Sudden Infant Death Syndrome (SIDS)

Sudden Infant Death Syndrome (SIDS) is a topic covered in the 5-Minute Emergency Consult.

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  • Sudden, unexpected death of an infant <1 yr old who was typically well before being placed down to sleep
  • Death remains unexplained after being thoroughly investigated by autopsy, exam of the death scene, investigation of the circumstances, and review of the family and infant medical histories.
  • Leading cause of death in infants 1 mo–1 yr of age; the incidence has declined markedly since the initiation of the “Back to Sleep” program in 1994:
    • 1992: 120 deaths/100,000 live births (US)
    • 2001: 56 death/100,000 live births (US)
    • No change from 2001–2006
  • Peak occurrence of SIDS at 1–4 mo of age:
    • 90% occur <6 mo of age
    • 2% occur >10 mo of age
  • Ethnic differences: 2006 rates per 100,000 live births: All populations, 54.5; non-Hispanic white, 55.6; non-Hispanic black, 103.8; American Indian/Alaska Natives, 119.4; Asian American or Pacific Islander, 22.8; Hispanic, 27.
  • Sleeping on back (supine) reduces incidence significantly (“Back to Sleep”). Practice of infants sleeping on their backs began initially in Europe and then in US


  • Most likely multifactorial
  • SIDS infants likely have predisposing conditions that make them more vulnerable to both internal and external stressors.
  • Potential stressors include anemia, congenital diseases, dysrhythmias, electrolyte abnormalities, genetic defects, infection, metabolic disorders, neurologic events, suffocation, trauma, upper airway obstruction.
  • Maternal and antenatal risk factors:
    • Alcohol and illicit drug use
    • Intrauterine growth restriction
    • Lower socioeconomic status
    • Poor prenatal care
    • Prior sibling death secondary to SIDS
    • Shorter interval between pregnancies
    • Smoking
    • Younger age
  • Infant risk factors:
    • Bed sharing
    • Exposure to environmental smoking
    • Gastroesophageal reflux (GER)
    • Hyperthermia
    • Low birth weight, prematurity
    • Male gender
    • Soft bedding, soft sleeping surface
    • Recent febrile illness
  • Supine sleeping position, breast-feeding, and pacifier use are protective.
  • Home monitoring has not been shown to prevent SIDS.

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