Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Have crib deaths vanished?

Michael Hefferon, MD
Conditions
January 28, 2021
Share
Tweet
Share

An excerpt from Medical Myths: A Sceptic’s Journey.

It may be a long while since you’ve heard of a very small infant being found dead in the crib.

As a young doctor, I recall the encounters on cold February nights with devastated young parents. Pale ice-cold infants in the emergency department, who were beyond resuscitation.

Police officers asking horrible questions, and no answer — baby had a cold — what baby didn’t in February?. Most of these innocents were between 2 and 6 months. Autopsy to follow.

Nothing turned up, no matter how many times this was done.

While the term “crib death” goes back many centuries, SIDS, or Sudden Infant Death Syndrome, was the sanitized term we used in our medical notes.

In 1975, the incidence of SIDS was 1/300. Today it’s closer to 1/3,000. This would have had us doing autopsies on approximately 6 infants per year here in Kingston 30 years ago.

I recall the tragedy as parents were subjected to police questioning. I also recall a pathologist telling me that, “These parents are killing their kids.”

There was always that question as to whether we were missing something?

A second and even a third  SIDS death in one family gave us no further insight into the cause of this syndrome- and charges were sometimes brought against mothers and fathers to compound their grief.

Munchausen syndrome by proxy was popular, and admissions for “Near miss SIDS’” became commonplace. These were infants discovered blue, or not breathing in their cribs, but still alive.

Not much thought was given that risk factors existed in these families, which usually persisted after an infant’s death.

So, before we go into these risk factors, let’s look at the criteria used for diagnosis of SIDS:

ADVERTISEMENT

  • a healthy infant under a year of age
  • a complete clinical review
  • no other cause of death on the autopsy
  • a “non-criminal” death scene investigation.
  • typically a sleep association
  • 95 percent occurring in the first 6 months, with a peak at 2 to 4 months.

So, of course, this was a process of elimination.

But these descriptors of unexplained infant death go back to Biblical times: “And this woman’s child died in the night because she overlaid it” (1 Kings 3:19).

So this brings in the issue of bedsharing as a cause of unexpected infant death. While in some of these infants bedsharing was a factor, most occurred in a crib.

The term SIDS was not coined until 1971. At that time, it was given its own International Classification of Diseases code, ICD 798.0.

With a lot of challenges and very little evidence, we went after risk factors.

A risk factor is a variable associated with an increased risk of developing a certain disease. In other words, rather than it being the known cause of a disease, it merely increases the chance of developing a disease.

So what were the risk factors for SIDS?

  • male gender 6:4
  • prematurity 4:1
  • low birth weight 4:1
  • maternal smoking 5:1
  • prone sleeping (on tummy) 14:1
  • cold winter months.

You might think that this 14:1 risk factor might have prompted some intervention earlier.

While the first red flag on prone sleeping came in 1944, prone sleeping was still advised by public health authorities until the late 1980s. Could it be that simple?

The Back to Sleep campaigns of the early 1990s led to a 70 to 80 percent reduction in SIDS. There has now been little or no reduction since 2006.

The logic for prone sleeping had been to prevent aspiration (choking) on infant vomitus. Sure, babies puke all the time. But virtually no autopsy concluded that this (aspiration) was a cause of death in SIDS infants.

So was SIDS just a single mechanism? Maybe not, but more than half of these infants were probably suffocating, with oxygen deprivation and buildup of carbon dioxide in their airways.

Safe sleep campaigns, or Back to Sleep, were developed in the 1990s, dispensing the following advice:

  • supine sleeping position
  • firm bedding surfaces(not soft)
  • no bundling(over-wrapping)
  • avoidance of overheating
  • no pillows, furry toys, or bumper pads

Avoidance of second hand smoke should be obvious to new parents, coupled with the reassurance that breast feeding reduces the incidence of SIDS. However, breastfeeding increases co-sleeping incidence, which needs to be carefully monitored.

Put simply, these deaths are likely a failure of auto-resuscitation in susceptible infants, wherein the automatic arousal system fails to switch on, and breathing ceases.

Vaccination, on the other hand has no causal association with SIDS.

Along the way, many millions of research dollars were consumed to pursue a cause for this tragic phenomenon of infant demise.

The medical profession, logically pursued a medical cause for all of this. There were, of course, leads.

  • These were deaths occurring mostly in winter.
  • Babies commonly had “a cold.”
  • A virus called RSV was known to cause apnea.
  • A cardiac rhythm disruption in newborns called “long QT syndrome” caused infant cardiac arrest.
  • Some families had more than one infant with SIDS.

So it was largely based on these medical theories that the research money was spent.

The back to sleep campaign was so cheap, and so effective!

A new term has now evolved to address sudden infant death: SUID, Sudden unexplained Infant Death.

Of the 4,000 infant deaths in the U.S. per year, about half are SIDS. Clearly, an infant can die of known causes, but there is more work to be done in the realm of SIDS.

Michael Hefferon is a pediatrician and author of Medical Myths: A Sceptic’s Journey and Of Plagues and Vampires: Believable Myths and Unbelievable Facts from Medical Practice.

Image credit: Shutterstock.com

Prev

6 unconscious biases against vitamins and supplements

January 28, 2021 Kevin 4
…
Next

Zoom is foie gras of the brain [PODCAST]

January 28, 2021 Kevin 0
…

Tagged as: Pediatrics

Post navigation

< Previous Post
6 unconscious biases against vitamins and supplements
Next Post >
Zoom is foie gras of the brain [PODCAST]

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Michael Hefferon, MD

  • The historical medical significance of carrots

    Michael Hefferon, MD
  • The truth about Baron Von Munchausen, Munchausen’s Syndrome, and Munchausen’s by proxy

    Michael Hefferon, MD
  • Are there more psychiatric visits during a full moon?

    Michael Hefferon, MD

Related Posts

  • The public health solution to gun deaths

    Nancy Dodson, MD, MPH, Jeffrey Oestreicher, MD and Nina Agrawal, MD
  • Systemic racism and Indigenous deaths in health care

    Benjamin Brookwell
  • It is time for the Supreme Court to help stem gun deaths

    David Galinsky, MD
  • 5 things America can do today to reduce gun deaths

    Megan L. Ranney, MD, MPH
  • Should only infectious disease specialists be allowed to prescribe antibiotics?

    Craig Bowron, MD
  • Qualifying conditions for medical marijuana

    Patricia Frye

More in Conditions

  • What if medicine had an exit interview?

    Lynn McComas, DNP, ANP-C
  • Finding healing in narrative medicine: When words replace silence

    Michele Luckenbaugh
  • Why coaching is not a substitute for psychotherapy

    Maire Daugharty, MD
  • Why doctors stay silent about preventable harm

    Jenny Shields, PhD
  • Why gambling addiction is America’s next health crisis

    Safina Adatia, MD
  • How robotics are reshaping the future of vascular procedures

    David Fischel
  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Why male fertility needs to be part of every health conversation

      Hoag Memorial Hospital Presbyterian | Conditions
    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Inside human trafficking: a guide to recognizing and preventing it [PODCAST]

      The Podcast by KevinMD | Podcast
    • Graduating from medical school without family: a story of strength and survival

      Anonymous | Education
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
  • Recent Posts

    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Adriana Smith’s story: a medical tragedy under heartbeat laws

      Nicole M. King, MD | Physician
    • What if medicine had an exit interview?

      Lynn McComas, DNP, ANP-C | Conditions
    • Why U.S. health care pricing is so confusing—and how to fix it

      Ashish Mandavia, MD | Physician
    • From survival to sovereignty: What 35 years in the ER taught me about identity, mortality, and redemption

      Kenneth Ro, MD | Physician
    • When doctors forget how to examine: the danger of lost clinical skills

      Mike Stillman, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Why male fertility needs to be part of every health conversation

      Hoag Memorial Hospital Presbyterian | Conditions
    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Inside human trafficking: a guide to recognizing and preventing it [PODCAST]

      The Podcast by KevinMD | Podcast
    • Graduating from medical school without family: a story of strength and survival

      Anonymous | Education
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
  • Recent Posts

    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Adriana Smith’s story: a medical tragedy under heartbeat laws

      Nicole M. King, MD | Physician
    • What if medicine had an exit interview?

      Lynn McComas, DNP, ANP-C | Conditions
    • Why U.S. health care pricing is so confusing—and how to fix it

      Ashish Mandavia, MD | Physician
    • From survival to sovereignty: What 35 years in the ER taught me about identity, mortality, and redemption

      Kenneth Ro, MD | Physician
    • When doctors forget how to examine: the danger of lost clinical skills

      Mike Stillman, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Have crib deaths vanished?
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...