnancy or after childbirth, your baby's risk of developing SIDS is increased. Crib deaths are more common in households where mothers smoked, were exposed to secondhand smoke during pregnancy, or where children smoked. One study confirms that if pregnant women did not smoke, the number of deaths in the crib would be reduced by 40%.

Do not smoke during pregnancy and do not allow others to smoke in the presence of the baby, even in the next room with an open window, fan and air ionizer. Encourage guests to go outside to smoke and keep the air around your child free of tobacco smoke.

Don't let your child overheat

Overheating also increases the risk of SIDS. Maintain a comfortable temperature in the room where the baby sleeps (between 16 and 20 C, ideally 18 C). Children should not sleep near a radiator, heater or fireplace, or in direct sunlight. Do not use a hot water bottle or thermal blanket for heating.

Place the baby in the crib so that his legs rest against the side of the bed and he cannot slip down and cover his head with a blanket. Tuck the blanket no higher than shoulder level. If you are using a sleeping bag, make sure it fits properly so your baby cannot slide down inside it.

Signs that your baby is overheating are sweaty, damp hair, prickly heat, rapid breathing, anxiety, and fever. Feel your baby's belly or neck to check if it's cold or hot, and choose an appropriate blanket. You should not touch the arms and legs for this purpose - they can be cold, even if the baby is warm.

After returning from a walk, immediately remove extra clothes from the baby, even if you have to wake up the baby for this.

Never sleep on a sofa or chair with a baby

After motion sickness or feeding, place the baby in the crib. The safest place for a baby under six months old to sleep is in a crib in your room.

Have your baby sleep on a smooth, firm mattress that matches the size of the crib. Water beds, ottomans and the like are not suitable places for a baby's sleep. The upholstery of the mattress must be waterproof and covered with a single layer sheet.

Use regular sheets and baby blankets or special sleeping bags for bedding rather than duvets. The sleeping bag should not be too large so that the baby does not get entangled in it.

If the baby is hot, remove one blanket from him, if he is cold - add one (do not forget that a blanket folded in half is equal to two blankets). Do not use duvets, quilts, bed bolsters or pillows.

Breastfeeding

Some recent research has shown that breastfeeding reduces the risk of SIDS. Breast milk provides your baby with all the nutrients he needs for the first six months of life and also protects the baby from infections.

See the doctor regularly

Follow a vaccination schedule that reduces the risk of SIDS, and seek medical advice if your baby is sick.

What about daytime sleep?

One recent study has shown that it is important to follow safety advice for babies' sleep not only at night, but also during the day. You should put the baby on its back and make sure that the baby does not cover his head with a blanket while sleeping. This study also confirms the importance of keeping your baby in the same room as you sleep during the day. The wicker cradle and carrycot are perfect for daytime naps while you can go about your business.

What is your advice regarding the use of a pacifier?

Some studies suggest that using a pacifier while putting your baby to bed (even during the day) reduces the risk of SIDS. One theory explaining this effect is that the dummy circle helps air to enter the baby's airways, even if he accidentally covers his head with a blanket. If you decide to use a pacifier, wait for breastfeeding to start, usually when your baby is one month old. Gradually wean your toddler off the pacifier over the 6 to 12 months period.

Don't worry if your baby's pacifier falls out of his mouth while he sleeps. And don't insist if the child doesn't want a pacifier.

Can a baby sleep monitor help?

Healthy babies do not need a respiration monitor. It is an electrical device that sounds an alarm if the baby's breathing is interrupted for a certain period of time. When using it, you may need to attach the sensor to the baby's body, place an ultrasonic transmitter or a special mat in the crib.

very tired

The risks associated with sleeping together are also increased if your little one:

was born prematurely (up to 37 weeks)

born with a low case weight (less than 2.5 kg)

One can understand the despair of parents when, against the background of full health, for no apparent reason, they find their child dead in the cradle. The subsequent investigation of the circumstances of the death of the newborn, the analysis of his development history (outpatient card), as well as the results of the postmortem examination do not answer the question of the cause of the death of the child. Such a condition, the fact of which is established by the method of excluding any other pathology, is included in the International Classification of Diseases called Sudden Infant Death Syndrome (SIDS). According to studies carried out in various European countries, the incidence of SIDS is from 0.5 to 4 per 1000 infants. Unfortunately, reliable statistics of this kind do not yet exist in Russia, since the awareness of medical workers in relation to SIDS is low and often death of unknown etiology is classified as a result of complications of ARVI or other common diseases.

This syndrome is known to be more common in boys; the ratio of boys to girls is 1.5: 1. The most dangerous in terms of the risk of developing SIDS is considered to be the age of 2-4 months. Most often, sudden infant death occurs in the autumn or winter months of the year.

A large-scale study of this problem in the world began in the 60s of the now last century. Since then, many attempts have been made to explain the onset of SIDS, and it can be argued that significant steps have already been taken to identify risk factors and prevent SIDS. Unfortunately, due to the fact that in our country sudden infant death syndrome was not accepted by the medical community as a full-fledged diagnosis for a long time, time was lost that could be used to develop preventive measures that have brought success in the prevention of the syndrome in the developed countries of the world. But in the 1980s, on the individual initiative of enthusiastic doctors, studies were finally begun, thanks to which the state of Russian science has now approached the global one.

Why?

This is the first question that arises for both grief-stricken parents and the attending physician. Science is not yet able to answer this question unambiguously, although there are a huge number of hypotheses. Many of them were consistently rejected: the likelihood of “strangling”, “crushing” the child by a sleeping mother or a pillow; overheat; inhalation of vomit; psycho-emotional stress; infections; enlargement of the thymus gland. However, while these assumptions are not valid for SIDS, they have proven useful in developing a number of hygiene requirements for infant care. Thus, the mother is advised to sleep separately from the baby and it is not recommended to lay the newborn on her tummy to sleep (it is preferable to lay the baby on her back or on her side to sleep with a soft cushion at the neck that prevents her from turning face down). The child should not be too warmly dressed, and during sleep there should be no harsh sounds. During the game, the child should not be sharply shaken or tossed.

Currently, the following theories of the occurrence of the syndrome dominate: "Heart"

This is one of the earliest hypotheses that have received serious confirmation today. Its essence boils down to the fact that the syndrome may be due to the development of heart rhythm disturbances that are fatal for the child's body, or arrhythmias... Normally, the human heart has a so-called automatism, that is, the ability to independently, not subject to the influence of regulatory systems (nervous and endocrine), but in "cooperation" with them, to develop impulses leading to its reduction. Therefore, the heart always beats in a certain rhythm, creating pauses for itself for rest, alternating with contractions that push blood into the aorta for blood supply to organs and tissues. Thus, the heart rhythm is the key to an adequate supply of oxygen to the whole body. Arrhythmias are extraordinary, abnormal, often just chaotic heartbeats. At the same time, situations that are incompatible with life sometimes arise: cardiac arrest, ultra-frequent disorderly contraction, or fibrillation... As a rule, serious rhythm disturbances are manifested by a sudden sharp pallor of the child, lethargy, apathy, pulsation of the cervical vessels visible to the eye, and sometimes vomiting.

Arrhythmia can occur not only in children with heart disease. This is what makes the diagnosis difficult. It is possible to suspect and prevent life-threatening arrhythmia only on the basis of a very qualified analysis of electrocardiograms, as well as all possible precursors of arrhythmia.

Respiratory function is vital. In the brain is located respiratory center controlling this function. We do not think about how to take a breath, it happens automatically. The respiratory center also regulates the breathing rate. As soon as the oxygen content in the blood drops and, accordingly, the carbon dioxide content increases, respiration becomes more frequent. This happens, for example, during physical exertion, being in a stuffy room. On the contrary, pauses may occur in breathing, which are of a protective nature, for example, when liquid or food gets into the upper respiratory tract. In addition, in infants, there is a phenomenon such as episodes of holding their breath during sleep, or apnea... Apnea can also occur in adults with snoring. It is normal for an infant to hold the breath for no more than 20 seconds. The reason for such delays is the immaturity of the respiratory regulation system. As the child grows, episodes of apnea become more rare and almost disappear by 3 months. It was proved that the periods of apnea were more often observed in children with SVSM. Death can occur from complete cessation of breathing during sleep. Therefore, having noticed the signs of breath holding in the child, you should shake the baby up, rub the hands and feet. Unfortunately, apnea episodes are usually recognized only retrospectively when talking to the parents of the deceased infant.

Summing up, it should be noted that the circumstances and all possible mechanisms of SHSM are caused by impaired adaptation of the central and autonomic nervous systems. It is she, as noted above, that exercises control over breathing and cardiac activity. The immaturity of the nervous system of the newborn is the basis on which any of the life-threatening disorders is based. Therefore, the state of the central nervous system of the newborn should be given special attention. Most scientists now believe that children who subsequently die of SIDS were born with much weaker protection from the internal and external stresses that occur in the life of any young child.

Risk factors for SIDS

Risk factors include environmental factors, age and sex characteristics, social and obstetric factors. We mentioned age-sex characteristics at the beginning of the article when we talked about the greater prevalence of the syndrome in boys and children 2-4 months of age. life. Environmental factors include the change of seasons (cold snap), since getting used to the cold requires a certain tension of the baby's adaptive reserves. Social factors such as the age of the parents, their bad habits, the living conditions of the child also play an important role. Various disorders during pregnancy and childbirth lead to increased susceptibility of children to the effects of adverse environmental factors.

Ward off trouble

To date, the main method for the prevention of SIDS is the timely identification of risk factors and adequate medical supervision of children who are at risk of developing this syndrome. Since 1996, the Children's Scientific and Practical Center for Heart Rhythm Disorders of the Ministry of Health of Russia has been operating in our country. One of the main tasks of the Center is to develop criteria for the risk of sudden cardiac death, methods for early detection of life-threatening arrhythmias in children.

There are also indications for an extraordinary visit to the district pediatrician with a child of the first year of life:

  • in case of difficulty waking up from sleep and / or an unusual half-asleep state of the child;
  • in case of difficulty breathing, hoarseness or coughing;
  • if the child has unusually long or severe crying;
  • if the child has repeated refusal to eat, repeated vomiting, frequent loose stools;
  • in case of a sharp increase or decrease in body temperature.

Undoubtedly, the cornerstone of the prevention of SIDS is the attitude towards a healthy lifestyle for both the expectant mother and the newborn. All recommendations for caring for a child, despite their seeming simplicity, have a serious theoretical and practical basis. Even at the planning stage of pregnancy, a woman should take care of her health; it is of great importance to quit bad habits both before and during pregnancy, as well as after childbirth (for example, smoking in the room where the child is, increases the risk of SIDS). Of course, social programs to improve living conditions, sanitary and educational work, and medical examination of children play an important role. So it is in our power to minimize the likelihood of a tragedy.