The State of Our Health - Crib Deaths: A Closer Look

Among infant deaths — death before the first year — crib death, formally known as Sudden Infant Death Syndrome (SIDS), is the third leading cause of death. The two leading causes are congenital malformations, deformations, and chromosomal abnormalities (a single category) and disorders due to short gestation and low birth weight, not elsewhere classified (another single category).

Until 1992, SIDS was the second leading cause of infant mortality. In the 1980s, more than 5,300 babies died of SIDS every year. In the first half of the 1990s, this average had dropped to 4,880. Death rates are shown for the 1983 to 1994 period from a special study conducted by the Centers for Disease Control (see source).

According to an expert panel convened by the National Institute of Child Health and Human Development, SIDS is defined as "the sudden death of an infant under 1 year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history." In other words, SIDS is not understood. SIDS is described as "a diagnosis of exclusion and of unknown etiology." Etiology is the science of demonstrating causes. Risk factors are known. The following is the wording used by MEDLINEplus:

Risk factors include babies who sleep on their stomachs (up to 4 months. of age), soft bedding in the crib (up to 1 yr. of age), multiple births, prematurity, a history of a sibling who had SIDS, maternal smoking, maternal substance abuse, young maternal age, short intervals between pregnancies, late prenatal care and low socioeconomic status. Male infants are affected more than females. While studies show an increase in these factors, the impact or importance of each factor is not well defined or understood in sudden infant death syndrome.⁹

A strong association between SIDS and babies sleeping on their stomachs had been observed by 1990. This led to a national campaign, initially spear-headed by the American Academy of Pediatrics. Mothers were advised to put their children to sleep on their backs or sides (the "Back to Sleep" campaign). Declines in the SIDS death rate began to reflect this education/campaign — which was widely backed by the federal government and state health departments throughout the nation in hard-hitting campaigns, some tailor made for racial groups. Similar declines in crib deaths were also observed in other countries where similar efforts were launched.

The campaign to bring SIDS under control is an excellent example of the manner in which the health authorities, governmental and private, cooperate, first, in sifting through data and observations to understand intractable and difficult to understand health problems — and then launching effective programs that save lives by outreach and education alone. Other risk factors — like low birth weight and socioeconomic and cultural factors (poverty, youth pregnancy) — are more difficult to manage. It is also clear that the message is not reaching as many mothers in the black community as in the white.

Source: Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. "Sudden Infant Death Syndrome, United States, 1983-1994." Published in Morbidity and Mortality Weekly Report, v. 45, no. 40, 11 October
1996.