SUDDEN INFANT DEATH

SYNDROME (SIDS)
Developed by
Florida Association of EMS Educators
in cooperation with the
Florida SIDS Alliance
FAEMSE

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

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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

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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
(703) 821-8955
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) 795253, 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 Institute< 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
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