Sudden Infant Death Syndrome:

Study Outline for EMT's and Paramedics

DEFINITION

Sudden Infant Death Syndrome (SIDS) is a recognized, unpredictable medical disorder. SIDS is the sudden and unexpected death of an apparently healthy infant; the death remains unexplained after the performance of a thorough autopsy, death scene investigation and examination of medical history.

BASIC STATISTICS

SIDS occurs in 2/1000 live births (6,000-7,000 death each year in the U.S.); it is the leading cause of death in infants between 2 weeks and 1 year of age.

SIDS has a distinctive age distribution: rare in the first weeks of life, peak incidence from 2 to 4 months, rare after 6 months.

SIDS is more common in boys than girls

SIDS occurs at a higher rate: in African-Americans and American Indians than Caucasians and Asians in premature and low-birth-weight infants in twins and triplets

TYPICAL HISTORY

Minor illness (cold or upper respiratory infection) within two weeks prior to the death in about 50% of cases

No prior symptoms of life-threatening illness

Death occurs quickly and quietly, during a period of presumed sleep Child may be found faced down in the bedding or in an unusual position

ROLE OF THE EMT OR PARAMEDIC

Evaluation - The Infant's Appearance

Because a SIDS event usually occurs during sleep, some time may pass before the unrespon­sive infant is discovered. Because infants lose their body heat rapidly after death, normal post­mortem changes may have occurred by the time of discovery, The appearance of the SIDS infant may shock both the first responder and the baby's parents. The following post-mortem changes may be seen:

1) a frothy, possibly blood-tinged, mucus around the baby's mouth or nostrils. These pulmonary secretions may also have stained the bed clothes

2) dependent pooling of the blood to the underside of the body, with pallor of the upper side. A baby found lying on his or her stomach may have darkened areas on the underside of the face, arms, and legs as well as on the chest or abdomen

3) livor mortis, or decomposition of the blood, which gives the skin a dark red, fixed color

4) rigor mortis, or stiffening of the body

5) evidence that the baby was very active just prior to the death, such as rumpled bed clothes, an unusual position or location in the bed. (This activity is caused by muscular contractions of the body with death.) Note that an unusual position, coupled with dependent pooling of the blood, may produce pressure marks on the body where the pooled blood was pressed aside as, for example, by a crib slat.

6) disfiguration in the contours of the face of an infants who died on his or her stomach. This squashed look is caused by generalized relaxation of body tissue in death

The Physical Assessment of the Infant: ABC's

1) Airway?

2) Breathing?

3) Circulation?

Observations on the scene: These may assist in diagnosing the baby's condition or in explaining the appearance of the body.

1) Position of the baby in the crib (bed, etc.),

2) Condition and characteristics of the crib,

3) Presence of objects in the crib,

4) Unusual or dangerous items in the room, such as sharp objects or plastic bags

5) Presence of medication. (Take medication to hospital.) 

EMERGENCY CARE

CPR: Unless the baby is obviously dead (unquestionably dead to a lay person), infant CPR should be started. (It is reassuring and comforting to parents to know that all that was possible was done for their child.)

Transport: Unless policy specifically prohibits it, all infants should be transported to an appropriate medical facility, whether or not CPR has been initiated. If the infant was obviously dead and CPR is not being administered, parents should be allowed whatever time they wish with their child before transport.

Parents should be allowed to accompany their baby in the ambulance. If specific policy or circumstances prohibit this, parents should be told where the baby is being taken. ( The police may drive them to the hospital or they may need to be told to call a friend or relative to drive them.)

THE FAMILY

Family reactions: With a SIDS death, family members' immediate reactions range from numb shock to hysteria or rage. Because the family is in a state of crisis, even small interventions have great impact for good or ill. It is important for the emergency medical team:

1) to be prepared for any of a range of emotional reactions in family members,

2) not be judgmental about the extremeness of families' reactions or about family members' seeming lack of feeling,

3) not to take personally any expression of angry feelings.

Securing Necessary Information: Emergency Medical Team members should explain to the parents that they need certain information regarding the infant's health to determine the care to be given. Minimize the number of questions. Do not ask or say anything which could be taken as criticism of the parents or their parenting ability. Ask only essential questions such as:

1) "How old is the baby?"

2) "Has the baby been ill?"

3) "Has the baby been on any medication?"

4) "Have you noticed anything unusual?"

5) "Can you tell me what happened?" 

Generally, parents will have no idea what happened but they will be anxious to try verbally to recon­struct events. Let them talk.

Supporting the Family: The emergency medical team supports the family in a variety of ways: by providing immediate attention to the infant (and initiating CPR unless it is clearly inappropriate), by using sensitivity in their inquiry about the baby's health, by being accepting of parents feelings and non-judgemental about physical conditions of the house, and by allowing parents to accompany their infant en route to the hospital.

On arrival at the hospital, the infant becomes the responsibility of the hospital staff. At this point, the emergency medical team members can be of direct support to the family. If no hospital staff member is available to stay with the family, he/she should stay with them. By his/her presence, he/she offers reassurance and support. He/she can also help locate absent family members or others the parents would like to have with them. He/she can provide a sympathetic ear. Once the physician has pronounced the death and tentatively diagnosed SIDS, the EMT or paramedic can reassure the family that they were in no way responsible for the death

REFERENCES

Naeye, R.L. Sudden Infant Death. Scientific American, 1980, 242 56-62.

Smialek, Z. Observations on immediate reactions of families to sudden infant death. Pediatrics, 1978, 62, 160-165.

Valdes-Dapena, M. SIDS: A review or the medical literature 1974-1979. Pediatrics, 1980, 66, 597-614.

 

 

 

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