A child is a gift from the Creator. In Native teachings, birth is a symbol of awakening, emerging, changing and new beginnings. That is why the creation of life is sacred: a baby is beginning the journey of life and is a gift of the Spirit to parents and the community. When a baby dies, it is a tragic event. Sudden Infant Death Syndrome (SIDS) - which occurs when an apparently healthy infant dies suddenly and quietly as he or she sleeps - is especially hard to understand and cope with.

SIDS is the leading cause of death in Canada for infants between the age of one month and one year. Also known as "crib death" or "cot death," SIDS strikes one in every 3,000 babies. A seemingly healthy infant falls asleep in his or her crib, stroller, car seat or parents' arms, and never awakens. No signs of suffering are associated with the death. Sadly, First Nations communities in Canada face at least a three times higher rate of SIDS among their infants. And studies show that while the death rate from SIDS has fallen since 1980 in the general population, it remains high among Aboriginals.

Infant mortality is divided into two periods: neonatal mortality (death that occurs in the first 27 days after birth) and post-neonatal mortality (death between 28 days and one year). Neonatal death rates among Registered Indians in Canada are close to the national average. However, the post-neonatal death rate remains extremely high:

Aboriginal mothers aged 19 to 24 have a 6.5 per cent greater risk than non-Aboriginal mothers of losing an infant to SIDS. A University of Calgary study found that Aboriginal babies in Alberta were 10 times more likely to die from SIDS than non-Aboriginal babies. In Saskatchewan, the SIDS rate between 1982 and 1994 was 5.5 per cent higher among Native infants than among non-Native infants. A U.S. study from 1992-1996 reported a SIDS rate of 19 per 1,000 Native American infants, compared to nine per 1,000 in the general population. Risk factors for SIDS in this study included over-bundling, lack of prenatal care, lack of post-natal care, poverty, and smoking and drinking alcohol during pregnancy.

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WHAT IS SIDS?

SIDS is diagnosed after all other possible causes of death have been ruled out through an autopsy, investigation of the death scene, and review of the infant's medical history. Most SIDS deaths occur between two and four months. SIDS is uncommon after six months, and rare after 12 months. SIDS happens quickly, usually while the infant sleeps. During sleep, certain normal stressors occur: heart rate and blood pressure decrease, the mouth or nose may be partly blocked, breathing may stop temporarily, or the infant may inhale carbon dioxide when the nose or mouth is covered.

Research shows subtle differences in the way a SIDS infant responds to these stressors. In a normal, healthy baby, the brainstem sounds an alarm when, for example, the baby needs more oxygen. But the alarm system of a SIDS baby isn't triggered in the same way. Medical experts use a "triple-risk model" to describe three ways in which an infant may be at risk of SIDS. Any one, by itself, may not be harmful - but when all three occur together, SIDS can result.

Vulnerable Infant: Although they seem completely healthy, some babies have an underlying defect that makes them especially vulnerable to normal life stresses. The defect is believed to lie in the brainstem, which controls heart rate, breathing and other body systems.
Critical Development Period: Rapid changes occur in a baby's first six months of life as crucial body systems develop. Such systems include sleep and waking patterns, breathing, heart rate, blood pressure and body temperature.

Outside Stressors: Certain stressors, such as cigarette smoke, tummy sleeping, a mild upper respiratory tract infection, or increased carbon dioxide levels, challenge a baby's normal "alarm system" responses.

Risk factors for SIDS
No one factor causes SIDS, however the risk is increased when babies:
sleep on their stomachs or sides, rather than on their backs
are exposed to second-hand smoke in utero or after birth
are male
have First Nations status (poverty, lower education levels, and poor health and social conditions are health determinants often seen with First Nations peoples; these are believed to contribute to higher SIDS rates)
are born prematurely or have a low birth weight
are born to mothers who had no or late prenatal care, or who were less than 20 years old at the time of their first pregnancy
become too hot while sleeping, either from too many blankets or a hot room temperature
share a bed with an adult smoker.

HOW CAN PARENTS LOWER THE RISK OF THEIR CHILD DYING FROM SIDS?

Place infants to sleep on their back, not on their stomach.
SIDS is less common in babies who sleep on their back. Studies show that placing babies on their back to sleep has lowered SIDS cases by up to 50 per cent in countries where infants traditionally slept on their stomach.
Do not worry that a baby might choke while lying on his or her back - it is not more likely to happen in this position. When babies are old enough to turn over from back to stomach, you don't need to place them to sleep on their back anymore.

Many parents worry that consistently placing their babies to sleep on their back will cause "flat head." Most flattening resolves on its own, and the condition does not affect brain function. Make sure baby has plenty of "tummy time" when he or she is awake and being watched. This is important for development and will help to avoid temporary flat spots on the back of the head.

Ensure the baby sleeps on a firm, flat surface.
Avoid laying baby down on a soft mattress, water bed, soft quilt, pillow, comforter or duvet. Keep the crib free of pillows, stuffed toys and bumper pads.

Dress the baby comfortably for sleeping - not too hot.

Don't smoke while pregnant.
Mothers who smoke during pregnancy are three times more likely to have a SIDS baby. Smoking is common in Aboriginal communities, partly due to the key role that tobacco has traditionally played in Aboriginal culture. But pregnant women and their families should realize that smoking commercial cigarettes does not reflect the traditional use of tobacco, which in the past was reserved for special rituals and ceremonies.

After the baby is born, don't allow smoking inside your home.
Exposure to passive smoke from people in the household doubles the baby's risk of SIDS. Ideally, the baby should not be exposed to any cigarette smoke at all. Next best is to reduce exposure - the less people smoke around the baby, the lower the baby's risk of SIDS and other health problems.

If you smoke or use alcohol or drugs, don't share a bed with your infant.
Bed sharing is common in many families, but it does not necessarily reduce the risk of SIDS. In fact, the risk increases if the baby sleeps with a person who smokes. And bed sharers who use alcohol or drugs may be less able to respond if, for example, they roll onto the baby and the baby cries.

Some mothers bed-share to promote breastfeeding. Mothers who do this should sleep on a firm mattress so the baby is less likely to be accidentally entrapped. The baby should be able to sleep face up with no chance that bedding will cover his or her face. Bed-sharing is safest when the baby has never been exposed to smoke, either before or after birth.

Breastfeed the infant, if possible.
Only 54 per cent of Aboriginal mothers breastfeed their babies, compared to 75 per cent of mothers in Canada overall. However, Aboriginal mothers tend to breastfeed longer than the general population.

Some studies show SIDS is less common in breast-fed infants. Possibly, breast milk protects from infections that might trigger sudden death in a vulnerable infant. There are many positive effects from breastfeeding, and it is the best way to feed a baby.

However, a woman should NOT breastfeed her baby if she has HIV/AIDS, which can pass through breast milk and infect the baby, or if she uses drugs and/or alcohol - also transmitted through breast milk.

Never leave a baby alone anywhere except in a crib.
Crib slats should be no more than 2-3/8 inches apart, to prevent the possibility of the baby's head being trapped.

Other measures:
Before the baby is born, a woman should have good prenatal care. This includes proper nutrition, no smoking, drug or alcohol use, and frequent medical check-ups beginning early in pregnancy. These measures may help prevent the baby from developing an abnormality that could put him or her at risk for sudden death.

After the baby is born, parents should take the infant to their health care provider for regular well-baby checkups and routine immunizations. Claims that immunizations increase the risk of SIDS are not supported by data - in fact, babies who receive their scheduled "shots" are slightly less likely to die of SIDS.

If an infant ever has an incident where he or she stops breathing and turns blue or limp, the baby should be evaluated by a doctor to determine the cause.

Electronic home monitors are not recommended as a way to reduce the risk of SIDS.

WHEN BABIES LEAVE THE CIRCLE OF LIFE: SIDS AND GRIEF:

It is important to remember that SIDS is not the parent's or family's fault. The cause of SIDS is unknown. While we know ways to reduce the risk, we do not know how to prevent SIDS. Parents should not blame themselves. The death is NOT due to poor parenting or to a lack of physical, emotional or spiritual attention.

It is normal for parents to feel sad, confused, or angry. They must be reassured that they are not alone. Those who lose a baby to SIDS can consider speaking with people in their community - a medicine man or woman, clan mothers, elders or someone else known for advising and helping. Other parents who have also experienced a child's death may be able to listen and understand the pain. A grieving ceremony or other such ritual can help remember and honour the baby and its spirit, which came briefly into this world.

Parents' grief may be complicated by the common misperception that SIDS risk factors are the actual cause of SIDS. They are not. But people may believe that if the baby was sleeping on its stomach or was bottle-fed, or if there was smoking in the household, these must have "caused" SIDS to occur. A well-informed and compassionate CHR or health care worker can explain this to a grieving family, and help them reduce risk for a subsequent baby. The CHR or health care worker should also emphasize that there is a low rate of recurrence of SIDS within a family.

Important points to remember about SIDS
· SIDS is not caused by external suffocation
· The type of feeding method used does not cause SIDS
· SIDS is not caused by immunizations
· SIDS is not caused by child abuse or neglect
· Vomiting or choking does not cause SIDS
· SIDS is not contagious
· SIDS does not cause pain or suffering to the infant
· SIDS is not the cause of every unexpected infant death