Dr. Greene, I am terrified of SIDS. What can I do to prevent it and when can I stop worrying?

Everything dear to us causes pain. Becoming a parent opens up new landscapes within us: new hopes, fears, delights, and sorrows. There is no magic moment when you will stop worrying. Sometimes, even when we do everything right, babies die. The fragility and unpredictability of life underscore how precious each life is.

Thankfully, there are specific steps you can take to minimize the risk to your child.

SIDS, or Sudden Infant Death Syndrome, is defined as the sudden, unexpected and unexplained death of any infant or young child. What a horror for any parent! When surveyed about what they would have appreciated in those chilling moments after the death, SIDS parents responded with several concrete requests they were often too stunned to make at the time (Journal of Emergency Medicine, Sep 1997):

• To hold their baby one last time
• To have the clothing returned to them
• To have a print or mold of their baby's hand
• To have a lock of hair.

These poignant requests underline the tragedy of SIDS, the most common cause of infant death in developed countries. SIDS accounts for about half of the deaths that occur between one month and one year of age.

Genetics plays a large role. SIDS is more common in boys than in girls, and it is more common in some population groups (Black, Native American, Hawaiian, Filipino, Maori).

Most of the affected infants have damaged or immature brainstems, making it difficult for them to wake up when they are in trouble. A recent series of autopsies has demonstrated visible brain abnormalities in over 70 percent of the SIDS babies examined (Pediatric Neurology, Jul 1998).

While parents often feel horribly responsible after SIDS, sometimes there is nothing they could have done to prevent it. There are many factors outside of our control.

Sometimes infants can even die of SIDS in the hospital. For example, a 5-month -old baby boy was admitted to Rotunda Hospital in Northern Ireland after he had experienced three near-SIDS events. He underwent a sleep study to try to identify what was causing these events. During the study he had no periods of slow heart rate or inadequate breathing. Nevertheless, he died of SIDS while he was still in the hospital. His heart slowed and stopped, and even expert medical care couldn't prevent it (Archives of Diseases in Children, May 1998).

Infants at risk for SIDS may have abnormalities in heart conduction. Almost 35,000 healthy babies in Italy had EKGs performed in the first week of life. They were then followed for a year. Most of those who ended up dying of SIDS had an abnormality on their original EKGs (a prolonged QTc interval). Those with this abnormality were more than 40 times more likely than their peers to die from SIDS (New England Journal of Medicine, Jun 11, 1998). These findings hold promise for future screening and prevention.

There are already several important preventive measures available. Events that occur even before the baby is born affect the risk of SIDS.