SIDS is a term used to describe the sudden, unexplained death of an infant that remains unexplained after a thorough case investigation that includes a complete autopsy, an examination of the death scene, and a review of the clinical history. SIDS is the leading cause of death of children 1 month to 1 year of age. In the United States, 5,000 to 6,000 infant deaths are attributed to SIDS each year. Many of these occur in the child care setting.

The cause of SIDS is unknown. SIDS is not contagious. Vomiting, choking, or minor illnesses such as colds or infections do not cause SIDS. Deaths due to vaccine reactions or child abuse are not classified as SIDS deaths. While we don't know what causes SIDS, we have identified four factors associated with increased risk of SIDS: (1) placing a baby on the stomach (prone position) to sleep; (2) being exposed to tobacco smoke during pregnancy and after birth; (3) using soft surfaces and objects that trap air or gases, such as pillows, in a baby's sleeping area; and (4) not breastfeeding a baby. However, risk factors alone do not cause SIDS. Most babies with one or more of the above risk factors do not succumb to SIDS.

To decrease the risk of SIDS in the childcare setting: Place babies on their backs to sleep. This recommendation from the American Academy of Pediatrics and the National Back to Sleep Campaign applies to most babies. However, some babies should lie in a prone position, such as those with respiratory disease, symptomatic gastro-esophageal reflux, or certain upper airway malformations. If uncertain about a baby's best sleeping position, consult the baby's parents or doctor. Don't smoke; provide a smoke-free environment for babies in your care; encourage parents who smoke to quit. Recent research indicates that the risk of SIDS doubles among babies exposed only after birth to cigarette smoke and triples for those exposed both during pregnancy and after birth. Use firm, flat mattresses in safety-approved cribs for babies' sleep. Don't use soft sleeping surfaces and objects that trap gas in the babies' sleeping area. The U.S. Consumer Product Safety Commission has issued advisories for parents on the hazards to infants sleeping on beanbag cushions, sheepskins, foam pads, foam sofa cushions, synthetic-filled adult pillows, and foam pads covered with comforters. Encourage mothers who breastfeed to provide you with bottled breast milk that is clearly labeled with their child's name. Studies show that babies who died of SIDS were less likely to have been breastfed. Breastfeeding prevents gastrointestinal and respiratory illnesses and infections.

If a child in your care is not breathing and is unresponsive: Call 911. Begin cardiopulmonary resuscitation (CPR). Immediately notify emergency medical personnel (dial 911). Immediately notify the child's parents.

If a child in your care dies: Do not disturb the scene of death (i.e., don't move anything), if possible. Contact your emergency childcare backup person to tend to the other children. Document the entire sequence of events. Prepare to talk with law enforcement officers, a coroner or medical examiner, and licensing and insurance agencies. Notify the parents of the other children in your care of the death. You may later need to provide additional information regarding the death.

If the death of a child in your care is attributed to SIDS: Seek support and SIDS information from your local health department of from local, state, or national SIDS resources. For inquiries or to request materials, call "Back to Sleep" at 1-800-505-CRIB or write "Back to Sleep" at P.O. Box 29111, Washington, DC 20040. Obtain a copy of "When Sudden Infant Death Syndrome (SIDS) Occurs in Childcare Settings...", contact the National Sudden Infant Death Syndrome Resource Center, 2070 Chain Bridge Road, Suite 450, Vienna, Virginia 22182. Telephone: (703) 821-8955, ext. 249; Facsimile: (703) 821-2098. Provide the parents of other children in your care information on SIDS that is appropriate for them and for their children.

For further support, contact the Sudden Infant Death Syndrome Alliance, 1314 Bedford Ave., Suite 210, Baltimore, Maryland 21208. Telephone: 1-(800) 221-7437 or (410) 653-8226.

© January 1997