What's the cause of "crib death"?

Factual Questions
1

I’ve got a two-month old baby in the house and the subject of “crib death” keeps arising among my parental peers.
There seems to be no consensus as to what the cause is.

I’m told (and the numbers seems to support) that having a baby sleep on their back reduces the risk; so that’s what we’re doing.
At first, I thought that having the baby sleep on her back reduced the amount of weight pressed against the lungs. That a back-sleeping baby breathes easier.
Makes sense, sure. But there isn’t a preponderance of evidence to make that the “cure”. Back-sleeping only seems to reduce the occurance of crib death, but not elimiate it.

Some further evidence seems to point to the flame-retardant that’s added to crib mattresses being a cause. That these chemicals react with a fungus that grows inside a used mattress and that they produce a heavier-than-air layer of gas close to the top of the mattress. Stomach sleeping babies inhale this poisonous mixture and it takes it’s toll on the child’s nervous system. Effectively shutting down breathing first, and then heart function. However, autopsies would show nothing.
Back-sleeping babies would not inhale the very thin layer of gases; but may still absorb a lethal dose of toxins through the skin.
This website says that the solution is to wrap the baby’s mattress in a high-grade polyethelyne that puts an air-tight barrier between the gases and sleeping baby.

Franky, I’m not sure of what to think. But I’m thinking that I’ll probably err on the side of caution and wrap her mattress.

But my underlying question still remains…
What causes “crib-death”?

2

“Crib Death” is clinically known as SIDS and it is one of pediatric medicine’s biggest unsolved mysteries. Bo one really knows what causes it or how to prevent it completely. Here is some information:

http://kidshealth.org/parent/general/sleep/sids.html

3

From the Center for Disease Control:

FACTS ABOUT SIDS

Progress in Reducing Risky Infant Sleeping Positions – 13 States, 1996-1997

From the National Institutes of Health:

SIDS: “Back to Sleep” Campaign

4

And from the American Academy of Pediatrics:

Changing Concepts of Sudden Infant Death Syndrome: Implications for Infant Sleeping Environment and Sleep Position

That, while acknowelging that we still do not know what causes SIDS, nevertheless

5

SIDS, or crib death, is probably not one cause of death, but many causes of death, none of which can be discovered via autopsy. Some of these you mention, others are on the link above.

SIDS is the diagnosis given when they can’t figure out why the infant died. Perhaps some suffocated, perhaps some had brain stem failure which meant the lungs weren’t getting signals to breathe. Perhaps some simply had hearts that stopped beating.

The important thing to do is to do all that you can (perhaps wrap your matress - what will it hurt, anyway?), make sure the sheets are tight fitting and all the way on, put her on her back to sleep. Get some of those wedge things if she likes to roll over, don’t have blankets or pillows or stuffed animals in her sleeping area, and then relax. You’ve done all you can, and statistically, you’ve done a great deal to reduce the chances of anything happening to her.

One thing you should be aware of is that since the Back To Sleep campaign has been so successful, there’s a new problem occuring, which is positional plagiocephaly, or flattened head syndrome. Most cases resolve themselves by 12 months, but sometimes surgery is required. The best things you can do to help minimize the risk are to change her head position each night (one night to the right, the next to the left) and to let her have tummy time for play while she’s awake and you’re watching her during the day.

Welcome to parenthood. As soon as you have all your fears addressed, a new one comes along!

6

Part of the problem for studying SIDS is that the first documented and defining cases have since been proven to be cases of infanticide. :frowning:

So, while there is a good deal of evidence to suggest that SIDS does happen a lot of researchers are stuck wondering whether any specific SIDS death might not be a murder. Add in that it is likely that SIDS is also a label for several different (competing for want of a better word) conditions, you’re left with a very small number of cases overall, and a great deal of uncertainty over whether any particular case is actually comparable to any other case.

Here’s a site discussing some of the difficulties with SIDS cases overall. http://echo.forensicpanel.com/1999/8/1/infanticideas.html

7

Darn, shoulda just waited. You said everything I wanted say, only better. :smack:

8

Are you sure about that? I knew that some cases had been.

9

One of my nieces has a flat back-of-head. She just wouldn’t turn her head at all. She has gotten a lot better over the past several months–she is about 13 months–but she still looks weird.

Always something to worry about. Don’t subscribe to Parents magazine if you’re worry-prone–I swear, half the stories are This unheard-of awful thing will happen to you if you don’t prevent it right now by wrapping your child in germ-free cotton balls!!

10

Germ-free cotton balls? If you do not use anti-septic, hypo-allergenic, polypropylene scrunchies, you may as well put a gun to the kid’s head and pull the trigger, then sign the kid up for deep psychoanalysis!

11

I’m afraid I misremembered some of the details. This link provides a pretty good overview. The short answer is that the Doctor’s work, published in 1972, began to provide proof of a genetic link to SIDS. Unfortunately, the mother, has since confessed and been convicted of murdering all her infants. It’s not quite as bad as I had stated, but it’s not good.

Again, I’m not saying that SIDS is something that is used only to cover up infanticide. According to the forensic medicine overview link I’d provided earlier, only about 10% of all SIDS cases seem to be infanticide. And I’m not trying to claim that SIDS deaths are all murders. However, I do believe that in that 90% of SIDS cases that are not recognized as infanticide, there are other infanticides that were simply not recognized. :frowning:

12

I would tend to discount the flame-retardant fume theory, if only because babies have been dying from crib death for much longer than the chemicals have been in use. My older brother died in his sleep in 1955. Mom put him to bed at 8pm, healthy and happy, and when she checked on him at 10 pm he was dead. His death certificate lists “acute, diffuse, suppurative meningitis” as the cause of death, but my mom insists that the doctor said it was really crib death, and that he just listed meningitis because he had no better guess. This many years later, clouded by emotion and age, who really knows what the doctor meant.

My kids were born before the “Back to Sleep” movement. All we were ever warned about was blankets and pillows, and that it was more likely to affect boys than girls. With boys you pretty much hold your breath until their first birthday, fragile creatures that they are.

13

Ironically, the hygiene stuff is detrimental to the development of a child’s immune system, especially at this age, and is therefore one of the more dangerous things that people do for/to their children is fight bacteria too efficiently. The immune system needs to be exposed to bacteria to develop.

Some 5-6 years ago second hand smoke was identified as one of the more major causes of SIDS. I haven’t heard much about it since so I wonder what the status of that piece of science currently is.

14

Except for cases of premature babies, every case I have heard of “crib death” has been a baby in a household where one or both parents smoked heavily.

I don’t know if there have been statistical studies on this, but just this anecdotal info seems like just another reason for parents to stop smoking.

15

Interesting. How many anecdotes have you heard?

16

Not every case of SIDS happens in smoking households, but smoking is indeed a risk factor. The increase in SIDS risk appears to be related to the “dose” of passive-smoke exposure–the greater the exposure to smoke both before and after birth, the higher the risk of SIDS (Bulterys MG, Greenland S, Kraus JF. Chronic fetal hypoxia and sudden infant death syndrome: interaction between maternal smoking and low hematocrit during pregnancy. Pediatrics 1990;86:535-40. and Klonoff-Cohen HS, Edelstein SL, Lefkowitz ES, Srinivasan IP, Kaegi D, Chang JC, et al. The effect of passive smoking and tobacco exposure through breast milk on sudden infant death syndrome. JAMA 1995;273:795-8.) 30–40% of all cases of SIDS could be prevented if the number of pregnant women who smoke can be reduced from 30% to zero.

Mothers who smoke are strongly discouraged from co-sleeping, as they have a higher chance of having their infant die of SIDS than other co-sleepers.

Smoking in pregnancy ups risk of SIDS threefold.

Numerous research studies confirm that maternal smoking during pregnancy increases the risk of SIDS.

*Haglund B, Cnattingius S. Cigarette smoking as a risk factor for sudden infant death syndrome: a population-based study. Am J Public Health 1990;80:29-32 [Published erratum appears in Am J Public Health 1992;82:1489].

Malloy MH, Kleinman JC, Land GH, Schramm WF. The association of maternal smoking with age and cause of infant death. Am J Epidemiol 1988; 128:46-55.

DiFranza JR, Lew RA. Effect of maternal cigarette smoking on pregnancy complications and sudden infant death syndrome. J Fam Pract 1995;40(4):385-94.

Bulterys MG, Greenland S, Kraus JF. Chronic fetal hypoxia and sudden infant death syndrome: interaction between maternal smoking and low hematocrit during pregnancy. Pediatrics 1990;86:535-40.

Schoendorf KC, Kiely JL. Relationship of sudden infant death syndrome to maternal smoking during and after pregnancy. Pediatrics 1992;90:905-8.

American Academy of Pediatrics Committee on Environmental Health. Environmental tobacco smoke: a hazard to children. Pediatrics 1997;99:639-42.

Klonoff-Cohen HS, Edelstein SL, Lefkowitz ES, Srinivasan IP, Kaegi D, Chang JC, et al. The effect of passive smoking and tobacco exposure through breast milk on sudden infant death syndrome. JAMA 1995;273:795-8.

Mitchell EA, Ford RP, Stewart AW, Taylor BJ, Becroft DM, Thompson JM, et al. Smoking and the sudden infant death syndrome. Pediatrics 1993;91:893-6.

17

In my lifetime I’ve encountered at the very least 100 DOA SIDS babys. Every single solitary one of them had stool in their diaper. I’ve asked a few doctors about this. The theory that I’ve been given is that the hypoxic/hypercapnic infant has a Vagal nerve (one of the cranial nerves) malfunction while grunting to poop, and cardiac arrest ensues. All agree that there are a number of pathologies that may contribute.

Anyone else shared these observations?

18

Can’t help on the causation of SIDS, but couldn’t the stool be present just b/c the rectal vault is full and with death comes the relaxation of the sphincter?
I, too, had heard that a % of SIDS cases were in fact, infanticide.

I had kids during a shift in focus for babies–one kid I was told–put her on her tummy! The youngest I was told–no place but on his back! There were similiar issues with solid foods etc.

All my kids slept however they wanted to–and keep in mind that once they roll over independently, putting a bolster to prevent them turning may frustrate them and make them cry.

Please, do follow the advice given by the AAPA–I don’t mean to pour cold water. I am only saying that advice and support can only go so far.

19

Could be, but I can’t think of very many adults that pooped their britches postmortem. Plenty of adults suffer cardiac arrest while taking a dump.

20

I have seen many (not tons) of adults post-code(deceased)–alot of them are incontinent of stool. Not all, but enough for me to consider the connection. I am not ruling yours out. Most of the adults are not incontinent of urine, but that is b/c they usually have catheters in place.