Sids and Kids Western Australia

SIDS is defined as the sudden and unexpected death of an infant < 1 year of age during their sleep, that remains unexplained after a thorough investigation (autopsy, medical history, circumstances of death). SIDS is the main cause of death in infants < 1 year of age. The peak time for SIDS deaths to occur is between the ages of 2 and 4 months. Although it can happen to younger babies and older infants, approximately 90% of SIDS deaths occur in babies aged less than 6 months.

SIDS and Kids Western Australia has achieved more than a 70% reduction in the number of SIDS deaths through its past and present health promotion campaigns, "Kids & SIDS - Three Ways to Reduce the Risk" and "SIDS and Kids Safe Sleeping".

At present, we do not know what causes SIDS or how to prevent SIDS. However, research from Australia, New Zealand, the United Kingdom and the Netherlands suggests that some factors may reduce the risk of SIDS.

Sleeping on the back reduces the risk of SIDS. Tummy or side sleeping increases the risk of SIDS. Healthy babies placed to sleep on the back are less likely to choke on vomit than tummy sleeping infants.

Keeping a baby's face and head uncovered during sleep decreases the risk of SIDS. It is important that a baby does not get too hot while sleeping. Many babies who have died from SIDS were found with their heads and faces covered by bedding, which probably caused overheating and an increase in their arousal threshold. Sleeping on the tummy, too much clothing, heavy bedding, or a room that is too warm may also lead to overheating. Re-breathing by baby of expired air when the face or head is covered or obstructed may also contribute to SIDS.

Smoking during pregnancy significantly increases the risk of SIDS, particularly if the mother smokes during the second or third trimester of her pregnancy. It is important that babies be kept in a smoke-free environment during pregnancy and after birth.

The SIDS and Kids health promotion program, "SIDS and Kids Safe Sleeping", provides expectant and new parents, health professionals, child care workers, and high school and university students with the latest information on ways to reduce the risk of SIDS. Resources include a brochure, poster, video, door hanger and a brochure designed specifically for indigenous communities. These resources are distributed free of charge to hospitals, antenatal clinics, child health centres, child care centres, doctors, and the print and electronic media. Students completing assignments on SIDS may also call for an information pack. Phone (08) 9474 3544 to order free literature.

For a full description of the resources available, please go to our Resources and Publications page.

* Safe Sleeping Education In-Services to hospitals, child care centres, child health centres, universities and schools.

* Education to emergency response groups including police, ambulance workers and hospital staff.

Although much research has been carried out over the past twenty years into the mechanism of SIDS,

no definitive cause has been identified. Perinatal risk factors such as premature birth, low birth weight, being one of a multiple pregnancy or being exposed to maternal smoking in utero have all been identified as significant risk factors for SIDS. Environmental risk factors such as prone sleeping position, infant overheating or overcooling, and ambient room temperatures above 24°C, have also been identified. In addition, social factors such as infants born to teenage mothers, young and unsupported mothers, and mothers of low socioeconomic status, increase the risk for SIDS.

Currently, many researchers investigating the mechanism of SIDS believe that an infant dies only when a number of factors occur simultaneously. This hypothesis encompasses both epidemiological and scientific data on SIDS. It is also well documented that the incidence of SIDS peaks between 2 - 4 months of age. During this period, major changes are occurring in virtually all physiological systems, as infants attain adaptive mechanisms, enabling them to maintain homeostasis (balance). These include automatic control of ventilation, sleep/wake state organisation, temperature regulation and development of circadian rhythms. If during this critical period the "at risk" infant is also exposed to an external stressor, such as a respiratory tract or gastrointestinal infection, fever, the prone sleeping position, or hyperthermia due to over wrapping, then the threshold for SIDS may be reached (Filiano & Kenny 1994).

Positional Plagiocephaly is a disorder in which the back or one side of a baby's head is flattened, often with little hair growing in the area. Constant pressure on one area of a baby's skull can flatten or deform it, due to the thinness and softness of the bones of babies' skulls.

It is important to vary baby's position so that baby is not always resting on the same part of the occiput (back of the head).

Turn baby's head to alternate sides when putting baby to bed (on the back), in order to prevent prolonged pressure on the same spot.

Week about, put baby to bed at alternate ends of the cot (feet to the bottom of the cot). This varies their head position as they turn towards sounds, activity, or a favourite image (mobile, picture etc.).

"Tummy time" while baby is awake and being supervised is very important. This not only allows an infant to strengthen many muscles which are not used when lying on the back, but also gives the back of the head time without external pressure pushing against it. Strong neck muscles and good head control may also reduce the risk of SIDS. Even if baby does not enjoy "tummy time", it is important to persist and gradually increase the time spent on the tummy during "awake" times.

Babies should sleep on their backs, play on their tummies, and sit up, supported, to watch the world go round.

Cots which meet the Australian Standard are safe cots. All new and second hand cots sold in Australia must meet the Australian Standard for Cots (AS 2172), and will carry a label to say so.

The safest cot mattress is one which is the right size for the cot, and is firm and clean.

Try not to have baby sleep on the tummy before six months of age. Do this by sleeping baby on the back or using a safe infant sleeping bag, as these delay rolling over. Most back-sleeping babies can't roll onto the tummy by themselves until about 5 or 6 months of age when the critical risk period has passed.

No. There is no research to show that any specific baby care product reduces the risk of SIDS.

Australia's mothers & babies 2006, the 16th annual report on pregnancy and childbirth in Australia released this month by the Australian Institute of Health and Welfare (AIHW) . The report presents demographic, pregnancy and childbirth factors of women who gave birth in 2006 and the characteristics and outcomes of their babies.

The report is produced by the AIHW National Perinatal Statistics Unit based at the University of New South Wales.

The fetal death rate was 7.4 (7.3 in 2005) the neonatal death rate was 3 the perinatal death rate was 10.3

In 2006, 277,436 women gave birth to 282,169 babies in Australia. This included 280,078 live births and 2,091 fetal deaths , resulting in a fetal death rate of 7.4 per 1,000 births (7.3/1,000 in the previous year). The state and territory fetal death rates ranged from 6.4 per 1,000 births in New South Wales (5.9/1,000 in the previous year) to 11.0 per 1,000 births in the Northern Territory (11.4/1,000 in the previous year) (Table 5.1).

The increase in births continued, with 9,750 more births (3.6%) than reported in 2005.

8.2% were preterm (less than 37 weeks gestation), compared with 7.3% in 1997 6.4% of liveborn babies were of low birthweight (less than 2,500 grams) 14.9% of liveborn babies were admitted to a special care nursery or neonatal intensive care unit the death rate prior to birth was 7.4 per 1,000 births and the death rate up to 28 days after birth was 3.0 per 1,000 live births, giving a total perinatal death rate of 10.3 per 1,000 births. The most common cause of perinatal death was congenital abnormality.

- more had deferred starting a family, with 14.0% of first births being to women aged 35 years or older, compared with 8.3% in 1997

10,183 were of Aboriginal or Torres Strait Islander origin, making up 3.7% of all mothers

17.3% reported smoking at all during pregnancy, showing no real change over the previous four years

25.1% had their labours induced, the most commonly reported reason being prolonged pregnancy

58.1% had a spontaneous vaginal birth, 0.4% had a vaginal breech birth, while deliveries using forceps accounted for 3.5% and vacuum extractions for 7.2%

83.5% of those who had previously had a caesarean section had a further caesarean section in 2006

the median length of stay in hospital was 3.0 days, and was longer for women who had a caesarean section (5.0 days).

The mothers reported to the NPDC for 2006, who identified as being Aboriginal or Torres Strait Islander, gave birth to 10,191 liveborn babies and 121 stillborn babies (fetal deaths) which was a rate of 11.7 per 1,000 births compared with 7.2 per 1,000 births for non-Indigenous mothers. There were 266,628 non-Indigenous mothers who gave birth to 269,264 live births and 1,962 stillbirths. In 2006, 13.7% of babies of Aboriginal and Torres Strait Islander mothers were born preterm. This was greater than the proportion of 5.1% in babies of non-Indigenous mothers.

The mean gestational age of stillborn babies was 27.6 weeks in 2006 compared with 38.9 weeks for liveborn babies. Preterm birth occurred in 81.8% of stillborn babies, compared with 7.7% of liveborn babies.

For Australian-born mothers the fetal death rate was 7.1 per 1,000 births, compared with 8.6 per 1,000 births for mothers born overseas

Fetal death rates were higher among babies of first-time mothers (8.5 per 1,000 births) than among babies whose mothers had at least one previous birth (6.7

per 1,000 births) However, for grand multiparous women , the fetal death rate was higher at 11.9 per 1,000 births.

The fetal death rate of twins (18.3 per 1,000 births) and other multiple births (35.9 per 1,000 births) was higher than that of singleton babies (7.0 per 1,000 births)

Fetal death rates were higher for babies of mothers who gave birth in public hospitals than in private hospitals (8.2% and 5.5%), and fetal deaths occurred more frequently in the lowest gestational age and birthweight groups

For 2006, data were available for seven states and territories: New South Wales, Queensland,

Western Australia, South Australia, Tasmania, the Australian Capital Territory and the

Northern Territory. The proportion of women who smoked while pregnant ranged from 13.5%

in New South Wales to 29.3% in the Northern Territory. Overall, 17.3% of women in these states

proportion over the previous four years. The average age of mothers who smoked during pregnancy was 27.0 years compared with 30.1 years for those who did not smoke. Teenage mothers accounted for 11.6% of all mothers who

Aboriginal or Torres Strait Islander mothers accounted for 13.9% of mothers who smoked during pregnancy in the jurisdictions which provided smoking data. Over half of the Aboriginal and Torres Strait Islander mothers reported smoking during pregnancy (52.2%), compared with 15.6% of non-Indigenous women who gave birth.

There were 816 neonatal deaths reported to the NPDC for 2006, giving a rate of 3.0 per 1,000 live births .

The neonatal death rates ranged from 2.0 per 1,000 live births in South Australia to 5.2 per 1,000 live births in the Australian Capital Territory.

Higher neonatal death rates were reported for younger mothers. The age-group specific neonatal death rate was 5.2 per 1,000 live births for babies of teenage mothers (aged less than 20 years) and 3.3 per 1,000 live births for babies of mothers aged 20–24 years

The neonatal death rate of babies born to Aboriginal or Torres Strait Islander mothers was 7.1 per 1,000 live births for 2006, The neonatal death rate for babies of non-Indigenous mothers was 2.8 per 1,000 live births

Neonatal death rates were higher for babies of mothers who gave birth in public hospitals (3.7 per 1,000 live births) than for those of mothers who gave birth in private hospitals (1.2 per 1,000 live births).

Neonatal death rates decreased with increasing gestational age, from 418.3 per 1,000 live births for those born at 20–27 weeks gestation, to 0.5 per 1,000 live births for those born at term or post-term.

For birthweight, neonatal death rates decreased from 193.7 per 1,000 live births for babies of less than 1,500 grams, to 0.3 per 1,000 live births for babies 4,000 grams or more

In the NPDC there were 2,907 reported perinatal deaths in 2006, resulting in a perinatal death

rate of 10.3 deaths per 1,000 births (Table 5.1). Of these perinatal deaths, 71.9% were fetal deaths

Perinatal death rates were highest in babies of teenage mothers (20.3 per 1,000 births), followed by babies of mothers aged 20–24 years (12.5 per 1,000 births)

The perinatal death rate of babies born to Aboriginal or Torres Strait Islander mothers was 20.7 per 1,000 births . The rate was 10.1 per 1,000 births in babies born to non-Indigenous mothers

Rates were also higher in overseas-born mothers compared with Australian-born mothers (11.5 and 10.1 per 1,000 births respectively)

Perinatal death rates were higher among babies of first-time mothers (11.8 per 1,000 births) than among babies whose mothers had at least one previous birth (9.5 per 1,000 births)

Perinatal death rates were higher for babies of mothers who gave birth in public hospitals (12.0 per 1,000 births) than for those of mothers who gave birth in private hospitals (6.7 per 1,000 births)

perinatal death rates were higher for babies in the 20–27 week gestational age group (704.7 per 1,000 births) and lowest at 37 weeks or later (2.0 per 1,000 births)

Babies weighing less than 1,500 grams at birth had the highest perinatal death rate (451.4 per 1,000 births) and babies weighing 3,000–3,999 grams had the lowest (1.4 per 1,000 births).

For the 2006 data, five jurisdictions provided causes of death according to the PSANZ-PDC . The main causes of perinatal deaths in these jurisdictions for 2006 were:

Gestation: Perinatal deaths of term babies (37-41 weeks) were most commonly due to unexplained antepartum death (26.6%)

The most common cause of perinatal death in singletons was congenital abnormalities (30.0%)

Deaths of twins and higher order multiple births were mostly due to spontaneous preterm birth and specific perinatal conditions

Of perinatal deaths to mothers aged less than 20 years, 39.5% were due to maternal conditions

In mothers aged 40 years or over, 42.0% of perinatal deaths were caused by congenital abnormalities

Laws PJ & Hilder L 2008. Australia’s mothers and babies 2006. Perinatal statistics series no. 22.

fetal deaths are included in the NPDC if the birthweight is at least 400 grams or the gestational age is 20 weeks or more

women who have had four or more previous pregnancies resulting in a live birth or stillbirth

This did not include data from the Northern Territory where information about neonatal deaths was not available

The majority of states and territories have implemented the Perinatal Society of Australia and New Zealand Perinatal Death Classification (PSANZ-PDC) to classify causes of perinatal deaths