For Tony and Angela, who asked that we not use their real names, SIDS -- sudden infant death syndrome -- struck when their daughter, Brianna, was 3 months old.
Tony tells a story familiar to so many parents who have lost children to SIDS.
"We put her to bed about 6 p.m., after a great day," he said. "It had been sunny and warm, and we'd had her with us at the park. She was too little to ride the swings, but I'd held her in my lap as we went down the slide. I went in to check on her when we went to bed at 10:30 or so, and she was just gone."
"We blamed ourselves for so long," says Angela, "We thought we had done something wrong, that somehow we must have been bad parents for such a terrible thing to happen. How could our baby be taken from us like that? It wasn't right. It wasn't fair."
There was anger, both at each other and at the doctors who couldn't give them a definite cause for Brianna's death. When the cause of death was ruled to be SIDS, Tony at first didn't believe it.
"Our baby girl was healthy. She never had any breathing problems. She slept fine, woke up fine … it didn't make sense."
The sad fact is that SIDS -- sometimes informally called crib death -- rarely does. The causes are still largely a mystery, but there are things parents can do to lessen the chance that they will share Tony and Angela's heartbreak.
What Is SIDS?
SIDS is one of the great mysteries of modern medicine. Put simply, infants stop breathing at some point during sleep.
According to the American SIDS Institute, SIDS is diagnosed when the death of a child under 1 year of age remains unexplained after a thorough case investigation, including a complete autopsy, examination of the death scene and review of the clinical history.
According to the National Center for Health Statistics, there were 2,246 deaths from SIDS in the U.S. in 2004, the last year for which stats are available. This was down from 4,073 a decade earlier.
Greater Risks
Years of statistical analysis have revealed that certain population segments are more at risk than others. According to the Centers for Disease Control and Prevention, the overall average is 52.9 deaths from SIDS per 100,000 live births. For black infants, the incidence is 108.8 per 100,000, and among American Indian and Alaska native populations, incidence tops out at 124 per 100,000.
Central and South American populations had the lowest incidence, at 19.9 deaths per 100,000. So far, nothing has been found to cause the difference.
Premature infants have a greater risk of SIDS, and boys are at slightly higher risk than girls.
Although the mountain of statistics continues to grow, the root causes of SIDS remain largely unknown. We have a name for the disorder, but the nature of the beast continues to elude us.
SIDS Prevention
There is far better news when it comes to preventing SIDS. The CDC, working in concert with pediatricians and other health professionals, has compiled a list of things parents can do to help greatly reduce the chance of SIDS striking their child.
Prenatal care: Good prenatal care leads to healthier babies. The more physically robust a child is, the lower its chance of succumbing to SIDS. This means mother and baby should both be cared for well, and moms-to-be should avoid smoking or drug use.
Back to sleep: Placing an infant to sleep on his or her back greatly reduces the chance of airway obstructions and has been proven to reduce the incidence of SIDS. This measure has become the single biggest step in fighting SIDS since the disorder was first named. This means
every time baby sleeps, naps included. In several states, "back to sleep" is the law for day-care providers.
Firm sleeping surface: Babies should sleep on a firm surface, such as a safety-approved crib mattress covered with a fitted sheet. Never put an infant to sleep on a pillow, comforter or other soft surface.
Temperature control: Many parents believe that baby's room should be kept very warm, but for safest sleep the room should be at a temperature that is comfortable for an adult.
Avoid bed clutter: Bumpers, ruffles, pillows and stuffed animals may look nice in the crib, but they are all potential breathing obstructions to the infant.
Air flow: A low fan or other air mover to keep air from stagnating in baby's room is thought by some advisory groups to help stimulate breathing and keep oxygen concentration in the air adequate.
The American SIDS Institute also recommends a home monitoring system for infants considered at risk, such as those weighing less than 3.5 pounds at birth, those who have had a sibling die of SIDS or who have already suffered other health problems. The American Academy of Pediatrics disagrees with the use of products sold as anti-SIDS monitors, and there is no statistical evidence from any independent agency yet available.
Deaths Occur Despite Measures
The sad fact, however, is that SIDS occurs even to babies whose parents have taken all the proper precautions. Until a solid cause has been found and foolproof prevention discovered, the best that can be done is reducing the risk.
Tony and Angela have another child now, and he is 1 year old, past the greatest SIDS danger zone. But they still take all the recommended precautions and check on him frequently while he sleeps.
Angela says that she doesn't want her son to grow up in the shadow of his late sister, but that the memory of what happened to her will never be far away.
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