Silent tragedy: Understanding Sudden Infant Death Syndrome

Imagine the joy of bringing a new life into the world, and the excitement of finally taking your baby home, watching their innocent, angelic face as they sleep peacefully. The satisfaction that comes with seeing your baby make the first steps and milestones in their young life.

Now, picture the unthinkable of waking up to find your precious child no more.

This is the heartbreaking reality for parents who experience Sudden Infant Death Syndrome (SIDS), a tragedy that strikes without warning, leaving families devastated.

Dr Christine Wanjiru Njagi, a paediatrician at the Kenyatta National Hospital, defines SIDS as “the sudden death of an infant under 1 year of age that remains unexplained after a review of the clinical history, examination of the scene of death, and postmortem.”

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This clinical definition underscores the mysterious nature of SIDS, often referred to as “cot death,” which continues to baffle medical professionals worldwide.

SIDS is a diagnosis of exclusion, meaning it’s what doctors conclude when all other possible causes of death have been ruled out.

Dr Njagi explains, “It’s what we conclude when an infant under one year of age dies suddenly and unexpectedly, and we can’t find any other cause even after a thorough investigation, including an autopsy, examination of the death scene, and review of the clinical history.”

The World Health Organization (WHO) identifies SIDS as one of the leading causes of death among infants aged a month to a year in developed countries.

Globally, it’s estimated that SIDS claims the lives of approximately one in 1,000 live births. However, these statistics vary significantly across different regions and populations.

In Kenya, studies suggest that the incidence may be higher than in developed countries. However, precise data on SIDS is limited due to challenges in reporting and diagnosing.

A research paper published in the East African Medical Journal estimated that SIDS could account for up to 10 per cent of infant deaths in some urban areas of Kenya.

The World Population Review has placed Kenya’s overall infant mortality rate at 31.5 per 1,000 live births in 2022. While this figure encompasses all causes of infant mortality, it highlights the broader context of child health challenges in the country.

Across Africa, SIDS rates vary, but accurate data is often lacking due to limited resources for proper diagnosis and reporting. Countries with higher overall infant mortality rates, such as Chad, Central African Republic and Somalia, may also have higher SIDS rates, although specific data is scarce.

While the exact cause of SIDS remains unknown, researchers have identified several risk factors.

“Prone sleeping position (sleeping on the stomach), prenatal or postnatal exposure to tobacco smoke, soft sleeping surfaces, hyperthermia/overwrapping the baby, bed sharing—particularly with mothers who smoke—and lack of breastfeeding,” says Dr Njagi.

Understanding these risk factors has led to the development of prevention strategies. The National Institute of Health (NIH), in the United States, launched the “Safe to Sleep” campaign in 1994, which has contributed to a significant reduction in SIDS rates in the U.S. and other countries that have adopted similar initiatives.

Key recommendations from this campaign include always placing babies on their backs to sleep. Also, for naps and at night, use a firm sleep surface such as a mattress in a safety-approved crib. Keep soft objects, toys, and loose bedding out of the baby’s sleep area, and do not allow smoking around your baby. It also recommends keeping babies sleep areas close to, but separate from where adults sleep, breastfeed your baby and give it a dry pacifier that is not attached to a string for naps and at night.

“Do not let your baby get too hot during sleep, follow health care provider guidance on your baby’s vaccines and regular health checkups,” says Dr Njagi.

The paediatrician explains that the impact of SIDS extends far beyond the immediate loss. Parents who lose their infants to SIDS often experience severe psychological trauma.

A study published in the Journal of Paediatric Psychology found that parents who lost children to SIDS had significantly higher rates of depression, anxiety, and post-traumatic stress disorder compared to the general population.

“These mental health effects can persist for years, affecting not only the parents but also siblings and extended family members.” explains Dr Njagi.

For parents who suspect that their infants have succumbed to SIDS, the pediatrician advises the following steps: Notify the authorities immediately so that an investigation can be conducted, allow for an initial investigation of the death scene, combining the expertise of both law enforcement and medical personnel and consent to a comprehensive autopsy conducted by a pathologist.