Pharmacologic Highlights

No pharmacologic management is known to prevent SIDS and ALTEs.

Independent

The following information is helpful to parents to prevent SIDs: (1) Place babies supine for sleep; (2) Pacifier use may reduce risk for SIDS; (3) Avoid overbundling babies; (4) Avoid excessively soft or padded sleep mattresses; and (5) Avoid second-hand cigarette smoke exposure and create a smoke-free zone. Management after the death of an infant from SIDS is focused on helping the family cope with the infant's loss. Parents often react with disbelief, anger, or shock. Confusing the situation with child abuse, which will compound the family's emotional trauma, should be avoided.

A thorough investigation of the incident is important, but questions need to be asked carefully and with compassion. Obtain a thorough history from the caretaker about the situation, but be careful not to accuse the family of mistakes in caregiving. Obtain the information within a few hours of the event so as to obtain a thorough history. Reassure the family or caretaker that SIDS was not their fault and was unpreventable. Offer support and counseling, and provide a referral as appropriate. Support groups and resources include the following:

Compassionate Friends, www.compassionatefriends.org National SIDS Resource Center, 800-821-8955

Sudden Infant Death Syndrome Alliance, 800-221-7437, www.sidsalliance.org

Remember to assist the surviving siblings, who may need referrals for counseling to understand their feelings of guilt, loss, or vulnerability. Help parents deal with their other children and with their own need for extra attention and concern.

• Description of the SIDS event: Precipitating factors, risk factors, situation, timing, sleep and wake patterns of infant, position during sleep, type of mattress

• Health history of infant: Previous illnesses, birth weight and length of gestation, history of

• Maternal health history: Tobacco and substance use, parity, nutrition, socioeconomic status

Make sure that the caregiver and family have contact information for support services. Encourage the family to receive grief counseling and let them know that grieving takes many months or even more time. Arrange for a visit with the primary care provider at the end of a year to evaluate family functioning. If home monitoring is instituted for succeeding children, make sure the caregiver understands the monitors and can make decisions about true and false alarms. Teach the caregiver cardiopulmonary resuscitation if it is deemed appropriate.

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