Michigan  Child  Death  Review  Program

Sudden Infant Death Syndrome (SIDS) is defined as the sudden death of an infant under one year of age, which remains unexplained after a thorough case investigation, that includes three parts: a complete autopsy with negative findings, a scene investigation and a review of the medical history. If these three criteria are not met, SIDS should not be the cause of death. Since SIDS is considered a diagnosis of exclusion, all other possibilities must be ruled out.

Although autopsies are now routinely performed before a SIDS diagnosis is made, death scene investigations and medical history reviews are often not conducted. It is especially difficult to differentiate between SIDS and suffocation with only an autopsy, because neither may have positive findings at autopsy.  In many cases, a death scene investigation is the only way that SIDS and suffocation risk factors can be identified.

With some four decades of research completed, we still do not know the cause of SIDS.  We are more aware that SIDS probably does not have a simple, singular cause but is most likely an interaction between environmental, physiological and social risk factors.  SIDS deaths have continued to decline nationwide, dropping in 2001 to a record low in the United States. Nationally, SIDS deaths in 2001 totaled 2,234, down from 2,648 in 1999.

Many believe the decline is due to the changing practice of putting babies to sleep on their backs. The “Back to Sleep” campaign was launched in 1994 by the American Academy of Pediatrics and the National Institutes of Health. Still, the “Back to Sleep” message is not reaching everyone. African American babies are 2.4 times more likely than white babies to die of SIDS, and Native American babies are 2.8 times more likely to die of SIDS. According to a study in the Journal of the American Medical Association, between 1994 and 1998, 17% of white babies and 32% of black babies were still sleeping on their stomachs.  Forty-one percent of the parents that responded to the study said that their physician did not discuss sleep position with them and agreed that a recommendation coming from their doctor would have a strong influence on their decision.  The study found that physicians need to make the “Back to Sleep” recommendation to parents as early as possible since the risk of SIDS is greatest in the first months of life. Findings show that reinforcement of the back sleeping position by physicians and nurses, with support from other sources, is the best way to influence parents to follow this recommendation.

In Michigan, Tomorrow's Child (then  known as the Michigan SIDS Alliance) served as the lead organization for this campaign.  Since then, SIDS deaths have been reduced by over 60% in Michigan.

Better death scene investigations in the state are providing new insights by helping to identify risk factors.  The recent reductions in SIDS number in Michigan are due to a shift in diagnosis rather than an actual decrease in the number of deaths.  As unsafe sleep environments are identified by investigation, many infant deaths that would have been called SIDS in the past years are now being identified as asphyxias or undetermined cause.

The Consumer Product Safety Commission (CPSC) and Gerber Products also released the results of a national survey highlighting risks to African American babies.  Only 31% of the African American parents surveyed put their babies on their backs, and 85% of these babies sleep with soft bedding such as quilts, comforters and pillows in their cribs.  Therefore, the CPSC, Gerber and the BET television network are launching a national “Safe Sleep” campaign to help lower the rate of SIDS especially among African Americans.  In Michigan, MDCH, DHS and Tomorrow's Child of Michigan are conducting a major campaign to encourage infant safe sleep practices among African American families, as well as the general population of Michigan.

In early 1999, the CPSC joined forces with the American Academy of Pediatrics and others in issuing new guidelines for infant safe sleep environments.  Ann Brown, Chairman of the CPSC, in issuing the new guidelines, encouraged families to change habits: "Don't sleep with your baby or put the baby down to sleep in an adult bed.  The only safe place for babies is in a crib that meets current safety standards and has a firm, tight-fitting mattress.  Place babies to sleep on their backs and remove all soft bedding and pillow-like items from the crib."

Maternal smoking during pregnancy and second-hand smoking in the infant’s environment have also emerged as risk factors in several epidemiological studies of SIDS.  An infant of a mother that smokes has almost a five times greater risk of SIDS than an infant of a mother who does not smoke.  And while scientists are finding it difficult to distinguish between the effects of prenatal smoking by the mother and second-hand postnatal exposure, it is generally believed that prenatal smoking is the greater risk factor.