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SIDS (Sudden Infant Death Syndrome) is the subconscious fear of many parents. It usually attacks babies within the first year of life and more boys than girls. But what is it? What causes it? Is it preventable? When it occurs, how can parents face it?

SIDS​—A Parent’s Daily Fear

“The sudden, unexpected death of an apparently healthy baby is probably the most poignant and devastating event that can overtake a young couple​—yet in Western society it is also the most common kind of infant death after the first week of life.”​—Professor Bernard Knight, Sudden Death in Infancy—​The ‘Cot Death’ Syndrome.

IT WAS 4:00 a.m. of December 22, 1984. Ken Eberline poked his head into the bedroom to see how seven-month-old Katie was doing. Little Katie was the firstborn pride and joy of Ken and Tottie, who were in their early 30’s. The baby was sleeping peacefully. Ken left the house. He had a long drive to Las Cruces, New Mexico, to teach a seminar.

Tottie got up at 7:30 a.m. and went to see how Katie was. Katie was strangely silent. Tottie looked again, touched her, and immediately knew the worst. Katie was dead. She had died of crib death, or SIDS (Sudden Infant Death Syndrome). This sudden, silent death creeps up on thousands of families every year.

A Compassionate Medical Examiner

How did Tottie and Ken react to their loss? Tottie told Awake!: “As soon as I realized what had happened, I called 911, the emergency services. The paramedics and the police arrived in haste along with a medical examiner. They were all so kind and compassionate. Of course, doubts rushed to my mind​—what had I done or failed to do that could have caused this?

“The medical examiner calmed my fears. He explained that he had lost a child in the same circumstances nine years earlier. ‘There was nothing you could have done to prevent it,’ he assured me. ‘Even if you had been standing by the crib with a monitor, you could not have saved her.’ He added: ‘You cannot anticipate it and you cannot prevent it. In certain cases, everything just shuts down at once, and at present there is no way of knowing the cause.’ I am sure that his remarks saved me from a lot of guilt and self-incrimination.”

How did Ken and Tottie cope with their loss? A later article will answer that. But there are other questions to which every parent of a young baby wants answers: What causes SIDS? Are there any warning signals? Is it preventable?

SIDS​—Tracking Down Symptoms and Causes

“Sudden infant death syndrome (SIDS) is responsible for approximately 2 deaths per 1000 live births in the United States, resulting in 7500 to 10,000 deaths annually.”​—The New England Journal of Medicine, April 30, 1987.

ONLY in recent years has SIDS become known as a definition of a cause of death. In previous generations this type of death got buried in all the other statistics on the multiple causes of infant death that prevailed. Advances in medical science have now eliminated so many previous causes of infant death that SIDS now stands out​—so much so that the World Health Organization established the “Sudden infant death” category in its International Classification of Diseases as recently as 1979. Yet, some medical experts think they can trace examples of what we now call SIDS all the way back to Bible times!

They quote the case of the two women who came before King Solomon, each claiming to be the mother of a live baby rather than the one that had died because the mother “lay upon him.” (1 Kings 3:16-27) As pathologist Bernard Knight writes: “Overlaying was the classical belief for the cause of cot [crib] death until very recently.” One factor makes it doubtful, though, that the Bible describes a case of SIDS​—the baby died at an age that Knight surmises to have been “too young for a true sudden infant death.”

While it is true that some babies have died because of being accidentally suffocated by a sleeping mother, it is also true that many of these cases over the centuries have been what today is called sudden infant death syndrome.

The Mystery of SIDS

SIDS is a world problem. It is estimated, for example, that from 1,000 to 2,000 infants die every year in Britain under the SIDS definition. The average in developed countries is about one baby in every 500. Based on an estimated world population increase of 83 million per year, that represents at least 166,000 deaths yearly. But it also implies millions of worried parents who harbor the secret fear. As Phyllis, a New York mother in her early 30’s, confessed: “Every time I put my baby to bed, I pray that it will wake up again.”

SIDS continues to baffle the medical researchers and pathologists. An article in the magazine Pediatrics recently discussed SIDS in twins. Thirty-two cases were examined, and “no cause of death was found despite complete postmortem investigations.” Ten other cases of SIDS in twins were researched by university clinics in Antwerp, Paris, and Rouen. The findings? “The cause of SIDS remained unexplained after a complete autopsy.” The mystery cause, or causes, continues.

However, as shown in another report, in 11 of 42 pairs who were compared, “the future SIDS victim was more than 300 g lighter than his or her surviving sibling.” The conclusion was that the only items differentiating the SIDS infants from the control infants were a “lower mean weight and height at birth, the previous occurrence of cyanosis [bluish skin and mucous membranes caused by lack of oxygen in the blood] or pallor during sleep, and the recurrent profuse night sweats.”

In their report on 16 SIDS cases in England, a group of doctors stated: “SIDS usually occurs between 1 and 6 months of age with a peak at 2 to 4 months. . . . Other factors previously reported to be associated with SIDS are a maternal history of smoking during pregnancy, young maternal age at birth, unmarried status, large family size, [and] low socioeconomic status.” They add: “SIDS is also reported more frequently in male infants and is more prevalent during the autumn and winter months.” Yet, Bernard Knight cautions: “It must be emphasised that sudden infant death can​—and does—​strike at any family, irrespective of the position in the social hierarchy.”

Pathologists Try to Unravel the Mystery

When an infant dies without obvious cause, the coroner or medical examiner will usually call in a pathologist to examine the body and perform an autopsy. The reason for this is to try to pinpoint the exact cause of death and use this knowledge to prevent future cases. What have the pathologists found in many of these cases?

Over the years different trails have been followed. At one time SIDS was attributed to suffocation by pillows, bedclothing, and posture. That was rejected when it was proved that babies normally struggle out of any suffocation posture. And bedclothes are usually porous enough to allow for breathing. Then it was thought that bottle feeding and the use of cow’s milk was the cause. But breast-fed babies also died from SIDS. For a long time apnea, interrupted breathing, was blamed. Now that has been largely abandoned as a primary cause.

Some years ago some pathologists “truly believed that respiratory infection was the underlying cause of death . . . Though it is now [in 1983] generally thought that the infection is the trigger rather than the underlying cause, there is no doubt that some mild inflammatory condition of the air passages is implicated in a large proportion of SIDS.”​—Sudden Death in Infancy.

Professor Knight concludes that “it now seems obvious that there is no single cause of cot death” but that “there are several factors which come together in a given baby at a given time and cause death. We know some of the factors but not others.” Thus, the detective work continues as more clues are sought. Recently, however, a new discovery was made.

Hemoglobin Change​—Cause or Symptom?

This development was reported in The New England Journal of Medicine of April 30, 1987. It stated: “Prolonged elevation in the levels of fetal hemoglobin (hemoglobin F) in infants with SIDS could denote a compromised delivery of oxygen to sensitive tissue sites.”a The report indicated that after the birth of a baby, there is normal replacement of fetal hemoglobin with hemoglobin A produced by the baby’s body​—thus its own oxygen-carrying hemoglobin. In the victims of SIDS, a significant number of the victims still had a higher proportion of less effective fetal hemoglobin than was normal. So, what conclusion did the doctors draw?

“Our interpretation of this finding is that infants with SIDS are characterized by a marked delay in the switch from hemoglobin F to hemoglobin A​—a phenomenon that may reflect an underlying chronic condition.” Why does this happen? “The reason for the abnormal persistence of hemoglobin F is uncertain.”

Although they did not see this as a cause of SIDS, they did view it as a useful marker with which to pick out the babies that might be more subject to SIDS, “especially those beyond 50 weeks of post-conceptional age.”

The doctors who originated this study stated that “studies of SIDS suggest an association with low birth weight, prematurity, retarded growth development, and maternal smoking.”

This latter point is worthy of comment. Dr. Bernard Knight, of the University of Wales, Cardiff, wrote: “Quite a strong association of smoking with SIDS has been shown, though again it is difficult to know whether this is a direct link or merely an association with social factors.” Nevertheless, he does quote statistics that are revealing. In a survey of 50,000 births in the city of Cardiff, the rate of SIDS for mothers who have not smoked or who have stopped smoking was 1.18 per 1,000 live births. But for mothers who smoked more than 20 cigarettes a day, the figure jumped to 5.62 per 1,000 live births​—a fivefold increase!

Some mothers ask: “What about breast-feeding? Does that give greater protection against SIDS?” Dr. Bergman, prominent in the United States in the field of SIDS research, stated: “I happen to believe in breast feeding and I think it is better for a whole lot of reasons; but I don’t think that people who have lost crib death babies should have it suggested to them that their baby might still be alive if they had only breast fed.”

In view of the foregoing, is there anything parents can do to head off the threat of SIDS? Is it preventable?

[Footnotes]

[Box on page 6]

Parents Viewed With Suspicion

The enigma surrounding SIDS deaths has sometimes caused unnecessary pain and suffering to the parents. How so? Because outsiders, including sometimes the police and medical personnel, have viewed the death as highly suspicious, especially when it has occurred simultaneously in twins. And according to a survey covering over 47,000 births in Cardiff, Wales, between 1965 and 1977 there was a fivefold increase in the risk of SIDS in twins. Dr. John E. Smialek, writing in the medical journal Pediatrics, reported two exceptional cases that occurred five years apart in Wayne County, Missouri, and Detroit, Michigan, U.S.A.

He states: “The announcement of the deaths of the first set of twins resulted in an atmosphere of intense suspicion of the parents . . . by members of the medical community and other lay persons who were unaware of the existence of this phenomenon [SIDS].” That is easy to understand when we recall that SIDS has received major publicity only since 1975, when the U.S. government supported information and counseling programs on the subject. When a similar twins case of SIDS happened in Detroit five years later, there was much less suspicion. Professionals and the public were becoming informed.

Yet, even now, when so much more is known about the subject, Dr. Smialek admits: “Although SIDS is now widely accepted as a condition that parents have no power to predict or prevent, the occurrence of the simultaneous deaths of infant twins is a phenomenon that still evokes bewilderment and suspicion.”

But why should twins be more susceptible to SIDS? Pathologist Bernard Knight answers: “They are very often premature and are often under normal birth-weight. They more often need to spend the early part of their lives in special care units in maternity hospitals. . . . All these factors make them more vulnerable to sudden infant death.”

[Picture on page 4]

“There is no single cause of cot [crib] death.”​—Professor Knight

[Picture on page 7]

“The occurrence of the simultaneous deaths of infant twins is a phenomenon that still evokes bewilderment and suspicion”

SIDS​—Can It Be Prevented?

“Home monitoring of infants who are considered to be at high risk for sudden infant death syndrome (SIDS) has been increasingly used in recent years in an attempt to prevent sudden infant death.”​—Pediatrics, June 1986.

HOME monitoring has increasingly been used, but does it prevent SIDS? Thousands of parents have used or are using home monitors. The monitor, attached to the baby, gives a warning signal when there is threatening irregularity in cardiac activity or breathing. Science News reports that an estimated 40,000 to 45,000 home monitors are in use in the United States and from 10,000 to 15,000 are manufactured each year. Since the danger period is the first year of life, the monitor does not have to be used for years. But are these devices really effective in saving lives?

Dr. Ehud Krongrad and Linda O’Neill, RN, of the Babies Hospital of Columbia University, New York, studied 20 babies considered to be at high risk. Their study indicates that it is extremely difficult to identify accurately a baby that is at risk and therefore really in need of a home monitor. They state: “No test is available to indicate with a high degree of specificity or sensitivity, or with a reasonable predictive value, that an infant is at high risk.”

They argue that parents are naturally very subjective in diagnosing their child’s reactions and state: “Most alarms perceived by parents as being true alarms associated with physical changes are not accompanied by cardiac electrical instability.” In fact, their data “suggest that the overwhelming majority of infants who die suddenly and unexpectedly do not exhibit any notable and or clinically useful symptoms.” As a result, George A. Little of Dartmouth Medical School stated: “If the criteria in the consensus panel report are applied by physicians, I’d anticipate a significant drop in home monitor use for infantile apnea.”

This conclusion serves to support the counsel of the medical examiner to Tottie, quoted in our opening article: “There was nothing you could have done to prevent it. Even if you had been standing by the crib with a monitor, you could not have saved her. You cannot anticipate it and you cannot prevent it. In certain cases, everything just shuts down at once, and at present there is no way of knowing the cause.” Unfortunately, in many fields, science and medicine do not have all the answers, and SIDS is one such field.

Another factor to bear in mind is that home monitors are electrical apparatuses, and therefore, as stated in an article in Pediatrics, “health professionals and consumers need to be aware that the presence of a monitor in a home represents potential risks, especially when the home includes a toddler or preschool child.” A loose cable is a temptation to any child, and a nearby connection can be the next simple step to an electrocution or a burn accident. Therefore, where a home monitor is used, extreme caution should be exercised when there are other children around.

Near-Miss Babies

A near-miss baby is one that has stopped breathing and is apparently dead but is caught in time. Perhaps a parent suddenly noted that the baby had ceased breathing and scooped it up to run for help or rush to the nearest hospital. Sometimes that sudden action and movement has served to trigger the heart and the breathing, and the baby has been saved without the need for any heart massage or CPR (cardiopulmonary resuscitation).

In some cases these near misses have been noted in babies that eventually died of SIDS. Dr. Marie Valdes-Dapena says that ‘near-miss infants are at special risk for sudden death.’ Therefore, doctors deduce that “these functions of breathing and heart rate are related to the autonomic nervous system and it seems almost certain that SIDS babies and potential cot deaths have some malfunction of this automatic part of the central nervous system.” But the cause remains a mystery.

So SIDS is used to define the death of a baby in circumstances that cannot be explained. An autopsy fails to produce a valid reason or cause for the death. And at the present stage of research and investigation, SIDS cannot usually be foreseen or prevented. So when a baby dies​—whether of SIDS or of any other cause—​how do parents cope with such a loss? How do they face their grief?

[Picture on page 9]

Baby attached to a home monitor to check breathing

SIDS​—Facing the Grief

SUDDEN infant death is a devastating tragedy. An apparently normal, healthy baby fails to wake up. It is totally unexpected, for who imagines that an infant will die before its parents? A baby that has become the center of a mother’s endless love is suddenly the reason for a mother’s endless grief.a

Guilt feelings begin to flood in. The parents feel responsible for the death, as if it were due to some neglect. They ask themselves, ‘What could we have done to prevent it?’ In some cases the husband, without foundation, might even unconsciously blame his wife. When he went to work, the baby was alive and healthy. When he got home, it had died in its crib! Then what was his wife doing? Where was she at the time? These irrational doubts have to be cleared up so as not to put a strain on the marriage.

Tottie, mentioned in our opening article, went through a difficult phase. She says: “If I am not careful, I still have bouts of guilt and depression. Mentally, I have to shift gears quickly and get out of that nonproductive thinking. Prayer has been a great help to me, as I have asked for help to recognize my own thought processes and to help me think more positively.”

How can other people help them in their grief? Tottie shot out the answer: “Some people act as if Katie never existed. If only they would realize that in fact you do want to talk about your loved one! It is therapeutic to talk. Katie will always be a lovely little child to us, and we want to remember her, not forget her. So why be afraid to talk about her?”

On the other hand, not all parents want to talk about their dead child. That is something that the visitor has to gauge.

Working Out the Grief

Grief reactions vary from person to person and from culture to culture. One study of SIDS in the United States found that, on an average, it takes the parents three years “to regain the level of personal happiness [they] felt they had held before the death.”

Doug, a computer systems analyst, and Anne, now in their early 40’s, lost little Rachel 12 years ago. That was when SIDS was still relatively unknown. Even though a doctor had checked the baby the day before, the attending policeman insisted that the coroner ask for an autopsy. Says Anne: “At the time we did not question the decision. Only later did we find out that the policeman had noticed blue marks on Rachel’s throat, and he suspected child abuse! As it turned out, the condition was merely an evidence of death, called livor mortis​—two blood spots that form and look like bruises. The autopsy came up with no reason for the death, and it was finally listed as sudden infant death.”

How did Doug and Anne face the loss? Doug explains: “I was at the Kingdom Hall when a friend told me I was urgently wanted at home. When I arrived at the house, I learned the worst. I could not believe it. I had been the last person to touch Rachel that night. Now she was dead. I broke down and wept, along with Anne. It was the only time I wept.”

Awake!: “What about the funeral? How did that affect you?”

“The surprising thing was that neither Anne nor I cried at the funeral. Everyone else was weeping.” Then Anne interjected: “Yes, but I have done plenty of crying for both of us. I think it really hit me a few weeks after the tragedy, when I was finally alone one day in the house. I cried all day long. But I believe it helped me. I felt better for it. I had to mourn the loss of my baby. I really do believe that you should let grieving people weep. Although it is a natural reaction for others to say, ‘Don’t cry,’ it doesn’t really help.”

Awake!: “How did other people help you through the crisis? And what things don’t help?”

Anne responded: “One friend came and cleaned up my house without my having to say a word. Others made meals for us. Some just helped by giving me a hug​—no words, just a hug. I didn’t want to talk about it. I didn’t want to have to explain over and over again what had happened. I didn’t need prying questions, as if I had failed to do something. I was the mother; I would have done anything to save my Rachel.”

Doug continued: “Sometimes innocent remarks were made that were not helpful, such as: ‘As Christians we should not mourn as others do.’ Now, I know that. But I can assure you, when you lose a child, at that moment even the firm knowledge of the resurrection is not going to prevent you from weeping and mourning. After all, Jesus wept when Lazarus died, and Jesus knew he was going to resurrect him.”

Anne added: “Another comment that we did not find helpful was, ‘I know how you feel.’ We know it was said with the best of intentions, but unless that person had lost a baby as I did, there is no way he or she could know how I felt. Feelings are very personal. True, most people can show sympathy, but very few can show real empathy.”

Awake!: “Did Rachel’s death cause any strain between you?”

Anne was quick to answer: “Yes, it did. I suppose we had different ways of mourning our loss. Doug wanted to put up photos of Rachel around the house. That was the last thing I wanted. I didn’t need those reminders. I didn’t want it to look as if we were making a cult out of her death. Anyway, Doug understood my feelings, and he took the photos down.”

Awake!: “How did little Stephanie, Rachel’s sister, react?”

“For a short period after Rachel’s death, Stephanie was afraid of getting sick. She feared that any illness would also kill her. And at first she was not too happy about going to sleep. But she got over it. When we had Amy, our next baby, Stephanie was always very afraid for her. She did not want her to die, and any cough or sniffle made her nervous for her sister.”

A Solid Hope Sustains

What about the use of sedatives during the grief period? Pathologist Knight writes: “It has been shown that heavy sedation may be counter-productive if it is a barrier to the normal process of bereavement and grieving. The tragedy has to be endured, suffered and eventually rationalised and to retard this unduly by knocking out the mother with drugs may prolong or distort the process.”

Awake! asked Doug what had sustained him and Anne through their grief.

“I remember that the funeral talk was helpful. What comforted us most of all that day was our Christian hope in the resurrection. Her loss was felt deeply, but the hurt was softened by God’s promise through Christ of seeing her again here on earth. From the Bible, we saw that the effects of death are reversible. The speaker showed from the Bible that Rachel was not in heaven ‘as a little angel’ nor in Limbo awaiting release to heaven. She was simply asleep in the common grave of mankind.”​—See John 5:28, 29; 11:11-14; Ecclesiastes 9:5.

Awake!: “How would you answer those who say that ‘God took her’?”

“It would be a selfish God who would take little children from their parents. The Bible’s answer at Ecclesiastes 9:11 is enlightening: ‘Time and unforeseen occurrence befall them all.’ And Psalm 51:5 tells us that all of us are imperfect, sinful, from the time of our conception, and the eventuality for all men now is death from any number of causes. Sometimes death strikes before birth, resulting in a stillbirth. In Rachel’s case, she contracted something as an infant that overwhelmed her system​—an unforeseen occurrence.”

Every day thousands of homes lose a child in death. Many of these are babies who die from SIDS. Compassionate friends, doctors, hospital staff, and counselors can mean so much in such tragic circumstances. (See box to the left.) Also, accurate knowledge of God’s purposes toward mankind can truly sustain grieving parents.

If you would like to know more about God’s promise of a resurrection to perfect life on earth, please feel free to contact Jehovah’s Witnesses in your neighborhood. They will gladly help you with comfort from God’s Word, without obligation.

[Footnotes]

[Box on page 12]

Suggestions for Helping Bereaved Parents

What You Can Do

1. Be available. Make meals. Clean house. Run errands. Care for the other children.

2. Express your genuine fellow feeling and sorrow at their loss.

3. Let them express their feelings and grief as they see fit.

4. Encourage them to be patient with themselves and not to demand too much from themselves.

5. Allow them to talk about the lost child as much as they wish, and you talk about the endearing qualities of the child.

6. Give special attention to the child’s brothers and sisters for whatever length of time it is necessary.

7. Relieve them of guilt feelings. Reassure them that they did all they could. Highlight whatever else you know to be true and positive about the care they gave.

What to Avoid

1. Don’t avoid them because you are uncomfortable. Just a sympathetic hug is better than absence.

2. Don’t say you know how they feel​—unless you have lost a child too.

3. Don’t be judgmental or tell them what they should feel or do.

4. Don’t become silent when they mention their dead child. And don’t be afraid to mention the child​—they want to hear good things about him/​her.

5. Don’t draw sham conclusions or lessons to be learned from the loss of the child. In their grief, there is no silver lining to this cloud.

6. Don’t remind them that at least they have other children or can have more. No other child is a substitute or replacement.

7. Don’t add to their guilt feelings by looking for faults in the home or hospital care.

8. Don’t use religious platitudes that put the blame on God.

(Based in part on a list prepared by Lee Schmidt, Parent Bereavement Outreach, Santa Monica, California.)