Sudden Infant Death Syndrome

Sudden Infant Death Syndrome : 

Sudden Infant Death Syndrome Robert A. Grayless, BS, EMT St. Joseph Township Fire Department Fort Wayne, Indiana

Objectives : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 2 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

Objectives : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 3 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

Objectives : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 4 Objectives Identify potential responses of emergency responders to an infant death Identify common signs and symptoms of Critical Incident Stress (CIS) Identify strategies for decreasing the impact of Critical Incident Stress (CIS)

Definitions - SIDS : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 5 Definitions - 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.

SIDS Statistics : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 6 SIDS Statistics Classified as a disorder Leading cause of death in infants 1 month to 1 year old 95% occur between 1 and 6 months of age; peak period is between 2 and 4 months 3,000 SIDS deaths per year in the U.S.

SIDS – What It Is : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 7 SIDS – What It Is Major cause of death in infants after 1st month of life Sudden and silent in an apparently healthy infant Unpredictable and unpreventable Quick death with no signs of suffering; usually during sleep

SIDS – What It Is Not : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 8 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

SIDS – What It Is Not : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 9 SIDS – What It Is Not Caused by immunizations Caused by allergy to cow’s milk

SIDS – General Characteristics : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 10 SIDS – General Characteristics 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

SIDS – General Characteristics : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 11 SIDS – General Characteristics Premature or low birth weight Upper respiratory infections, 60% in prior weeks Occurs quickly and quietly during a period of presumed sleep

SIDS - Research : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 12 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

Medical Findings Consistent with SIDS – External Appearance : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 13 Medical Findings Consistent with SIDS – External Appearance Normal state of hydration and nutrition Small amount of frothy fluid in or about the mouth and nose Vomitus present Postmortem lividity and/or rigors Livormortis Disfiguration/unusual position – dependent blood pooling/pressure marks

Medical Findings Consistent with SIDS – Internal Appearance (Autopsy) : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 14 Medical Findings Consistent with SIDS – Internal Appearance (Autopsy) Pulmonary congestion and edema Intrathoracic petechiae 90% of the time Stomach contents in trachea Microscopic inflammation in trachea

Typical SIDS Infant Scenario : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 15 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 placed down for a nap; found not breathing or appearing dead Parents not hearing signs of struggle

Emergency Responder Activity : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 16 Emergency Responder Activity Initiate resuscitation per EMS system protocols Support of parents Use calm, directive voice Be clear in instructions Provide explanations about treatment and transport

Emergency Responder Activity : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 17 Emergency Responder Activity Support of parents Reassure that there was nothing that they could have done Do not be afraid of tears and anger Allow parents to accompany infant to hospital if situation permits

Emergency Responder Activity : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 18 Emergency Responder Activity Obtain History Medical history Listen to the parents Do not ask judgmental or leading questions

Emergency Responder Activity : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 19 Emergency Responder Activity Use open-ended and non-leading questions Had infant been sick What happened Who found the infant and where What did (s)he do Had the infant been moved What time was infant seen last and by whom When was the last feeding How was the infant that day

Environmental Assessment : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 20 Environmental Assessment Observe for Location of infant Presence of objects in are where infant is found Unusual conditions High room temperature Odors Anything out of the ordinary

Anticipated Parental Responses : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 21 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

Expected Requests from Parents : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 22 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

If Parents Interfere With Care : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 23 If Parents Interfere With Care Show empathy Do not become angered or argumentative Avoid restraining parent Be professional – put yourself in their shoes

Emergency Personnel Responses : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 24 Emergency Personnel Responses Withdrawal, avoidance of parents Self-doubt Anger – wanting to blame someone Identification with parent Sadness and depression

Emergency Responder Expectations of Parent’s Behavior : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 25 Emergency Responder Expectations of Parent’s Behavior Hysterical and tearful responses Disbelief that not every parent will initiate CPR Disbelief/unable to accept parents decision to not have started CPR Cultural differences in mourning and grieving process

Critical Incident Stress Management (CISM) : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 26 Critical Incident Stress Management (CISM) Stress is an integral part of the emergency services profession

Signs and Symptoms of CIS : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 27 Signs and Symptoms of CIS Anger/irritability Physical illness Depression Recurring dreams Intrusive images Change in sleep pattern Mood change/swing Withdrawal Change in eating habits Inability to concentrate Restless/agitated Loss of emotion control Increased alcohol consumption

Strategies for DecreasingImpact of CIS : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 28 Strategies for DecreasingImpact of CIS Talk to your peers and share your feelings Exercise and balanced diet Avoid OT and plan leisure time Write in personal journal Obtain personal or religious counseling Request dispatch tape reviews Request assistance from local CISM team

SIDS Resources : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 29 SIDS Resources National SIDS Resource Center (703) 821-8955 SIDS Alliance (800) 221-SIDA www.sidsalliance.org National Institute of Child Health & Development www.nih.gov/nichd/

References : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 30 References California Fire Chiefs Association, Emergency Medical Section, “Sudden Infant Death Syndrome Instructor Instructor Guide”April 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 Doctor’s 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

References : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 31 References 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

References : 

Prepared by: Rob Grayless, BS, EMT 2/17/2011 32 References 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, “Parent’s Grief Help & Understanding After The Death of a Baby”, Medic Publishing Company, 1992 Klobadans, David, “First Responders and EMS Personnel - SIDS Training Outline”