Couple Learning to Cope With SIDS : No Way to Prepare for Baby’s First Brush With Death From a Quiet Killer
Silence was the warning, and my wife, responding to a mother’s instinct to check the unusual, found our little son turning blue in his crib.
That was our introduction to Sudden Infant Death Syndrome, the quiet, terrifying killer of babies.
Most new parents and parents-to-be think at one time or another about the prospect of SIDS--but there is no way to prepare for a firsthand experience with it.
Catherine was talking on the phone after 6-week-old Stuart had settled, protesting, for his morning nap while our other two children played.
She registered Stuart’s cries during her conversation. Then came the silence. Concerned, she decided to investigate the sudden stillness.
Dropping the phone and rushing to the crib, Catherine found Stuart had turned blue and had stopped breathing.
Researchers describe Sudden Infant Death Syndrome as the “sudden and unexplained death of an apparently healthy baby in which autopsy examination fails to demonstrate a cause of death.” The malady goes back to Old Testament times, when “accidental suffocation” was listed as a cause of death (I Kings 3:19-20). Doctors now agree, however, that it is virtually impossible for an infant to strangle accidentally.
Dr. Terry Marshall, a Greenwood, S.C., pediatrician, wrote in the Journal of the South Carolina Medical Assn. that late 19th Century and early 20th Century physicians thought SIDS was caused by a large thymus. Since that time, Marshall said, several theories have been expounded, including immunizations, allergic reaction to cow’s milk, thiamine deficiency, hypothermia and infections. But, Marshall said, abnormalities in SIDS victims are now believed to be more subtle than earlier believed.
Humans react differently to stress--many freeze, many perform feats beyond their imagined capabilities. Catherine is in the latter group. She immediately began mouth-to-mouth resuscitation while running to the house of a neighbor, who summoned an ambulance.
When it arrived moments later, Stuart had regained some of his color and had started to breathe on his own again. He was given oxygen and taken to Richland Memorial Hospital’s emergency room. Within the hour, his condition had stabilized.
The National Center for the Prevention of SIDS in Baltimore is the central clearinghouse for information about sudden infant death. It also provides fund-raising efforts for research and focuses on education about SIDS.
“We refer families to medical, counseling, and parent-support programs throughout the U.S.,” said Phipps Cohe, public information director. The center has a toll-free number (1-800-638-SIDS) that parents and others can call to obtain information.
“The National Institute of Child Health and Human Development is in the process of writing up a major five-year study of what SIDS babies have in common,” said Thomas L. Moran, SIDS center president. “There is new research going on all the time. There are 7,000 babies dying annually, most in the 2- to 4-month age group or 2- to 6-month age group.”
High-Risk Factors
Moran and Marshall outlined several high-risk factors for SIDS. Some are avoidable; others are not.
- Babies who have had an older sibling or other relative die of SIDS or have parents who survived the malady when children.
- Babies who are premature or have a low birth weight. This includes children of mothers not receiving proper prenatal care.
- Children of mothers addicted to narcotics.
- Babies with difficulty in breathing while feeding.
- Children of multiple births.
“But we’re talking about relative figures here,” Moran said. “We also show that native Americans and blacks have higher rates, but we’re not sure if it is a racial characteristic or because of a lower level of prenatal care.”
After Stuart left the hospital, he was rigged up to a monitor that would sound if his breathing stopped. During the first week, the monitor was relatively silent. There was one night in which it beeped several times, but a quick check revealed that he was OK. He was happy, healthy and learning to smile at his brother and sister.
On a Friday night, I put him in new diapers and placed him in his crib after hooking him to his monitor. He protested briefly, but soon quieted while I went to the kitchen to help Catherine with supper. Catherine noticed I had forgotten to turn on his night light.
She returned to the front room with Stuart in her arms. She slapped him lightly on the face and shook him, giving him a few puffs of air from her own mouth. His lips were again blue and his eyes opened blankly and lazily. It was obvious that he was trying to cry in response to his mother’s slaps, but nothing was coming out.
As Catherine tried vainly to resuscitate him, the breaths she was blowing into his tiny mouth went nowhere. But as his head lolled back, color returned to his mouth. When his head went forward, the flow of oxygen was again cut off.
Once again an ambulance took Stuart to Richland Memorial.
Pediatric intensive care at Richland Memorial is a gently serious place. Amid the life-saving machinery and tubes are paintings, posters, and colorful transfers of Mickey Mouse, Care Bears and other children’s favorites. The staff is helpful, efficient and good.
Stuart had revived, but was sluggish and lethargic. Essentially, the light had left his eyes. He was hooked to bigger monitors and left to sleep after his second adventure in the emergency room within 10 days. Catherine, who had borne the first episode so well, was clearly shaken and tentative.
In the next room was a girl with an orange tone to her skin. She was balding and had obviously undergone recent radiation treatments and chemotherapy. But she watched television intently, surrounded by gaily-colored paintings and some balloons.
It shook me to learn the girl died that night of leukemia. Discreetly covered on a gurney, she was wheeled down the hall to an elevator while advance nurses and staffers closed doors and held the elevator in her path.
I hoped they’d treat Stuart with the same respect.
There are two types of SIDS that are predominant, according to Marshall. One is central apnea, during which the child simply stops breathing. Marshall said this type of apnea is sometimes treatable with drugs, though researchers do not know what signal the brain sends to the body.
The other type of apnea is obstructive apnea, during which the trachea is constricted by muscle activity or there is another type of blockage in the airway. If no obstruction is found through X-rays or other diagnostic processes, Marshall said, there is simply not much that can be done except to allow the child to outgrow the apnea.
One of the tests used for apneic children is a charted sleep study available at several hospitals around the nation, including Duke University, Johns Hopkins, and Self Memorial Hospital in Greenwood, S.C.
Sleep Patterns
The study is a combination lie detector, oxygen analysis, eye-movement measure, muscle-movement indicator and other tests. It is taken while the child sleeps heavily, and indicates sleep patterns and how often attacks of apnea occur. It also sometimes provides a clue as to what kind of patterns precede apnea.
“Several investigators have identified abnormal breathing patterns or respiratory-control mechanisms in infants in whom SIDS later occurred,” Marshall wrote in one report. “Episodes of prolonged apnea, increased periodic breathing, and excessive short apnea, sometimes with obstruction, have been detected in sleep studies in infants who later died from SIDS.”
Stuart, his mother and I spent two days at Self Memorial in Greenwood. After his sleep study, he had again returned to his normal personality. During the two nights at Self Memorial, his monitor beeped only once. There were no problems.
But we worried. Nothing physically abnormal was discovered. Sleep studies showed several attacks of apnea, but no side effects. Marshall warned us that he could not predict when or if another incident would occur.
“I can’t promise you that it won’t happen again,” he said. “As a matter of fact, chances are that it will. That’s what the monitor is for--to allow you to catch it in time.”
Constant Vigilance
The most difficult thing to adjust to is the uncertainty inherent in dealing with SIDS. Babies are completely normal, then can be dead within 30 minutes for no apparent reason. Because of that threat and the added pressures of constant vigilance, parents of babies who survive such attacks form support groups. Aside from some relief from the emotional pressures involved, the groups also provide practical advice.
The monitor itself is a minor burden. Though it can sometimes be bulky, its battery allows it to be taken anywhere. When awake, the child can be disconnected and play as any other child would.
Parents are all instructed in infant CPR. Doctors recommend that someone trained in CPR be with or near the child at all times in case another attack occurs. This can pose problems with baby-sitting, since many grandparents, neighborhood teen-agers or other commonly used stand-ins are untrained in CPR.
Stuart is back home now, glad to see his brother and sister. Catherine and I are glad to be back in our own home and out of the hospital. Life has pretty much returned to normal, except for the constant presence of Stuart’s monitor. But we’ve taken to calling our youngest son “Sir Stuart of Apnea,” and generally deal with the problem lightheartedly.
But it could again become serious in a hurry. As Stuart’s doctor said: “You were one of the lucky ones.”
‘I can’t promise you that it won’t happen again. As a matter of fact, chances are that it will.’
‘It shook me to learn the girl died that night of leukemia.’
