Understanding the Risks of Sudden Unexpected Death in Infancy
Published: 23 February 2023
Published: 23 February 2023
Sudden unexpected death in infancy (SUDI) is the sudden and unexpected death of an apparently healthy baby within the first year of life (raisingchildren.net.au 2022).
SUDI can be categorised as either:
(raisingchildren.net.au 2022; Healthdirect 2020)
Although SUDI can occur whilst a baby is awake, most deaths occur whilst the baby is asleep, with a peak incidence between two and four months of age (Better Health Channel 2021).
In Australia, SUDI accounts for approximately 3 deaths out of every 10,000 births (raisingchildren.net.au 2022).
The exact cause of SUDI is unknown, and there are no consistent warning signs that it will occur (Better Health Channel 2021).
All infants are at general risk of SUDI; however, specific risk factors include:
(Better Health Channel 2021; raisingchildren.net.au 2022)
The Triple Risk Model is based on the theory that SUDI is caused not by a ‘single characteristic that ordains an infant for death, but on an interaction of risk factors with variable probabilities’ (Bergman, as cited in Red Nose Australia 2021).
The Triple Risk Model suggests that in order for SUDI to occur, all three of the following conditions must be present at the same time:
(Red Nose Australia 2021)
It’s now generally accepted that SUDI is multifactorial in nature and that one risk factor alone is enough to cause death (Red Nose Australia 2021).
Although SUDI is not always preventable, particularly in the case of underlying medical problems, providing a safe sleeping environment for the infant is the best way to reduce the risk of death (Healthdirect 2020).
This is because safe sleeping strategies aim to remove as many risk factors for SUDI as possible (Red Nose Australia 2021).
Ever since national awareness was brought SIDS risk factors in 1991, the rate of SIDS in Australia has decreased dramatically (AIHW 2022).
In fact, between 1980-1990, there was an average of 195.6 SIDS-related deaths per 100,000 births (d’Espaignet et al. 2007). As of 2017, this figure has dropped to 6 SIDS-related deaths per 100,000 births (AIHW 2022).
This is why following the safe sleep recommendations for infants is crucial.
(Better Health Channel 2021; raisingchildren.net.au 2022; Healthdirect 2020)
(Better Health Channel 2021; raisingchildren.net.au 2022; Healthdirect 2020)
There is evidence to suggest that the use of pacifiers is associated with a reduced risk of SUDI. However, the reason for this is not completely understood, and this has not been confirmed through a randomised control trial (Red Nose Australia 2018; RCHM 2020).
There are a variety of potential theories as to why pacifiers might reduce the risk of SUDI. These include:
(Red Nose Australia 2018)
In Australia, the use of pacifiers is not actively encouraged nor discouraged. It’s up to caregivers to make an informed decision themselves after considering both the potential advantages and disadvantages of pacifier use (Red Nose Australia 2018; RCHM 2020).
If a pacifier is used, however, it’s recommended that for breastfed infants, pacifiers should only be introduced after breastfeeding has been established and phased out after one year (Red Nose Australia 2018; RCHM 2020).
Losing a child suddenly and unexpectedly is a devastating experience that can have a severe psychological impact on the bereaved family. Feelings of guilt, anger, fear, blame and despair are common. Support from family, friends, healthcare professionals, counsellors and/or social workers will be extremely valuable. Some bereaved families may find it helpful to talk to other families who have lost an infant to SUDI (Better Health Channel 2021; raisingchildren.net.au 2022).
Midwives, nursery nurses, health visitors and other maternity care staff are in an ideal position to educate and influence parenting practices.
As Bredemeyer (2004) says, there are many opportunities from antenatal care to postnatal check-ups for midwives to set an example and reinforce the message about the use of the supine position when laying a baby down to sleep.
Parental education should also include information about environmental factors that are known to increase the risk of SUDI, such as exposure to cigarette smoke and potentially unsafe sleeping practices such as co-sleeping and bed-sharing.
Of course, when healthcare professionals and midwives talk to new parents, the last thing they want to think about is SIDS.
It’s a scary topic that can be difficult to talk about, but as Bates (2014) states, after over 40 years of research, we now know how to significantly reduce the risk of it happening and how to keep babies safer.