Sudden Infant Death Syndrome

Aka: Sudden Infant Death Syndrome, Crib Death, SIDS

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II. Epidemiology

  1. Incidence: 0.57 per 1000 live births
  2. Responsible for 1400 to 2200 deaths per year in the United States
    1. Accounts for slighly less than half the number of unexpected infant deaths in the U.S.
  3. Ages affected: 1 to 6 months (peaks at ages 1-4 months)
  4. Males are more likely to die of SIDS (RR 1.2)
  5. SIDS occurs most often between midnight and 8 am

III. Pathophysiology

  1. Triple-Risk Model (SIDS is final common pathway of 3 contributing factors)
    1. Underlying Vulnerability (e.g. Prolonged QT, Autonomic Dysfunction)
    2. Exogenous Stress (e.g. prone position, smoke exposure)
    3. Stress occurs during critical time in development (age <1 year old)

IV. Risk Factors: Ordered by Level of Risk

  1. Major Risk Factors
    1. Bed Sharing with smoking mother (OR 13.90)
    2. Gestational age <37 weeks (OR 11.67)
    3. Bed Sharing with infant <12 weeks old (OR 10.37)
    4. Soft bedding material (OR 5.10)
    5. Prone sleeping position (OR 4.30)
    6. Low brth weight <2500 g (OR 3.3)
    7. Bed Sharing with non-smoking mother (OR 2.09)
    8. Mother smoked during pregnancy (OR 2.06)
  2. Other Risk Factors
    1. Side sleeping position (OR 1.9)
    2. Smoke exposure as infant (OR 1.65)
    3. Sleeping in a Car Seat or stroller (OR 1.5)
  3. Protective Factors
    1. Up-to-date Immunizations
    2. Pacifier use during sleep (not attached)
    3. Breast Feeding
  4. References
    1. Adams (2009) Am Fam Physician 79(10): 870-4 [PubMed]

V. Risk Factors: Ordered by Category

  1. Infant Factors (Non-Modifiable)
    1. Preterm Birth (Gestational age <37 weeks)
    2. Low birth weight <2500 g
    3. Family History of previous SIDS deaths
  2. Sleep Environment
    1. Bed Sharing (Co-Sleeping) prior to 4 months of age (especially with smoking mother)
    2. Prone sleeping position (also side sleeping to lesser extent)
    3. Soft sleep surface (pillows, bedding)
  3. Substance Use by Parents
    1. Parental Smoking (associated with 61% of SIDS deaths)
    2. Maternal Alcohol Abuse (associated with 16% of SIDS deaths)
    3. Maternal Drug Abuse
  4. Socioeconomic Factors
    1. Teenage parents
    2. Minimal Prenatal Care

VI. History: By coroner or medical provider

  1. Reporting demographics
    1. Time infant was last normal
    2. Name of person who found the infant
  2. Infant status when found
    1. Respiratory status of infant when found (i.e. breathing or apneic)
    2. Sleep environment and surface on which the infant was found
    3. Items present around the infant when found (e.g. blankets)
    4. Position of infant when found (e.g. prone)
  3. Contributing factors
    1. Co-Sleeping
    2. Recent illness

VII. Diagnosis: Autopsy

  1. Assess for other possible cause
    1. Requires a full medical examiner evaluation into unexpected infant death
    2. SIDS is a diagnosis of exclusion after other causes have been evaluated
  2. Findings consistent with SIDS
    1. Intrathoracic Petechiae
    2. Mild respiratory tract congestion
    3. Brainstem gliosis
    4. Extramedullary hematopoiesis

VIII. Differential Diagnosis

  1. Apparent Life-Threatening Events In Children (ALTE or BRUE) or
    1. ALTE (or BRUE) events are not related to SIDS and are not a risk for SIDS
  2. Anoxia (Aspiration, Asphyxiation, Drowning)
  3. Cardiac Arrhythmia or Congenital Heart Defect
  4. Dehydration
  5. Inborn Errors of Metabolism
  6. Overwhelming infection (e.g. Neonatal Sepsis, Pneumonia)
  7. Poisoning
  8. Trauma (including Non-accidental Trauma)
  9. Hyperthermia

IX. Management: Emergency Department

  1. Avoid cleaning baby post-Resuscitation
  2. Evaluate neck flexibility on intubation (stiff or flexible)
    1. Stiffness may suggest longer duration since time of death
    2. Rigor mortis cannot otherwise be determined in infants due to lack of musculature
  3. Describe secretions found in the airway
    1. Do not clear the suction canister of secretions until examined by coroner
  4. Toxicology Screening
    1. May be performed during Resuscitation
    2. Coroner will perform if not already done
  5. Imaging
    1. Skeletal Survey is typically performed by coroner (multiple views, without limitations of radiation exposure)

X. Management: Family Support

  1. Counseling services

XI. Resources

  1. American SIDS Institute
    1. https://sids.org/

XII. Prevention

  1. Avoid Bed Sharing (especially prior to 4 months of age)
    1. Bed Sharing is most dangerous on soft surface, substance use (e.g. Alcohol, Tobacco), age <12 weeks
    2. Room sharing for first 6 months, however, is recommended (may reduce SIDS risk 50%)
  2. Infants should sleep in their own bassinet or crib
    1. See Crib Safety
    2. Firm sleep surface
    3. No pillows, comforters, toys or bedding
      1. Layers of clothing (or wearable blankets) may be used instead
      2. Avoid hats after the first day of life (may increase risk of SIDS)
    4. Swaddling (snugly wrapped blanket) is considered safe until infant shows signs of rolling over (3-4 months)
      1. Swaddling can result in suffocation if infant rolls
    5. Avoid sleeping in a Car Seat or stroller (or other inclined device)
  3. Child should sleep in supine position (Back to sleep campaign)
    1. Practice prevention of Deformational Plagiocephaly (related to supine sleeping)
      1. Supervised prone position while infant is awake starting at 2 weeks of age
      2. Gradually advance supervised prone position to 15-30 minutes/day (at age 2 months)
      3. Limit time that infants are in Car Seats or strollers
    2. Gross Motor Delays may occur due to supine positioning, but resolve by 18 months old
    3. Back to sleep campaign started in 1992 and reduced SIDS Incidence by 39%
  4. Pacifier Use
    1. Pacifiers use during sleep reduces SIDS risk even if expelled during sleep
    2. Do not attach Pacifier to any clothing or string
  5. Tobacco Cessation for parents (prior to pregnancy or prenatally is best)
  6. Keep Immunizations up-to-date
  7. Infant monitors are not recommended by AAP (not effective in preventing SIDS)
    1. Many OTC commercial cardiorespiratory monitors are directly marketed to parents
    2. Home monitors are expensive, inaccurate and offer false reassurance
  8. Breast Feeding substantially reduces SIDS Risk (OR 0.27)
    1. Hauck (2011) Pediatrics 128(1): 103-10 [PubMed]

XIII. References

  1. Bertone and Spangler in Herbert (2013) EM:Rap 13(11): 8-9
  2. Merenstein (1994) Handbook Pediatrics, Lange
  3. (1996) BMJ 313:191 [PubMed]
  4. (1996) BMJ 313:195 [PubMed]
  5. Adams (2015) Am Fam Physician 91(11): 778-83 [PubMed]
  6. Adams (2009) Am Fam Physician 79(10): 870-4 [PubMed]
  7. Alexander (2005) J Forensic Sci 50(1): 147-51 [PubMed]
  8. Darrow (2025) Am Fam Physician 111(2): 164-70 [PubMed]

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Related Studies

Ontology: Sudden infant death syndrome (C0038644)

Definition (MEDLINEPLUS)

Sudden infant death syndrome (SIDS) is the sudden, unexplained death of an infant younger than one year old. Some people call SIDS "crib death" because many babies who die of SIDS are found in their cribs.

SIDS is the leading cause of death in children between one month and one year old. Most SIDS deaths occur when babies are between two months and four months old. Premature babies, boys, African Americans, and American Indian/Alaska Native infants have a higher risk of SIDS.

Although health care professionals don't know what causes SIDS, they do know ways to reduce the risk. These include

  • Placing babies on their backs to sleep, even for short naps. "Tummy time" is for when babies are awake and someone is watching
  • Using a firm sleep surface, such as a crib mattress covered with a fitted sheet
  • Keeping soft objects and loose bedding away from sleep area
  • Making sure babies don't get too hot. Keep the room at a comfortable temperature for an adult.

NIH: National Institute of Child Health and Human Development
Definition (NCI) Unexpected death in infancy which remains unexplained following autopsy, review of the medical history, and investigation of the death circumstances and death scene.
Definition (NCI_NCI-GLOSS) The sudden and unexpected death of a healthy child who is younger than one year old, usually during sleep. The cause of SIDS is not known.
Definition (MSH) The abrupt and unexplained death of an apparently healthy infant under one year of age, remaining unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history. (Pediatr Pathol 1991 Sep-Oct;11(5):677-84)
Definition (PSY) Unexpected death of an apparently healthy infant during sleep.
Definition (CSP) sudden and unexpected death of an apparently healthy infant, typically occurring between 3 weeks and 5 months of age, most infants dying at night, and not explained by postmortem data.
Concepts Disease or Syndrome (T047)
MSH D013398
ICD9 798.0
ICD10 R95
SnomedCT 207535006, 207536007, 207534005, 207538008, 158718001, 207671002, 51178009
LNC LA10530-6
English Sudden Infant Death Syndrome, SIDS, Cot Death, Cot Deaths, Crib Death, Infant Death, Sudden, SID, Sudden Infant Death, Death, Cot, Death, Crib, Sudden infant death syndrome, SIDS - Sudden inf death synd, [D]Cot death (context-dependent category), [D]Crib death (context-dependent category), [D]Sudden infant death syndrome (context-dependent category), [D]Sudden infant death syndrome NOS (context-dependent category), Sudden infant death, Sudden infant death syn.NOS, Sudden infant death syndr., Sudden infant death syndrome NOS, [D]Cot death, [D]Crib death, [D]Sudden infant death syn.NOS, [D]Sudden infant death syndr., [D]Sudden infant death syndrome, [D]Sudden infant death syndrome NOS, SUDDEN INFANT DEATH SYNDROME, sudden infant death syndrome (diagnosis), sudden infant death syndrome, COT death, SIDS (Sudden infant death syndrome), Death infant sudden, Death sudden infant, Infant death sudden, Sudden infant death synd, SIDS (sudden infant death syndrome), crib death, Sudden Infant Death [Disease/Finding], crib deaths, sudden infant death, sudden infant death syndrome (SIDS), [D]Cot death (situation), [D]Sudden infant death syndrome NOS (situation), [D]Sudden infant death syndrome (situation), [D]Crib death (situation), Cot death (event), Death, Sudden Infant, Cot death, Crib death, Unexpected sudden death of infant, SIDS - Sudden infant death syndrome, Sudden infant death syndrome (finding), cot death, cot death; death, death; cot death, death; sudden, cause unknown, infant (cot death), death; sudden, infant, infant death syndrome; sudden, infant; sudden death, sudden infant death syndrome [SIDS], sudden infant death; syndrome, sudden; death, cause unknown, infant (cot death), sudden; death, infant, sudden; infant death syndrome, syndrome; sudden infant death, Sudden death of nonspecific cause in infancy
Spanish MUERTE SUBITA INFANTIL, SMSL (Síndrome de muerte súbita del lactante), Muerte súbita del lactante, Muerte de cuna, [D]síndrome de muerte súbita infantil, SAI (categoría dependiente del contexto), [D]muerte en la cuna (categoría dependiente del contexto), [D]muerte en cama para bebés (categoría dependiente del contexto), [D]síndrome de muerte súbita infantil (categoría dependiente del contexto), [D]muerte en la cuna, [D]muerte en cama para bebés, [D]muerte en cama para bebés (situación), [D]síndrome de muerte súbita infantil, [D]muerte en la cuna (situación), [D]síndrome de muerte súbita infantil, SAI (situación), [D]síndrome de muerte súbita infantil, SAI, [D]síndrome de muerte súbita infantil (situación), Muerte Súbita Infantil, Síndrome de la Muerte Súbita Infantil, Síndrome de la Muerte Súbita del Lactante, muerte en la cuna, muerte súbita inesperada del recién nacido, síndrome de muerte súbita del lactante (hallazgo), síndrome de muerte súbita del lactante, Síndrome de muerte súbita del lactante, SMSL, Muerte en la Cuna, Muerte Súbita del Lactante
German PLOETZLICHER KINDSTOD, Kindstod ploetzlich, SIDS (Sudden infant death syndrome), Wiegentod, Ploetzlicher Kindstod, ploetzlicher Kindstod, Kinderbettchentod, Krippentod, SIDS, Plötzlicher Kindstod, Plötzlicher Säuglingstod, Syndrom des plötzlichen Todes im Kindesalter
Italian Sindrome della morte improvvisa del lattante, Sindrome da morte improvvisa infantile (SIDS), Morte neonatale improvvisa, Morte improvvisa neonatale, SID, Morte in culla, SIDS, Sindrome della morte improvvisa del neonato, Morte improvvisa del neonato
Dutch plotselinge dood kind, wiegendood, SIDS (sudden-infant-death syndrome), dood; plotseling, oorzaak onbekend, zuigeling (wiegendood), dood; plotseling, zuigeling, dood; wiegendood, plots; zuigelingendood, plotseling; dood, oorzaak onbekend, zuigeling (wiegendood), plotseling; dood, zuigeling, sudden infant death; syndroom, syndroom; sudden infant death, wiegendood; dood, zuigeling; plotse dood, zuigelingendood; plots, Sudden infant death syndrome [wiegendood], sudden-infant-death syndrome, SIDS, Wiegendood
French Mort subite d'un enfant, Syndrome de mort subite d'un nourrisson (SMSN), Mort subite du nouveau-né, Mort subite chez le nourrisson, SYNDROME DE MORT SUBITE DU NOURI, Mort subite du nourrisson, Syndrome de mort subite du nourrisson, Mort au berceau, SMSN
Portuguese Morte súbita de bebé, MORTE SUBITA INFANTIL, Morte de recém-nascidos no berço, Síndrome da Morte Súbita na Infância, Morte Infantil Súbita, Morte Súbita na Infância, Síndrome da Morte Súbita do Lactente, Síndrome de morte súbita de bebé, Morte no Berço, Morte Súbita do Lactente, SMSL
Swedish Plötslig spädbarnsdöd
Japanese ﾆｭｳｼﾞﾄﾂｾﾞﾝｼｼｮｳｺｳｸﾞﾝ, ﾍﾞﾋﾞｰﾍﾞｯﾄﾞｼ, ﾆｭｳｼﾞﾄﾂｾﾞﾝｼ, SIDS, ＳＩＤＳ, 寝台死, 乳幼児突然死症候群, ベビーベッド死, 乳児急死, 乳児突然死, 乳幼児突然死, 揺籃死, 乳児突然死症候群, 幼児突然死
Czech náhlá smrt kojenců, Náhlá smrt dítěte, SIDS ( syndrom náhlého úmrtí dítěte ), Syndrom náhlého úmrtí dítěte, Úmrtí v postýlce, Náhlé úmrtí dítěte, Úmrtí kojence ve spánku
Finnish Kätkytkuolema
Russian NOVOROZHDENNOGO SMERT' VNEZAPNAIA, НОВОРОЖДЕННОГО СМЕРТЬ ВНЕЗАПНАЯ
Korean 영아 급사 증후군
Croatian SINDROM IZNENADNE SMRTI DOJENČETA, IZNENADNA SMRT DOJENČETA, SMRT, IZNENADNA, U DOJENČADI
Polish Śmierć nagła niemowląt, Nagłe zgony niemowląt, SIDS, Zespół nagłego zgonu niemowląt, Śmierć łóżeczkowa, Nagła śmierć niemowląt
Hungarian Bölcsőhalál, Hirtelen csecsemőkori halál, Hirtelen csecsemőhalál, SIDS, Hirtelen csecsemőhalál syndroma, Csecsemőkori hirtelen halál, SIDS (hirtelen csecsemőhalál syndroma)
Norwegian Krybbedød, Plutselig, uventet spedbarnsdød, Plutselig spedbarnsdød
Derived from the NIH UMLS (Unified Medical Language System)

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