SIDS - Knowledge

911: 2415: 815:, breastfeeding, limiting soft bedding, immunizing the infant and using pacifiers. The use of electronic monitors has not been found to be useful as a preventative strategy. The effect that fans might have on the risk of SIDS has not been studied well enough to make any recommendation about them. Evidence regarding swaddling is unclear regarding SIDS. A 2016 review found tentative evidence that swaddling increases the risk of SIDS, especially among babies placed on their bellies or sides while sleeping. 448:

rather to multiple risk factors. The frequency of SIDS does appear to be influenced by social, economic, or cultural factors, such as maternal education, race or ethnicity, or poverty. SIDS is believed to occur when an infant with an underlying biological vulnerability, who is at a critical development age, is exposed to an external trigger. The following risk factors generally contribute either to the underlying biological vulnerability or represent an external trigger:

1001: 950: 58: 835: 337: 1043: 772:. Genes indicating susceptibility to MCAD and Long QT syndrome do not protect an infant from dying of classical SIDS. Therefore, the presence of a susceptibility gene, such as for MCAD, means the infant might have died either from SIDS or from MCAD deficiency. It is currently impossible for a pathologist to distinguish between them. 962:

families include mother's age, household poverty index, rural/urban status of residence, and infant's age. More than 50% of African American infants were placed in non-recommended sleeping positions, according to a 2012 study completed in South Carolina, indicating that cultural factors can be protective as well as problematic.

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greater risk (100.7 per 100,000 live births) of having a SIDS-related death, compared to the U.S. population as a whole, and experience a 2.5 greater incidence of SIDS than in Caucasian infants. Rates are calculated per 100,000 live births to enable more accurate comparison across groups of different total population size.

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The exact cause of SIDS is unknown. Although studies have identified risk factors for SIDS, such as putting infants to bed on their bellies, there has been little understanding of the syndrome's biological process or its potential causes. Deaths from SIDS are unlikely to be due to a single cause, but

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in the United States in 2011. It is the most common cause of death between one month and one year of age. About 90% of cases happen before six months of age, with it being most frequent between two months and four months of age. It is more common in boys than girls. Rates of SIDS have decreased by up

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In 2013, there were persistent disparities in SIDS deaths among racial and ethnic groups in the U.S. In 2009, the rates of death range from 20.3 per 100,000 live births for Asian/Pacific Islander to 119.2 per 100,000 live births for Native Americans/Alaska Native. African American infants have a 24%

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plays a role, as SIDS is more prevalent in males. There is a consistent 50% male excess in SIDS per 1000 live births of each sex. Given a 5% male excess birth rate, there appears to be 3.15 male SIDS cases per 2 female cases, for a male fraction of 0.61. This value of 61% in the US is an average of

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The exact cause of SIDS is unknown. The requirement of a combination of factors including a specific underlying susceptibility, a specific time in development, and an environmental stressor has been proposed. These environmental stressors may include sleeping on the stomach or side, overheating, and

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Placing an infant to sleep while lying on the belly or side rather than on the back increases the risk for SIDS. This increased risk is greatest at two to three months of age. Elevated or reduced room temperature also increases the risk, as does excessive bedding, clothing, soft sleep surfaces, and

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Research suggests that factors which contribute more directly to SIDS risk—maternal age, exposure to smoking, safe sleep practices, etc.—vary by racial and ethnic group and therefore risk exposure also varies by these groups. Risk factors associated with prone sleeping patterns of African American

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Infants typically receive several vaccinations between the ages of 2 and 4 months, which is also the peak age for SIDS. Due to this coincidence, a number of studies have investigated the possible role of vaccinations as a cause of SIDS. These have found either no relation between vaccinations and

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with parents or siblings increases the risk for SIDS. This risk is greatest in the first three months of life, when the mattress is soft, when one or more persons share the infant's bed, especially when the bed partners are using drugs or alcohol or are smoking. The risk remains, however, even in

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have been uncovered in which the diagnosis was originally SIDS. Since an autopsy is often unable to determine whether asphyxiation is caused intentionally, medical practitioners rely on patient and family history and evidence of prior abuse to identify cases of infanticide. Some estimates in the

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SIDS deaths in the US decreased from 4,895 in 1992 to 2,247 in 2004, a 54% decrease. During a similar time period, 1989 to 2004, SIDS as the cause of death for sudden infant death (SID) decreased from 80% to 55%, a 31% decrease. According to John Kattwinkel, chairman of the Centers for Disease

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Hoffman HJ, Hunter JC, Damus K, Pakter J, Peterson DR, van Belle G, Hasselmeyer EG (April 1987). "Diphtheria-tetanus-pertussis immunization and sudden infant death: results of the National Institute of Child Health and Human Development Cooperative Epidemiological Study of Sudden Infant Death

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that listed SIDS as the cause of death, and suggested that many of these deaths may have been due to accidental suffocation. The study found that 69% of autopsies listed other possible risk factors that could have led to death, such as unsafe bedding or sleeping with adults.

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SIDS has been linked to cold weather, with this association believed to be due to over-bundling and thus, overheating. Premature babies are at four times the risk of SIDS, possibly related to an underdeveloped ability to automatically control the cardiovascular system.

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The most effective method of reducing the risk of SIDS is putting a child less than one year old on their back to sleep. Other measures include a firm mattress separate from but close to caregivers, no loose bedding, a relatively cool sleeping environment, using a

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thus recommends "room-sharing without bed-sharing", stating that such an arrangement can decrease the risk of SIDS by up to 50%. Furthermore, the academy has recommended against devices marketed to make bed-sharing "safe", such as "in-bed co-sleepers".

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Product safety experts advise against using pillows, overly soft mattresses, sleep positioners, bumper pads (crib bumpers), stuffed animals, or fluffy bedding in the crib, and recommend instead dressing the child warmly and keeping the crib "naked."

342: 252:. Typically death occurs between the hours of midnight and 9:00 a.m. There is usually no noise or evidence of struggle. SIDS remains the leading cause of infant mortality in Western countries, constituting half of all post-neonatal deaths. 563:

57% black male SIDS, 62.2% white male SIDS and 59.4% for all other races combined. Note that when multiracial parentage is involved, infant race is arbitrarily assigned to one category or the other; most often it is chosen by the mother. The

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may increase the risk of SIDS due to the risk of suffocation. They are not recommended for children under one year of age, as this risk of suffocation greatly outweighs the risk of head bumping or limbs getting stuck in the bars of the crib.

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By definition, SIDS deaths occur under the age of one year, with the peak incidence occurring when the infant is two to four months old. This is considered a critical period because the infant's ability to rouse from sleep is not yet mature.

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The term SUDI is now often used instead of sudden infant death syndrome (SIDS) because some coroners prefer to use the term 'undetermined' for a death previously considered to be SIDS. This change is causing diagnostic shift in the mortality

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SIDS, or a reduction of the risk of SIDS following vaccination. A 2007 meta-analysis found that vaccinations were associated with a halving of the risk of SIDS, and argued that immunisation should be a part of SIDS prevention campaigns.

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and other cot mattress materials are not a cause of SIDS. The report also states that toxic gas cannot be generated from antimony in mattresses and that babies had SIDS on mattresses that did not contain the compound.

854:" campaign. The incidence of SIDS has fallen in a number of countries in which this recommendation has been widely adopted. Sleeping on the back does not appear to increase the risk of choking, even in those with 2925: 4884: 4869: 532:

is a significant risk factor. In the United States from 1995 to 1998, the SIDS death rate for infants weighing 1000–1499 g was 2.89/1000, while for a birth weight of 3500–3999 g, it was only 0.51/1000.

1683:"Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015" 922:

Globally, SIDS resulted in about 22,000 deaths as of 2010, down from 30,000 deaths in 1990. Rates vary significantly by population from 0.05 per 1000 in Hong Kong to 6.7 per 1000 in Native Americans.

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Poets CF, Samuels MP, Wardrop CA, Picton-Jones E, Southall DP (April 1992). "Reduced haemoglobin levels in infants presenting with apparent life-threatening events--a retrospective investigation".

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Fleming PJ, Levine MR, Azaz Y, Wigfield R, Stewart AJ (June 1993). "Interactions between thermoregulation and the control of respiration in infants: possible relationship to sudden infant death".

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Bajanowski T, Vennemann M, Bohnert M, Rauch E, Brinkmann B, Mitchell EA (July 2005). "Unnatural causes of sudden unexpected deaths initially thought to be sudden infant death syndrome".

460:. Between no smoking and smoking one cigarette a day, on average, the risk doubles. About 22% of SIDS in the United States is related to maternal smoking. SIDS correlates with levels of 3239: 4074:"The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk" 2103:

Bajanowski T, Brinkmann B, Mitchell EA, Vennemann MM, Leukel HW, Larsch KP, Beike J (January 2008). "Nicotine and cotinine in infants dying from sudden infant death syndrome".

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has also been linked to SIDS (however, per item 6 in the list of epidemiologic characteristics below, extent of anemia cannot be evaluated at autopsy because an infant's total

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Millat G, Kugener B, Chevalier P, Chahine M, Huang H, Malicier D, et al. (May 2009). "Contribution of long-QT syndrome genetic variants in sudden infant death syndrome".

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considers pacifier use to prevent SIDS to be reasonable. Pacifiers do not appear to affect breastfeeding in the first four months, even though this is a common misconception.

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can only be measured during life). SIDS incidence rises from zero at birth, is highest from two to four months of age, and declines toward zero after the infant's first year.

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for families affected by SIDS is important, as the death of the infant is unexpected, unexplained, and can cause suspicion that the infant may have been intentionally harmed.

858:. While infants in this position may sleep more lightly, this is not harmful. Sharing the same room as the parents but in a different bed may decrease the SIDS risk by half. 3209: 2948: 2917: 319:

from one in a thousand to one in ten thousand. Globally, it resulted in about 19,200 deaths in 2015, down from 22,000 deaths in 1990. SIDS was the third leading cause of

2148:"Ependymal alterations in sudden intrauterine unexplained death and sudden infant death syndrome: possible primary consequence of prenatal exposure to cigarette smoking" 4535: 937:

Control and Prevention (CDC) Special Task Force on SIDS "A lot of us are concerned that the rate (of SIDS) isn't decreasing significantly, but that a lot of it is just

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Drinking of alcohol by parents is linked to SIDS. One study found a positive correlation between the two during New Years celebrations and weekends. Another found that

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Weber MA, Klein NJ, Hartley JC, Lock PE, Malone M, Sebire NJ (May 2008). "Infection and sudden unexpected death in infancy: a systematic retrospective case review".

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Smith MG, Liu JH, Helms KH, Wilkerson KL (January 2012). "Racial differences in trends and predictors of infant sleep positioning in South Carolina, 1996-2007".

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O'Leary CM, Jacoby PJ, Bartu A, D'Antoine H, Bower C (March 2013). "Maternal alcohol use and sudden infant death syndrome and infant mortality excluding SIDS".

4393:"Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010" 1601: 716: 2796: 358:

and should be applied to only those cases in which an infant's death is sudden and unexpected, and remains unexplained after the performance of an adequate

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is associated with a lower risk of SIDS. It is not clear if co-sleeping among mothers who breastfeed without any other risk factors increases SIDS risk.

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1980s and 1990s placed the potential rate of SIDS deaths caused by maltreatment around 10% and as high as 40%, but data from interventions such as the

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Carlin RF, Moon RY (February 2017). "Risk Factors, Protective Factors, and Current Recommendations to Reduce Sudden Infant Death Syndrome: A Review".

893:" or "sleep sack", a soft bag with holes for the baby's arms and head can be used as a type of bedding that warms the baby without covering its head. 5009: 1827: 4679: 3231: 1856: 1779: 5629: 4028:

Moon RY, Darnall RA, Feldman-Winter L, Goodstein MH, Hauck FR, et al. (Task Force on Sudden Infant Death Syndrome) (November 2016).

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Limited evidence suggested swaddling risk increased with infant age and was associated with a twofold risk for infants aged >6 months.

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Vennemann MM, Höffgen M, Bajanowski T, Hense HW, Mitchell EA (June 2007). "Do immunisations reduce the risk for SIDS? A meta-analysis".

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hypothesis for SIDS and the male excess in infant mortality have shown that the 50% male excess might be related to a dominant X-linked

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McIntosh CG, Tonkin SL, Gunn AJ (December 2009). "What is the mechanism of sudden infant deaths associated with co-sleeping?".

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Pollack HA, Frohna JG (May 2001). "A competing risk model of sudden infant death syndrome incidence in two US birth cohorts".

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Crib Death – Sudden infant Death Syndrome (SIDS): Sudden Infant and Perinatal Unexplained Death: The Pathologist's Viewpoint

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Powers DA, Song S (2009). "Absolute change in cause-specific infant mortality for blacks and whites in the US: 1983–2002".

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SIDS was responsible for 0.54 deaths per 1,000 live births in the US in 2005. It is responsible for far fewer deaths than

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that spares infants shortly after birth—the time of maximal risk for almost all other causes of non-trauma infant death.

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Williams FL, Lang GA, Mage DT (April 2001). "Sudden unexpected infant deaths in Dundee, 1882-1891: overlying or SIDS?".

5667: 4684:. National Center for Cultural Competence, Georgetown University Center for Child and Human Development. Archived from 886:

Due to the obvious dangers, experts have also warned that blankets or other clothing not be placed over a baby's head.

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Cultural Competence and Sudden Infant Death Syndrome and Other Infant Death: A Review of the Literature from 1990–2000

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issued a media release refuting expert testimony in one UK case, in which the conviction was subsequently overturned.

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gene that predisposed them to heart complications. Kathleen was pardoned 5 June 2023 after spending 20 years in jail.

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increases the risk of SIDS death roughly fourfold. From 1995 to 1998, the U.S. SIDS rate for births at 37–39 weeks of

4797: 4105:"Association between sudden infant death syndrome and diphtheria-tetanus-pertussis immunisation: an ecological study" 1894: 1645: 1296: 1255: 811:

A number of measures have been found to be effective in preventing SIDS, including changing the sleeping position to

280:. SIDS makes up about 80% of sudden and unexpected infant deaths (SUIDs). The other 20% of cases are often caused by 4081: 3655: 3261:

Horne RS (May 2006). "Effects of prematurity on heart rate control: implications for sudden infant death syndrome".

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of a child of less than one year of age. Diagnosis requires that the death remain unexplained even after a thorough

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Van Nguyen JM, Abenhaim HA (October 2013). "Sudden infant death syndrome: review for the obstetric care provider".

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Giulian GG, Gilbert EF, Moss RL (April 1987). "Elevated fetal hemoglobin levels in sudden infant death syndrome".

5062: 4995: 4030:"SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment" 3503:"Helicobacter pylori antigen in stool is associated with SIDS and sudden infant deaths due to infectious disease" 2804: 2430:"SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment" 855: 4029: 4448: 4077: 2034: 871: 843: 793: 494: 4010: 3053: 1368: 268:(also known as co-sleeping) or soft objects may also play a role. Another risk factor is being born before 37 5057: 1112: 5240: 5137: 269: 4334:

Carvajal A, Caro-Patón T, Martín de Diego I, Martín Arias LH, Alvarez Requejo A, Lobato A (May 1996). "".

3963:"Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding" 2918:"Kathleen Folbigg's children likely died of natural causes, not murder. Here's the evidence my team found" 5543: 796:

estimated that between 1% and 5% of SIDS cases were potentially attributable to undiagnosed infanticide.

2637:"Small for gestational age infants and sudden infant death syndrome: a confluence of complex conditions" 1634:

Duncan JR, Byard RW (2018). "Sudden Infant Death Syndrome: An Overview". In Duncan JR, Byard RW (eds.).

5235: 4822: 5305: 4205:"The UK accelerated immunisation programme and sudden unexpected death in infancy: case-control study" 2830:

Mage DT, Donner EM (September 2004). "The fifty percent male excess of infant respiratory mortality".

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Anderson TM, Lavista Ferres JM, Ren SY, Moon RY, Goldstein RD, Ramirez JM, Mitchell EA (April 2019).

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A 2022 study found that infants who died of SIDS exhibited significantly lower specific activity of

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Carpenter R, McGarvey C, Mitchell EA, Tappin DM, Vennemann MM, Smuk M, Carpenter JR (May 2013).

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Sullivan FM, Barlow SM (April 2001). "Review of risk factors for sudden infant death syndrome".

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Fleming PJ, Blair PS (February 2015). "Making informed choices on co-sleeping with your baby".

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Sleeping on the back has been found to reduce the risk of SIDS. It is thus recommended by the

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from 1994 found that antimony- and phosphorus-containing compounds used as fire retardants in

651:, an enzyme involved in the brain's arousal pathway, shortly after birth. This can serve as a 5132: 2056:"Maternal Smoking Before and During Pregnancy and the Risk of Sudden Unexpected Infant Death" 1398: 1056: 769: 685: 648: 457: 20: 5351: 5290: 5190: 5164: 4975: 4710: 1012: 910: 743: 652: 636: 4780: 4391:

Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. (December 2012).

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Nevas M, Lindström M, Virtanen A, Hielm S, Kuusi M, Arnon SS, et al. (January 2005).

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Many popular media portrayals of infants show them in non-recommended sleeping positions.

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may also be preventative. Measures not shown to be useful include positioning devices and

8: 5619: 5604: 4888: 3411:"Infant botulism acquired from household dust presenting as sudden infant death syndrome" 926: 736: 541:

was 0.73/1000, while the SIDS rate for births at 28–31 weeks of gestation was 2.39/1000.

316: 4427: 3362:"Post-mortem analysis for two prevalent beta-oxidation mutations in sudden infant death" 1681:

Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. (October 2016).

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After investigation, some of these infant deaths are found to be caused by suffocation,

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Pease AS, Fleming PJ, Hauck FR, Moon RY, Horne RS, L'Hoir MP, et al. (June 2016).

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Some have underestimated the risk of two SIDS deaths occurring in the same family; the

87: 4893: 4408: 4156:"Immunisation and the sudden infant death syndrome. New Zealand Cot Death Study Group" 3435: 3410: 3330: 2260: 1802:"Sudden Unexpected Infant Death and Sudden Infant Death Syndrome: About SUID and SIDS" 1698: 890: 5326: 5265: 5087: 4921: 4803: 4793: 4745: 4652: 4617: 4491: 4432: 4417: 4343: 4308: 4272: 4234: 4229: 4204: 4185: 4136: 4051: 3992: 3943: 3886: 3882: 3851: 3799: 3715: 3690: 3629: 3594: 3559: 3524: 3475: 3440: 3383: 3378: 3361: 3334: 3278: 3161: 3149: 3092: 3045: 3041: 2998: 2956: 2898: 2847: 2744: 2701: 2666: 2576: 2541: 2488: 2478: 2451: 2403: 2354: 2319: 2264: 2214: 2210: 2179: 2120: 2085: 2003: 1999: 1961: 1900: 1890: 1746: 1712: 1651: 1641: 1578: 1506: 1454: 1331: 1321: 1292: 1251: 1224: 1061: 933:, though it is the leading cause of death in healthy infants after one month of age. 521: 148: 74: 4961: 4586: 4503: 4471: 4320: 3641: 3571: 3395: 3290: 3010: 2713: 2588: 2331: 2276: 2244: 2226: 2132: 501:

Room sharing as opposed to solitary sleeping is known to decrease the risk of SIDS.

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For example, an infant with MCAD deficiency might die by "classical SIDS" if found

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SIDS Sudden Infant and Early Childhood Death: The Past, the Present and the Future

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SIDS Sudden Infant and Early Childhood Death: The Past, the Present and the Future

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SIDS Sudden Infant and Early Childhood Death: The Past, the Present and the Future

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SIDS Sudden Infant and Early Childhood Death: The Past, the Present and the Future

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The rate of SIDS per 1000 births varies among ethnic groups in the United States:

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campaign encourages having infants sleep on their back to reduce the risk of SIDS.

5644: 5594: 5523: 5498: 5468: 5378: 5285: 5225: 4915: 3741: 3519: 3502: 3120:"Butyrylcholinesterase is a potential biomarker for Sudden Infant Death Syndrome" 2791: 2520:"Breastfeeding and reduced risk of sudden infant death syndrome: a meta-analysis" 2041: 2030: 1048: 930: 812: 671: 609: 534: 381: 3135: 2740: 2389: 1801: 1399:"Ways To Reduce the Risk of SIDS and Other Sleep-Related Causes of Infant Death" 5634: 5518: 5458: 5122: 5117: 5107: 5102: 5067: 4964: 4926: 4776: 3625: 2470: 1882: 1635: 1313: 938: 776: 478: 464:

and its derivatives in the baby. Nicotine and derivatives cause alterations in

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campaign suggests that these figures were substantially inflated. In 2006 the

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Cradle of Death: A Shocking True Story of a Mother, Multiple Murder, and SIDS

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Fleming PJ, Blair PS, Platt MW, Tripp J, Smith IJ, Golding J (April 2001).

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Müller-Nordhorn J, Hettler-Chen CM, Keil T, Muckelbauer R (January 2015).

4102: 3822:"The Emerging Market of Smartphone-Integrated Infant Physiologic Monitors" 3744:(Website). Royal Statistical Society. (2001-10-23) Retrieved on 2007-09-22 3598: 2748: 2705: 2323: 1210: 949: 870:

appears to decrease the risk of SIDS, although the reason is unclear. The

5584: 5579: 5553: 5443: 5428: 5409: 5368: 5336: 5331: 5169: 5047: 4987: 4945: 4171: 3778:"Swaddling and the Risk of Sudden Infant Death Syndrome: A Meta-analysis" 3755:"Reduce the Risk of SIDS & Suffocation - AAP general recommendations" 3663: 1574: 1435:"Distinguishing sudden infant death syndrome from child abuse fatalities" 784: 747: 709: 708:

Some conditions that are often undiagnosed and could be confused with or

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Mage DT (1996). "A probability model for the age distribution of SIDS".

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Moon RY, Fu L (July 2012). "Sudden infant death syndrome: an update".

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Hauck FR, Thompson JM, Tanabe KO, Moon RY, Vennemann MM (July 2011).

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investigation of the death scene and circumstances of the death; and

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Sudden unexplained death of a child who is less than one year of age

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Arcutio, a device designed to prevent infant death by suffocation,

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Genetic evidence published in November 2020 concerning the case of

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and detailed death scene investigation. SIDS usually occurs during

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Measures not shown to be useful include positioning devices and

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It has been suggested that some cases of SIDS may be related to

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Mitchell EA (November 2009). "SIDS: past, present and future".

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which play an important role in the contraction of the heart.

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Rates of SIDS by race/ethnicity in the U.S., 2009, CDC, 2013

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and an unprotected female would occur with a frequency of

354:

The syndrome applies only to infants under one. SIDS is a

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Jaafar SH, Ho JJ, Jahanfar S, Angolkar M (August 2016).

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