SUDDEN INFANT DEATH SYNDROME (SIDS)

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SUDDEN INFANT DEATH SYNDROME (SIDS)

• Developed by
• Florida Association of EMS Educators in
  cooperation with the
• Florida SIDS Alliance

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Development Team

• Principal Developer
• John Todaro REMT-P, RN
• Contributing Developers
• Jaime S. Greene BA, EMT-B
• Bunny D. Hamer MSN, RN
• Steve Bonwit SIDS Parent
• (Justin, 11/6/95 - 3/25/96)

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Peer Reviewers

• Marcel J. Deray MD
• Director Sleep Disorders Center, Miami Childrens
  Hospital, Miami, Florida
• William Munios MD
• Pediatric Gastroenterologist, Miami, Florida
• Board Member, Florida SIDS Alliance
• Floyd Livingston MD
• Pediatric Pulmonologist, Nemours Childrens
  Clinic, Orlando, Florida

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Objectives

• Upon completion of this course of instruction,
  the student will be able to
• Define SIDS
• Describe the general population characteristics
  of a probable SIDS infant
• Describe the common physical characteristics of a
  probable SIDS infant

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Objectives

• Describe the typical scenario of a probable SIDS
• Identify important actions which should be
  initiated by an emergency responder
• Identify potential responses of parents to an
  infant death
• Identify potential responses of emergency
  responders to an infant death

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Objectives

• Identify common signs symptoms of Critical
  Incident Stress (CIS)
• Identify strategies for decreasing the impact of
  Critical Incident Stress (CIS)
• Identify community resources available to parents

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Definition - SIDS

• Sudden Infant Death Syndrome (crib death)
  - the sudden death of an infant, usually under 1
  year of age, which remains unexplained after a
  complete postmortem investigation, including an
  autopsy, examination of the death scene and
  review of the case history

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SIDS Statistics

• Classified as a disorder
• Leading cause of death in infants 1 month to 1
  year old
• 95 occur between 1 6 months of age - peak
  period between 2 4 months
• 3,000 SIDS deaths per year in the U.S.

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SIDS - What It Is

• Major cause of death in infants after 1st month
  of life
• Sudden silent in an apparently healthy infant
• Unpredictable unpreventable
• Quick death with no signs of suffering - usually
  during sleep

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SIDS - What It Is Not

• Caused by vomiting or choking
• Caused by external suffocation or overlaying
• Contagious or Hereditary
• Child abuse
• Caused by lack of love
• Caused by immunizations
• Caused by allergy to cows milk

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General Characteristics of SIDS

• Usually occurs in colder months
• Mothers younger than 20 years old
• Babies of mothers who smoke during pregnancy or
  are exposed to second hand smoke
• 60 male Vs 40 female
• Premature or low birth weight
• Upper respiratory infections, 60 in prior weeks
• Occurs quickly and quietly during a period of
  presumed sleep

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SIDS Research

• Evidence shows victims not as normal as they seem
• Maybe subtle but, undetectable, defects present
  at birth
• Areas presently under research
• Brain abnormalities
• Sleep position
• Multiple, non-life threatening abnormalities

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Medical Findings Consistent With SIDS
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External Appearance

• Normal state of hydration nutrition
• Small amount of frothy fluid in or about mouth
  nose
• Vomitus present
• Postmortem lividity /or rigors
• Livormortis
• Disfiguration/Unusual position - dependant blood
  pooling/pressure marks

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Internal Appearances On Autopsy

• Pulmonary congestion edema
• Intrathoracic petechiae 90 of time
• Stomach contents in trachea
• Microscopic inflammation in trachea

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Typical SIDS Infant Scenario

• Almost always occurs during sleep or appearance
  of sleep
• Usually healthy prior to death
• May have had a cold or recent physical stress
• May have been place down for nap, found not
  breathing or appearing dead
• Parents not hearing signs of struggle

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Emergency Responder Activity

• Initiate resuscitation per EMS System Practice
  Parameters Protocols

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Emergency Responder Activity Cont.

• Support of Parents
• Use calm directive voice
• Be clear in instructions
• Provide explanations about Tx transport
• Reassure that there was nothing that they could
  have done
• Do not be afraid of tears anger
• Allow parents to accompany infant to hospital if
  situation permits

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Emergency Responder Activity Cont.

• Obtain Hx
• Illicit medical history
• Listen to the parents
• Do not ask judgmental or leading questions
• Use open-ended non-leading questions
• Had infant been sick

• What happened
• Who found the infant where
• What did (s)he do
• Had the infant been moved
• What time was infant last seen by whom
• How was infant that day
• Last feeding

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Environmental Assessment

• Observe for
• Location of infant
• Presence of objects in area infant found
• Unusual conditions
• High room temperature
• Odors
• Anything out of ordinary

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Anticipated Parental Responses

• Normal responses may include
• Denial, shock and disbelief
• Anger, rage and hostility
• Hysteria or withdrawal
• Intense guilt
• Fear, helplessness and confusion
• No visible response
• May or may not accept infants death

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Expected Requests From Parents

• Repetitive questions
• Request to not initiate care
• Request to be alone with infant
• Request to terminate resuscitation efforts
• Requests for cause of death

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If Parents Interfere With Care

• Show empathy
• Do not become angered or argumentative
• Avoid restraining parent
• Be professional - put yourself in their shoes

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Emergency Personnel Responses

• Withdrawal, avoidance of parents
• Self-doubt
• Anger - wanting to blame someone
• Identification with parents
• Sadness depression

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Emergency Responder Expectations of Parents
Behavior

• Hysterical tearful responses
• Disbelief that not every parents will initiate
  CPR
• Disbelief/unable to accept parents decision to
  not have CPR started
• Cultural differences in mourning and grieving
  process

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Critical Incident Stress (CIS) Management

• Stress is an integral part of the profession of
  Emergency Services

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Signs Symptoms of CIS

• Anger/irritability
• Physical illness
• Depression
• Recurring dreams
• Intrusive images
• Changes in sleep patterns
• Mood changes/swings

• Withdrawal
• Changes in eating habits
• Inability to concentrate
• Restlessness/agitation
• Loss of emotional control
• Increased alcohol consumption

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Strategies for Decreasing Impact of CIS

• Talk to your peers/ share your feelings
• Exercise and balanced diet
• Avoid OT plan leisure time
• Write a personal journal
• Obtain personal or religious counseling
• Request dispatch tape reviews
• Request assistance from you local CISM team, post
  incident

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SIDS Resources

• National SIDS Resource Center
• [phone]
• Florida SIDS Alliance
• (800) SIDS-FLA
• SIDS Alliance
• (800) 221-SIDS WWW.sidsalliance.org
• National Institute of Child Health Development
• WWW.nih.gov/nichd/

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References

• California Fire Chiefs Association, Emergency
  Medical Section, Sudden Infant Death Syndrome
  Instructor Instructor GuideApril 1991.
• Department of Health, Education Welfare, Public
  Health Service Administration, Bureau of
  Community Health Services Training Emergency
  Responders SIDS An Instructor Manual, DEW
  Publications No (HAS) 79-5253, 1979
• State of California EMS Authority, SIDS Training
  Packet For Emergency Medical Responders and
  Firefighters, September 1990
• American SIDS Institute, SIDS Toward an
  Understanding
• Colorado SIDS Program, Commonly Asked Questions
  About SIDS A Doctors Response J Bruce Beckwith
  M.D. 19983
• National SIDS Resource Center, Information
  Sheet What is SIDS, May 1993
• Center for Pediatric Emergency Medicine, TRIPP
  1998, Version 2

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References Cont.

• National SIDS Clearing House, Fact Sheet SIDS
  Information The EMT
• David Lawrence, SIDS Handle With Care JEMS,
  December 1988
• Seasonality in SIDS-U.S. 1980-1987, MMWR,
  December 14, 1990, Vol..39., No. 49
• From the CDC, Atlanta, Georgia, Seasonality in
  SIDS JAMA, February,13, 1991, Vol. . 265, o. 6.
• From The National Health Institutelt Chronic
  Fetal Hypoxia Predispose Infants to SIDS, JAMA,
  December 5, 1990, Vol.. 264, No. 21.
• Carroll, John L. Loughlin, Gerald M., Sudden
  Infant Death Syndrome Pediatric review, Vol..
  14, No. 3., March 1993
• Jackson, Community Midwifery, United Leeds
  Teaching Hospital Trust SIDS PART 1 Definitions
  Classification of SIDS, Midwifery Chronicles
  Nursing Notes, August 1992

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References Cont.

• Jackson, Community Midwifery, United Leeds
  Teaching Hospital Trust SIDS PART 2 Definitions
  Classification of SIDS, Midwifery Chronicles
  Nursing Notes, August 1992
• Florida Emergency Medicine Foundation
  California EMS Authority, Pediatric Education
  for Paramedics 1997
• American SIDS Institute, Coping With Infant
  Loss, Grief and Bereavement, June 1994
• American SIDS Institute, Helping A Friend Cope
  With Infant Loss, Grief and Bereavement, June
  1994
• Parrott, Carol, Parents Grief Help
  Understanding After The Death of a Baby, Medic
  Publishing Company, 1992
• Klobadans, David, First Responders and EMS
  Personnel - SIDS Training Outline

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SUMMARY