Boys are affected more than girls. The incidence is highest during the second and third months of life; few cases occur in the first 2 weeks of life or after 6 months of age. More SIDS deaths occur between the hours of midnight and 9 A.M., and more occur in the colder than warmer months. Although racial and ethnic differences are unexplained, African American and Native American babies have a higher incidence of SIDS than do white and Hispanic/ Latino babies.
HISTORY. If you suspect that an infant is at risk for SIDS, elicit a history of risk factors. Determine if the infant has a history of apparent life-threatening events (ALTEs). In this situation, the infant may cease to breathe, develop pallor, have a marked change in muscle tone, choke or gag, or become unresponsive, and yet the child is successfully resuscitated. This "near miss" is thought to be a warning sign for future SIDS. If parents have lost a child to SIDS, the history of the event needs to be elicited carefully and with compassion because of the loss and grief patients are experiencing.
PHYSICAL EXAMINATION. Infants with ALTEs have a number of physical findings. Neurological examination has identified abnormalities of muscle tone, particularly with shoulder hypotonia. Other published reports describe increased incidence of periodic breathing during sleep with pauses of up to 10 seconds and possibly increased respiratory rates. Some infants have faster heart rates than normal, less heart rate variability, and shorter Q-T intervals. Some children, before the incident, have cold symptoms a week to a few days before SIDS.
PSYCHOSOCIAL. If an infant has had an ALTE, parents are likely to be anxious and afraid. Provide a referral to a support group and consider providing them with counseling to deal with their anxiety. For a family who has lost a child to SIDS, management is directed to assisting the family to cope with loss of an infant. Sadness and feelings of despair or hopelessness may evolve; patients and families should be encouraged to discuss these openly. Parents and siblings will likely experience feelings of guilt or anger and will need opportunities to express these feelings.
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